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The Maxillofacial Center,
165 Scott Avenue, Suite 100, Morgantown, WV 26508 USA
Phone: 304-292-4429 Fax: 304-291-5149
of NICO/General Disclaimer
Cavitational Osteonecrosis) is one of the jawbone versions of ischemic
osteonecrosis, a common disease affecting any bone but with special
affinity for those of the hips, knees and face. By definition, NICO is
associated with pain. Osteonecrosis itself may or may not be
painful. It may or may not affect multiple sites. It is a problem of
poor blood flow through the marrow and 4/5 of affected patients have
underlying coagulation problems. This website provides information
relative to this disease as it affects the jaws and facial bones. Every
attempt has been made to assure that the information included herein is
accurate and not overstated, but the Maxillofacial Center cannot be
responsible for misrepresentations. It is your responsibility to use
this information in an honorable and responsible fashion.
A Note to
with Jawbone Osteonecrosis (NICO)
You have microscopic evidence of ischemic osteonecrosis (literally,
"dead bone from poor blood flow"), a bone marrow disease with either
dead bone or bone marrow that has been slowly strangulated or nutrient-starved.
There are a number of local and systemic problems capable of producing this bone
disease (Table 1), but more than 4 of
every 5 patients with osteonecrosis have a problem, usually inherited, of
excessive production of blood clots in their blood vessels (Table
2). These are not normally picked up with routine blood studies. Bone is
particularly susceptible to this problem and develops greatly dilated blood
vessels, increased, often painful, internal pressures, stagnation of blood, even
infarctions (completely blocked vessels). This hypercoagulation problem might be
suggested by a family history of stroke and heart attacks at an early age (less
than 55 years), hip replacement or "arthritis" (especially at an early
age), and deep vein thrombosis. Chronic fatigue syndrome and fibromyalgia are
also associated with excess coagulation and are frequently found in patients
with osteonecrosis, but the significance of this association is not yet known.
The jaws have a special problem with this disease because, once damaged, the
diseased bone is poorly able to withstand low-grade infections from tooth and
gum bacteria. Also, when a dentist works on a tooth he or she uses strong
chemicals (vasoconstrictors, e.g., epinephrine) designed to make local blood
vessels smaller and thus keep the local anesthetic in place longer. For
someone who already has a problem with poor blood flow through the jaws, this
may be disastrous.
Regardless of the underlying cause, the bone develops either a fibrous
marrow (fibers can live in nutrient starved areas), a greasy, dead fatty marrow
("wet rot"), a very dry, sometimes leathery marrow ("dry
rot"), or a completely hollow marrow space ("cavitation"). Any
bone can be affected, but the hips, knees and jaws are most often involved. Pain
is often severe but about 1/3 of patients do not experience pain. The body has
trouble healing itself from this disease, but about 1/3 of cases do indeed heal
themselves. For the others, experience has shown that surgically removing the
damaged marrow, usually by scraping with curettes, will eliminate the problem
(and the pain) in almost 3/4 of patients with jaw involvement. Repeat surgeries,
usually smaller procedures than the first, may be required, and almost a third
of jawbone patients will need surgery in one or more other parts of the jaws
because the disease so frequently has "skip" lesions, i.e. multiple
sites in the same or similar bones, with normal marrow between. In the hip, at
least half of all patients will get the disease in the opposite hip over time;
this phenomenon occurs in the jaws as well. Recently, it has been found that
some osteonecrosis patients respond to anticoagulation therapies.
Sickle cell anemia
Deep sea diving
Starvation (e.g. anorexia
in bone marrow)
Chronic inactivity (e.g.
leg in cast)
Hypertension (high blood
Congestive heart failure
(weak heart beat)
Local anesthesia use
For more information about hypercoagulation,
For information about neurotoxicity in NICO lesions visit, http://www.altcorp.com.
For a good NICO support group visit http://delphi.com/nicoandaps/.
Avascular necrosis (another name for ischemic osteonecrosis); bone
marrow edema and regional ischemic osteoporosis (mild versions of
osteonecrosis); thrombophilia (increased tendency to form blood clots); hypofibrinolysis
(decreased ability to dissolve clots as they form); NICO
("neuralgia-inducing cavitational osteonecrosis;" painful
osteonecrosis of the jaws – the pain is often like a facial neuralgia); osteomyelitis
(infection of bone marrow).