Cavitations & Root Fillings.

A cavitation as described here is not generally recognised by conventional medicine. However they exist. They were first described by the father of modern dentistry, Dr G V Black, over 100 years ago. Uncomfortable facts take time to be accepted.
Cavitations or NICO's occur when bone is deprived of its blood supply and dies. When the bone dies a hole in the bone develops, literally a cavity and into this hole migrate anaerobic bacteria. These bacteria live without oxygen, indeed oxygen is poisonous to them. Bacteria organise themselves into colonies which can be visualised as cities. Cities require food to come in (you the patient are the food!) and generate waste material. The waste material made by these bacteria is toxic in the extreme and in cavitations this toxic material is constantly being released into the body.
If Mustard Gas, used in WW1, is taken as a yard stick, then most of the bacterial waste products are 10 or more times as toxic than Mustard Gas.

Cavitations can occur in any bone in the body usually after infection or trauma of some sort. Naturally dental extraction can easily be the cause of a cavitation, this is especially true of wisdom teeth extractions. Most extractions are due to infection, they involve stretching and sometimes fracture of the bone, all predisposing factors for cavitation formation. Added to this is the fact that if the membrane that holds the tooth in place, the periodontal membrane, is not removed at the same time as the tooth comes out, this to leads to cavitation formation. It is not common for the dentist removing the tooth to also remove the membrane at the same time, an unfortunate fact.

Cavitations can be symptomless in situ causing problems at other places in the body. They can also be intensely painful causing severe crippling pain similar to a very bad unremitting toothache or neuralgic pain. When this happens the cavitation is called a NICO or Neuralgia Inducing Cavitational Osteitis.

Not all extractions lead to cavitation formation. Just because you have a cavitation does not mean it must be treated. The decision as to whether to treat a cavitation depends on the size of the cavitation and the symptoms displayed by the patient. This must be assessed on an individual basis.

Diagnosis:
To find out if you have cavitations is not easy. Cavitations cannot be accurately diagnosed by normal X-rays. Normal X-rays show only an indication if a cavitation is present, however a CAT Scan does show cavitations but only does this accurately if all the metals in the mouth are removed before the CAT Scan is done. However, this diagnostic method requires high dose radiation exposure, specialist facilities and is fairly expensive.
Cavitat is an ultra sound device designed for detecting chronic bone infections like cavitation infections. It is highly accurate in skilled hands and needs to be read in conjunction with a good OPG x-ray. The Cavitat can show in 3D the position and size of Cavitation infections.
Our experience over the years has shown the Cavitat to be extremely accurate. It has never given a false positive reading. Occasionally it can miss a cavitation but local factors can come into play here. We are very pleased with the results of our Cavitat Machine.
A simple but not so reliable method of detecting cavitations is to place a finger and thumb on either side of the suspected cavitation and squeeze firmly. If pain is experienced then most likely this is a cavitation. As all cavitations are fluid filled, squeezing the bone increases the hydrostatic pressure inside the cavitation causing pain.
Neural therapy can often give an indication of the presence of a cavitation infection. A tiny single drop of local anaesthetic without adrenaline is placed over the suspected cavitation site. The symptoms associated with the cavitation can then subside for a short while. If the symptoms persist, a further drop of anaesthetic is injected usually starting from back of the mouth to the front until the site is found. This method, whilst good, is not 100% diagnostically correct. With suspected NICOs it is extremely accurate. The key is a use a tiny drop near the tooth apex. Once again experience is the key.
When local anaesthetics do not work, a reason is a cavitation infection near the injection site which can neutralise the local anaesthetic

NICO's:
These are Neuralgia Inducing Cavitational Osteitis lesions.
They are the cause of acute disabling mystery facial pain. Quite often mistaken for Trigeminal Neuralgia, they seem to defy traditional logic. The patient is sure that a tooth is to blame but when the tooth is extracted, the pain moves to another tooth or area. The patient can then loose many healthy teeth as the dentist searches for the cause of the pain. The pain is often referred to another part of the mouth some distance from the NICO site which further confusing the situation. NICO's arise commonly following a "routine extractions" or trauma such as whiplash. The conventional treatment is antidepressants which do partially suppress the symptoms but at a cost. They are no long term solution.
The best diagnostic tools are the Cavitat and Neural Therapy. See below for a case history.

Treatment:
Cavitations do not respond to antibiotics. The only effective treatment is to open them up and clean them out thoroughly. This means an operation.
We treat cavitations in a variety of ways, an old fashioned way is exactly as infections were handled before the advent of antibiotics. This is by opening and cleaning the cavitation then keeping the hole open with a dressing and changing the dressing daily. This has two purposes. The first is to allow oxygen into the cavitation to kill the bacteria and secondly if the wound is sewn together then there is a blood filled cavity ideal for re colonisation by bacteria. This allows a new cavitation to start. Keeping the wound open stops this and allows healing from the bottom up stopping new cavitation formation. However, this does lead to a loss of bone after healing sometimes creating a dip in the bone. Another disadvantage is the possible retention of the dressing in the surgical site. If all the dressings are not counted in and counted out, some may remain. This can happen when the patient is at home dressing the site alone or with the help of a family member. The gum grows over the dressing if it is left behind eventually requiring more extensive surgery to remove all the fibres.

The dressing should be sterile surgical cotton soaked in a mixture of Iodine, Oil of Cloves and Hyaluronic Acid. Iodine is fatal to bacteria and bacteria cannot become resistant to it unlike antibiotics. This is due to the unique biochemistry of Iodine. Oil of Cloves produces instant soothing in the operation site. Hyaluronic acid is the substance found in a baby's skin that makes it soft and supple. When applied to bone it encourages new blood vessels to grow through and over the bone in a matter of days. when the bone is covered with new blood vessels, it resembles the velvet on the new horns of a deer, infection cannot re-establish itself.

Our preferred method today is to clean and wash the site as above but with the addition of magnesium chloride. Magnesium Chloride 5% solution has proved to be of enormous significance in accelerating post operative healing. Magnesium Chloride was first used by the French Army in the first world war as wound irrigant. Subsequent research showed that it stimulated the immune system, was anti bacterial, anti fungal and anti viral as well. So now after cleaning the cavitation site as before, we irrigate the bone with magnesium chloride many times. The magnesium chloride solution is ozonated by bubbling ozone  through the solution for 30 minutes before use. In addition we flood the whole area with ozone gas. Ozone is in a league of its own in killing the anaerobic bacteria that cause the cavitation infection. The hole is then filled with an ozone gel and sewn up. This method has proven to be remarkably effective with added advantages to the patient. These are no dressing changes with can be painful and time consuming. Bleeding is better controlled with the ozone and the loss of bone is markedly reduced. However, some cavitations are best treated the old fashioned way with dressings. which method we choose is down to our considerable experience in treating cavitations.
The bone removed from a cavitation can be tested to see how toxic it is but the individual toxins cannot be identified as yet.

This can be read about in more detail on Bioscience.COM.

Case Histories: All patients treated at the Munro-Hall Clinic

Resolution of Chronic Facial Pain

Case History and Discussion.

 
This describes a case of the alleviation of chronic facial pain of over18 year’s duration.
This is new technology revisiting the past, of ultrasound Cavitat Scans showing focal infections in alveolar bone and how it was successfully dealt with.
The patient was a 55 year old female with a history of chronic facial pain emanating from the upper left edentulous maxilla. The pain was severe and constant and centred in the maxillary arch. It radiated to the left eye socket and over the left temporal region.
The patient had gone from dentist to doctor to oral surgeon eventually ending up at a specialised dental post graduate centre
X-rays and a battery of blood and other tests had all been negative. She was given no positive diagnosis other than the pain was probably of psychological origin. The treatment offered was tranquilisers and amitriptyline antidepressants to be taken daily.
The medications reduced the severity of the pain but did not eliminate it.
When we saw her, she had been on this regime for 18 years. The side effects of the medications were now quite prominent. They included weight gain due to fluid retention, pain in joints and a totally disrupted bowel function. In addition she had psoriasis over the back and legs rendering any supine position extremely uncomfortable for the last 6 years. None of these symptoms had responded to drug treatment.
Examination and history taking showed routine dental treatment including a root filling on the right side and a number of amalgam fillings. The upper left maxilla had no teeth behind the second premolar. These teeth had been removed some 25+ years previously for unknown reasons. There was no sign of inflammation, the perio condition was good, there were mild muscle and joint symptoms associated with a minor TMJ dysfunction but no pain or limitation of movement of the mandible. The extracted teeth had never been replaced.
Pressure by thumb and forefinger over the ridge around the second molar area elicited some pain. A panorex radiograph showed a radiolucent area in the same region. This is unusual but illustrative which is why we are using this particular case. More often than not the radiographic result is read as normal (however, experienced eyes see things differently).
An ultra sound scan was done of the whole mouth using the Cavitat scanner. This showed in 2D and 3D that there was a cavitation space in the area of the pain and radiolucency. Administration of a small amount of local anaesthetic without adrenaline in the area eliminated, albeit temporarily, the pain.
These results confirmed the diagnosis of a bony cavitation infection in the pain producing area.
This is a NICO infection or a Neuralgia Inducing Cavitational Osteitis or a Ratner bony defect.
Cavitation infections are unresponsive to antibiotics. Only surgical debridement can bring about resolution of these infections. The causal organisms are anaerobic and the best consistent results in our experience are to open, thoroughly clean the bone and flood the site with oxygen.
The patient being assessed as suitable for outpatient surgery a decision was made to surgically clean out the cavitation area.
A flap was drawn back exposing the bone under local anaesthetic of reduced adrenaline content. On all cavitations infections there is a fibrous knot of tissue directly above it. This makes retraction of the flap more difficult especially in thin friable areas but does pinpoint the entry point to the cavitation quite precisely.
When the flap was retracted the hole in the bone was immediately seen at the second molar region. At no point throughout the procedure were burs or any rotary instruments used. All procedures were performed with hand instruments only.
Using a Hemmingway spoon curettes, soft bone was removed from the ridge opening the cavitation from the wisdom tooth area to just behind the second premolar. Probing showed a hole in the bone about 1cm deep and the entire width of the ridge. All the inner bony surfaces of the cavitation were soft as is usual. Slow and thorough hand debridement followed until no softness was left. The contents of a cavitation are of a slimy jelly nature with a characteristic stale Smokey smell and dark almost black in colour. In a large cavitation such as this, the centre is hollow and the contents adhere to the bony walls. Painstaking thoroughness is required in this type of surgery.
Frequent and copious irrigation around the bone follows. This is with a 3 to 5% magnesium chloride aqueous solution ozonated prior to use for 30 minutes with 67ppm ozone. We use 10ml syringes and at least 6 syringes are used. Ozone gas, 20 ml also at 67ppm ozone was also put into the operation site using strict measures to prevent inhalation. The base of the cavitation was filled with ozonated olive oil and the entry to the cavitation filled with a thick sticky erythromycin gel. The site was firmly and tightly closed using resorbable sutures.
The erythromycin gel is made for us by a compounding pharmacist. Its use is not only a topical antibiotic but it "plugs" the hole. Ozone gel, an excellent bactericidal, becomes runny at body temperature and the erythromycin gel prevents this ozone gel running out. Ozone gel tastes particularly disgusting. Blood flows into this mixture nicely and a simple pressure pack controls bleeding.
The patient under went intravenous infusions of 35g Vitamin C during the operation and for another 3 consecutive days afterwards to control infection and accelerate healing.
The Vitamin C was diluted in Lactated Ringers1:4, and infused over three hours. The amount of Vitamin C used is dependant upon the weight of the patient.
The healing result was excellent as seen by the photograph of the operation site 7 days later.
The operation was performed in April this year. The chronic pain diminished substantially directly after the operation. Within three weeks the patient had reduced the medication by half, and was off all medication within eight weeks. She did this on her own against our advice of seeking medical supervision.
The chronic facial pain of 18 years duration had entirely resolved within two months. The pain in the joints has also gone and the bowels are now functioning normally. The psoriasis has been reduced markedly and the patient is no longer taking any prescription medication. A rescan some six months later show new bone growth at the operation site.
No antibiotics were needed or taken orally before or after the operation.
In her words "I have not felt so well for years".
She has now stopped all medication and is without facial pain or discomfort.

 

Cavitat Scan of maxillary upper left area. Green is normal tissue, black areas shoe the cavitation

Discussion:
The theory of focal infection, out of fashion now in dental circles but still accepted by vetinarians, held sway in the profession before the advent of readily available antibiotics. In our opinion the invention of the Cavitat Scanner, an FDA approved device, is the most significant development in dentistry since the advent of the high speed turbine. It shows with unerring accuracy in experienced hands, the location and size of these chronic infections.
The terms cavity and cavitation were used by an orthopaedic researcher in the 1930s, the former referred to holes in teeth and the latter to holes in bone. Cavitations are brought about by infarctions of the supplying blood vessels to the bone. They are seen most often in extracted wisdom teeth areas.
The father of modern dentistry, Dr G V Black described cavitations in his textbook on Oral Surgery in 1915 where he recommended surgical removal of these dead and infected areas.
They have been accurately described by a medical Professor, Dr Fischer.
This case was a classic NICO. Some of the time, cavitation infections are painless. Some patients have a shooting pain that can be confused with Trigeminal Neuralgia, others have a constant foul sour taste from drainage into the mouth from a cavitation. Cavitations are infected with anaerobic bacteria which release exotoxins. Research from Prof. Boyd Haley has shown that these toxins are very potent at inhibiting various enzyme systems. Not only this, when these toxins combine with heavy metals, e.g. mercury, even more potent toxins are produced. The control for toxin potency is Mustard Gas. These combined toxins are frequently more than ten times toxic than Mustard Gas. These bacterial products have been indicated in blood vessel dysfunction such as occluded coronary arteries and strokes.
This is entering a contentious area but it would explain the focal infection theory and is born out in clinical practice where we see a variety of medical conditions and symptoms resolve after successful cavitation cleaning.
The bacteria produce a slime which insulates the bacteria from the immune system and any blood born antibiotics and oxygen. The aim of surgery is to physically remove as much of the infective material as possible by curettage instruments and allow oxygen in. We prefer not to use rotary instruments if possible as this may lead to microscopic fractures in the bone that bacteria can access.
As cavitations are caused by interruptions of blood supply, infarctions, it would naturally follow that cavitations are seen more frequently in the older age groups. However, we have seen 20 year olds with cavitations. Other predisposing factors are smoking, long term cortisone use, oestrogen replacement therapy and reduced thyroid function.
Initiating factors are always trauma to bone of various descriptions such as extractions, ID injections, root canals, bruxism, periodontal infections, tooth apical infections or orthodontic treatment. Injuries from falling off bikes and horses, whiplash and even falling drunk onto a taxi door twelve years previously have also caused cavitations we have treated.
Ozonated magnesium chloride, 3% solution, is used as a rinse. Prof. Pierre Delbet used Magnesium Chloride in treating wounds during World War 1. He found increased leucocyte activity and phagocytosis reduced the incidence of post surgical infection using this rinse. We have added ozone to it as an extra measure against anaerobic bacteria. The bacteria are so well established that every reasonable measure must be employed to defeat them, hence the use of intravenous vitamin c, ozonated olive oil and the erythromycin gel. Experience over the years has found this rinse to be superior to any others we have tried in post operative infection control and trouble free healing.
We use systemic oral antibiotics if post operative soft tissue infection occurs and occasionally if a "dry socket" type of infection establishes itself in the bone. Both are extremely rare occurrences.
In the beginning we routinely used systemic antibiotics after surgery but ran into problems with sensitive patients reacting to the antibiotics. Discontinuing the prophylactic use of antibiotics has not resulted in an increase in infection.
Intravenous Vitamin C is an effective measure against all types of infection. We have performed close to 10,000 Vitamin C infusions over the years and found that this particular technique to be both safe and effective.
Other diagnostic techniques are MRI and CT scans. MRI scans can be hard to interpret and CT scans can be inaccurate if metal restorations are present as the x-rays are scattered by the metals making the computer analysis suspect. Pre Cavitat Scanner, CT scans were our diagnostic measure of choice but the potential inaccuracies plus the amount of radiation used means we no longer use this form of scan.
Success is measured by symptom relief by the patient and new bone growth in the operation site seen by a Cavitat Scan some 6+ months later. The re-occurrence of a cavitation infection after surgery has traditionally been around 30%, using the techniques described above, we have managed to reduce this to just over 10%.


OPG. Note dark distinct area upper left. Such a picture is unusual in these cases.

Fully opened cavitation. Only hand instruments used. No drills were needed, the bone was soft and mushy and was spooned out

 
Soft bone on top of maxilla removed

Bone exposed on flap retraction. Note the open defect in the bone some 20+ years after the extractions. The defect was directly under the fibrous attachment.

Area after 7 days. Note accelerating healing response typical of patients undergoing Hall V-Tox Therapy.

 

Root Fillings
If the nerve inside a tooth has died then the tooth may need a Root Filling.
A root filling is simply material put into a tooth where the nerve used to be. Traditionally a rubber like substance called Gutta Percha is used. This can contain mercury. Other materials include Formaldehyde, Cadmium, Steroids or even concentrated Sulphuric Acid.
The problem with root canals is both the toxic nature of the materials used and the fact that they do not fill fully the open spaces inside the tooth. Each tooth contained miles, and I mean miles, of little canals branching off the main canal. The main canal can be filled but traditional root filling materials cannot fill the tiny lateral canals. It is inside these lateral canals that anaerobic bacteria live and multiply. They too have waste products and it is the release of these toxic waste products, as in cavitations, that cause the problems.
Not all root fillings done conventionally are toxic. Just 90% of conventional root fillings tested at the clinic.

Diagnosis
A simple reliable test is available to show if a root filled tooth is toxic or not. This is the TOPAS test. The Topas test can be done immediately and the result known. A more precise test involving sending a paper point soaked in the fluid found around the neck of the tooth to Kentucky for testing. This takes longer and is more expensive.
In a TOPAS test a paper point is placed at the neck of the tooth for one minute. The point is removed and put into a solution that changes colour according to the degree of toxicity present. The solution is placed into a Colourimeter device made by Bioscience which accurately measures the change in colour and gives it a number. The process is repeated with a different solution to test for bacterial proteins. The gives a precise reading of both the severity of the toxins and the activity of the bacteria.

Treatment
If a root filling tooth is toxic it cannot be refilled. Its toxicity can be moderated using iodine and a TENS machine. How long the teeth remain toxin free is yet unknown. Our results show a maximum length of 3 weeks in a severely toxic tooth.
Toxic teeth are best removed using an atraumatic extraction technique and the wound treated as if it was a cavitation. This prevents later cavitations forming. The technique we use is a modified Ogura technique as this does not crack the bone. It is gentle but does take a long time. The socket is treated exactly as we would treat a cavitation site, that is with cleaning, washing with ozonated magnesium chloride, ozone gas, ozone gel etc.
Biocalex or Endcal as it has been renamed, is a root filling material that is toxin free. Not only that it expands on setting and penetrates the tiny lateral canals pushing out the bacteria and not allowing re infection of the tooth canals. It does require a different technique than conventional root filling as the scraping of the canal side in conventional treatment blocks the entry to the lateral canals therby virtually ensuring failure.
It is the only material that is safe to use at present, even then it is not 100% effective every time. Biocalex or Endocal is only faintly visible on X-rays, a fact which all patients with Biocalex/Endocal filled teeth must tell any future dentist they consult about this or it will be assumed that the tooth is incorrectly filled. Conventional root fillings are radio-opaque and show up white on x-ray film, Biocalex/Endocal does not unless Yterium is added to the mix.
The most frequently used sign of success for a root filling is when it is painless and not sensitive to pressure. This is no guarantee that the tooth is toxic free. An x-ray taken of a "successfully" root filled tooth will often show changes at the root tip. These are interpreted as inflammation healing. They changes are not a positive sign but in reality show encapsulated infection.

Dead teeth behave in the same way as root filled teeth. They are darker than living teeth. A blow or extensive drilling on a tooth is usually a good way of killing a nerve inside the tooth. A "Blue" tooth is a dead tooth. These teeth eventually blow up into acute infections needing extraction or root filling.