NICO Lesions

Also known as Ratner's bone cavities or bone cavitations, NICO (Neuralgia Inducing Cavitational Osteonecrosis) lesions are areas in the upper and/or lower jaws (more frequently in the lower) that produce severe, neuralgia-like pain symptoms, often mimicking those seen in trigeminal neuralgia. They are thought to arise from interference in the blood supply to that area of bone, such as may occur following tooth extraction, or from an infected tooth which, despite good endodontic therapy, may still have some residual areas of infection around it. This poor blood supply may result in localized bone infection (osteomyelitis) that can often result in bone death.

Pressing on the area, which will reproduce the patient's pain pattern, may help to make diagnosis of these lesions or, if the patient is exhibiting the symptoms at the time of examination, selective local anesthesia will relieve them, confirming the diagnosis.

Opinions differ regarding proper treatment of these lesions: some practitioners believe that the only approach is a surgical one, where the bone is opened and any dead or infected material -- and as well as any suspected teeth in the area -- is removed. Many also believe that any endodontically treated teeth should be removed, as well since, being dead, they are also a potential source of infection.

This can pose a problem for the restorative dentist, since the removal of considerable bone volume -- not to mention the loss of potential abutment teeth to hold fixed or removable tooth replacements -- can severely compromise any attempt at restoring the patient's chewing ability. Furthermore, a significant percentage of patients undergoing osteocavitation surgery require follow-up surgical procedures, further reducing the strength and volume of any potential tooth bearing bone. Also, improvements in endodontic techniques in the last few years have significantly reduced the incidence of chronic infection following root canal procedures.

A more conservative approach -- and in one which seems to offer great promise in the treatment and of cavitation lesions -- and involves the use of homeopathic preparations, injected into the lesions by means of a fine needle inserted in through a small hole drilled through the outer layer of the bone. The theory behind this procedure is that a properly formulated homeopathic preparation will stimulate the bone to initiate its own healing process. This procedure, performed in collaboration with a Naturopathic Physician, has succeeded in relieving the symptoms, reducing the pain, and promoting healing in a significant percentage of patients with NICO lesions. The homeopathic injection is part of a comprehensive health program, supervised by the Naturopathic Physician; it includes diet, possibly other systemic homeopathic preparations, lifestyle changes, and supplementation where indicated.

Another treatment modality which seems to offer some relief from these symptoms is Ozone Therapy, where ozone is introduced into the lesion by means of a small hole drilled into the bone - similar to the approach used with injected homeopathics.

We do not treat NICO lesions, but may be able to direct patients to practitioners who can help them.