• Abcessed tooth

  • Anesthesia dolorosa

  • Atypical facial pain

  • Cluster headaches

  • Eagle's syndrome

  • Ernest syndrome

  • Fibromyalgia

  • Impacted or semi-impacted tooth

  • Migraine

  • Multiple sclerosis

  • Muscle contraction headaches

  • Myofascial pain syndrome

  • Nervus intermedius neuralgia

  • Neuralgia-inducing osteonecrosis

  • Occipital neuralgia

  • Osteocavitations

  • Post-herpetic neuralgia

  • Pulpitis

  • Periodontal abcess

  • Tempotal tendonitis

  • Temporo mandibular joint disorder TMJ

  • Trigeminal neuralgia

  • Sinusitis


Under longstanding extraction sites of dental patients, intraosseous vacuolations form which produce painful lesions recognized by enlightened dentists as Neuralgia-Inducing Cavitational Osteonecrosis (NICO). These are pathological entities forming osteocavitations that sit alongside of or under root canal fillings put in by endodontists or dentists as substitutes to keep teeth that should have been removed. As such, the NICOs are major sources of systemic signs and symptoms which until recently had not been recognized as the reason for illnesses.

Neuralgia-Inducing Cavitational Osteonecrosis (NICO) is a jawbone version of ischemic osteonecrosis, a common disease affecting any bone but with special affinity for those of the hips, knees and face. Osteonecrosis, and its "lesser" variants, bone marrow edema and regional (transient) ischemic osteoporosis), is a problem of poor blood flow through the marrow and 4/5 of affected patients have underlying coagulation problems. By definition, NICO is associated with pain.  Osteonecrosis itself may or may not be painful. It may or may not affect multiple sites in one bone, or multiple bones.

The dead areas in a jaw bone come from actions common in dentistry such as tooth extractions, root canal treatments, and even drilling on a tooth. The farther back in the mouth the tooth extraction is, the more likely it is that a cavitation will form if the tooth socket is not properly cleaned out.

A correct technique for tooth socket cleaning includes the removal of the periodontal ligament that attaches the tooth to the socket, and removal of a portion of the bony socket.

Autopsy Case of Ischemic Osteonecrosis


The first autopsy example of NICO was published in the Journal of Oral Pathology & Medicine in 1999. This photo, from that case, illustrates a subcortical region of mushy brown marrow with microcavitations (arrows), located in the mandibular second and third molar region. This was barely visible on radiographs and the patient had been previously treated, unsuccessfully (prior to NICO therapy),  for atypical facial neuralgia/pain of this nerve branch and trigeminal neuralgia of the second trigeminal nerve branch. Notice the glistening brown/gray semitranslucent material around the inferior alveolar nerve. The nerve canal is mostly destroyed by the disease, leaving this "gelatinous marrow," a sign of ischemic damage.

How can Chronic Jaw Osteitis/ NICO lesions cause disease? visit the amazing web site of Dr. J Lechner: