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Wesley E Shankland, II, DDS, MS, PhD

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Systemic Problems and Risk Factors for NICO Lesions

 

Systemic Problems Associated With NICO Lesions

Researchers early in the 20th century and now recently have been concerned with systemic diseases caused by a primary problem (a focus of infection). The focal theory of infection fell out of favor with medical and dental doctors after the advent of antibiotics, but may researchers today believe that in spite of antibiotics, the focal theory of infection is alive and well. Ask and veterinarian doctor, and he or she will immediately agree that the focal theory of infection is a great concern of theirs.

Many researchers today believe that NICO lesions are the focus of various infections which may spread throughout the body. In the last few years, some of the most surprising medical news has been the discovery that bacteria from the mouth appear to be very influential in causing various heart, liver and kidney problems. If you have a joint implant or mitral valve prolapse, your dentist must prescribe an antibiotic before any dental treatment. Why? Because bacteria from the mouth can spread through the blood to cause serious problems elsewhere in the body. Could the toxins from NICO lesions do the same?

 

Initiating, Predisposing, and Risk Factors for NICO

There are many initiating, predisposing, and risk factors associated with cavitational lesions. It’s likely that a combination of these factors present in a someone may influence the occurrence, type, size, progression and growth patterns of a cavitational bone lesion.
Initiating Factors: Probably the major initiating factors are dental trauma, which produce physical, bacterial, and toxic components, as described below.

Table 2:  Dental traumas (initiating factors) associated with cavitational bone lesion development.

Physical Trauma Bacterial Trauma Toxic Trauma
Tooth Extractions Periodontal Disease Dental Materials
Dental Injections Cysts Root Canal Toxins
Periodontal Surgery Abscesses Anesthetic by-Products
Root Canal Procedures Root Canal Bacteria Anesthetic Vasoconstrictors
Grinding and Clenching Non-vital (dead) Teeth Chemical Toxins
Electrical Trauma from Dissimilar Metallic Restorations Improper Removal of Periodontal Ligament after Tooth Extraction? Bacterial Toxins
Heat from High Speed Drilling Infected Wisdom Teeth Other Toxins

 

Predisposing Factors: There are many predisposing factors and no doubt, many more will be discovered. Most of the known predisposing factors include: blood clotting disorders such as thromophilia, hypofibrinolysis, or others; age — evidence suggests that as many as 11% of older persons may have major or complete blockage of arteries feeding the jaws or of the smaller arterioles within the jaws themselves; radiation or chemotherapy for cancer; rheumatoid arthritis; lymphoma or bone dysplasia; changes in atmospheric pressures in occupations; osteoporosis; systemic lupus erythematosis; sickle cell anemia; homcystinemia; Gaucher’s disease; hyperlipidemia; hemodialysis; gout; antiphospholipid antibody syndrome; physical inactivity (bedridden); and deficiencies of thyroid or growth hormones.

Risk Factors: There are many risk factors which greatly increase the probability of the development of cavitational lesions, especially in the occlusion or blockage of tiny blood vessels within the jawbones. The most common risk factors are: heavy smoking; high and long-term cortisone usage; pregnancy; estrogen use; alcoholism; and pancreatitis. Undoubtedly, there are many other risk factors.

Wisdom Teeth Sites: Research findings indicate that 45% to 94% of all cavitational lesions are found at wisdom teeth extraction sites. These areas are anatomically predisposed to develop these bony lesions because they contain numerous tiny blood vessels which are apparently, easily damaged from trauma (oral surgery in these areas) and osteonecrosis can easily develop. Also, many local anesthetic injections are given in the wisdom tooth areas and many of the local anesthetic solutions contain vasoconstrictors (especially epinephrine) which is used to intentionally close or shut-down the blood supply to the bone, teeth and gingiva to prolong the effects of the anesthetic and reduce bleeding. The actions of closing down the blood supply to these wisdom tooth areas may be a major cause for NICO development.

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