Neuralgia-inducing cavitational osteonecrosis

Neuralgia-inducing cavitational osteonecrosis (NICO) is a diagnosis whereby a putative jawbone cavitation causes chronic facial neuralgia; this is different from osteonecrosis of the jaw. In NICO the pain is said to result from the degenerating nerve ("neuralagia").{{cite journal |vauthors=Ratner EJ, Person P, Kleinman DJ, Shklar G, Socransky SS |title=Jawbone cavities and trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=1 |pages=3–20 |date=July 1979 |pmid=287984 |doi= 10.1016/0030-4220(79)90229-9}}{{cite journal |vauthors=Roberts AM, Person P |title=Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=4 |pages=298–308 |date=October 1979 |pmid=291856 |doi= 10.1016/0030-4220(79)90027-6}}{{cite journal |vauthors=Bouquot JE, Roberts AM, Person P, Christian J |title=Neuralgia-inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia |journal=Oral Surg. Oral Med. Oral Pathol. |volume=73 |issue=3 |pages=307–19; discussion 319–20 |date=March 1992 |pmid=1545963 |doi= 10.1016/0030-4220(92)90127-C}} The condition is probably rare, if it does exist.{{cite book|last1=Scully|first1=Crispian|title=Oral and maxillofacial medicine: the basis of diagnosis and treatment|date=2013|publisher=Churchill Livingstone/Elsevier|location=Edinburgh|isbn=978-0-7020-4948-4|page=130|edition=3rd|url=https://books.google.com/books?id=U3WyAFrXVfIC&pg=PA130}}

Also called Ratner's bone cavity, a neuralgia-inducing cavitational osteonecrosis was first described in dental literature by G V Black in 1920. Several decades later, oral pathologist Jerry E Bouquot took especial interest in NICO.

The diagnostic criteria for NICO are imprecise, and the research offered to support it is flawed.{{cite journal |author=Zuniga JR |title=Challenging the neuralgia-inducing cavitational osteonecrosis concept |journal=J. Oral Maxillofac. Surg. |volume=58 |issue=9 |pages=1021–8 |date=September 2000 |pmid=10981982 |doi=10.1053/joms.2000.8745 }} The diagnosis is popular among holistic dentists{{cite web|last1=Yi|first1=Daniel|title=Roots of a Dental Controversy|url=http://articles.latimes.com/2006/jun/18/business/fi-teeth18/2|archive-url=https://web.archive.org/web/20150221053755/http://articles.latimes.com/2006/jun/18/business/fi-teeth18/2|url-status=dead|archive-date=21 February 2015|website=Los Angeles Times|access-date=25 June 2017|date=18 June 2006}} who attempt to treat NICO by surgically removing the dead bone they say is causing the pain.{{cite journal |vauthors=Bouquot JE, Christian J |title=Long-term effects of jawbone curettage on the pain of facial neuralgia |journal=J. Oral Maxillofac. Surg. |volume=53 |issue=4 |pages=387–97; discussion 397–9 |date=April 1995 |pmid=7699492 |doi= 10.1016/0278-2391(95)90708-4}}

It has been rejected as quackery by some dentists and maxillofacial surgeons.{{cite journal |author=Follmar KE |title=Taking a stand against fraud and quackery in dentistry |journal=J Am Coll Dent |volume=70 |issue=3 |pages=4–5 |year=2003 |pmid=14977370 }}{{cite web |last1=Kreidler |first1=Marc |title=Cavitational Osteopathosis, Bouquot, NICO, and 'Biological Dentistry' |url=https://quackwatch.org/related/cavitation/ |website=Quackwatch |date=18 May 2019 }}{{cite journal |vauthors=Bouquot JE, McMahon RE |title=Charlatans in dentistry: Ethics of the NICO wars |journal=J Am Coll Dent |volume=70 |issue=3 |pages=38–41 |year=2003 |pmid=14977380 }}{{cite journal |last1=Sciubba |first1=JJ |title=Neuralgia-inducing cavitational osteonecrosis: a status report |journal=Oral Diseases |date=July 2009 |volume=15 |issue=5 |pages=309–12 |doi=10.1111/j.1601-0825.2009.01532.x |pmid=19371400 }} In its position statement, dated 1996, the American Association of Endodontists asserted that although NICO occur and are treatable in toothless areas, NICO occurrence and treatment at endodontically treated teeth is generally implausible, that the diagnosis ought to be a last resort, and that routine extraction of endodontically treated teeth is misguided.{{cite web|title=AAE Position Statement on NICO lesions (Neuralgia-Inducing Cavitational Osteonecrosis)|url=http://www.aae.org/uploadedFiles/Patients/NICOlesionsnew.pdf|publisher=AAE Research and Scientific Affairs Committee|access-date=8 May 2013|archive-url=https://web.archive.org/web/20160305164026/http://www.aae.org/uploadedfiles/patients/nicolesionsnew.pdf|archive-date=5 March 2016|url-status=dead}}