Persistent Jaw Pain After Tooth Extraction | CBCT Diagnosis & NICO Cavitation Treatment

What is NICO in dentistry?

Neuralgia-Inducing Cavitational Osteonecrosis (NICO) refers to chronic jawbone lesions where bone healing is incomplete, often following dental extractions or infections, resulting in chronic pain and necrosis.

What causes Neuralgia-Inducing Cavitational Osteonecrosis?

NICO is caused by insufficient healing of bone tissue after dental trauma, infections, or surgical procedures.

The affected areas often show ischemic (low blood flow) conditions, leading to necrosis and chronic low-grade inflammation.

How do you know if you have NICO?

Typical symptoms include persistent jaw pain, TMJ discomfort, radiating facial pain, ear pain, chronic fatigue, and sometimes unexplained systemic issues.

Diagnosis requires advanced imaging (such as CBCT), as regular dental X-rays may miss these lesions.

What are the symptoms of NICO cavitations?

Symptoms can include:

• Ongoing jaw pain
• Ear discomfort
• TMJ symptoms
• Chronic sinus
• problems
• Headaches
• Fatigue
• Unexplained facial swelling or discomfort

Diagnosis and Differential Considerations

• Chronic localized osteitis / cavitation (NICO)
• Residual infection from incomplete tooth extraction
• Low-grade chronic osteomyelitis

Patients often seek support using search terms such as:

• Cavitational osteonecrosis treatment
• Osteonecrosis of the jaw
• Biological dentist for jawbone issues

NICO; A Case presentation

A 50-year old gentleman presented with chronic pain in the lower right jaw, including tenderness, discomfort radiating toward the ear, and pain in the temporomandibular joint (TMJ) area.

The symptoms had been ongoing since a tooth extraction, raising concerns about a jawbone infection after tooth extraction or a silent tooth infection not visible through routine dental examinations.

Patients with similar symptoms often search for:

• CBCT scan jaw pain
• Hidden dental infection symptoms
• Pain years after wisdom tooth removal

Advanced CBCT Imaging – Region Lower Right Six (LR6)

A Cone Beam CT (CBCT) scan was performed to explore the possibility of a dental infection that was not visible through traditional imaging. CBCT provides a 3D view of the jawbone and is highly effective in detecting subtle lesions, particularly cavitations in the jawbone.

CBCT Findings:

• A 3-dimensional radiolucent area around site LR6 (approx. 5mm × 12mm)
• A radiolucent channel extending toward the previous extraction site, suggesting incomplete healing
• Communication with the oral cavity, consistent with a residual infection or toxic bone lesion

Patients often associate these findings with terms such as:

• Dental cavitation symptoms
• Toxins in jaw bone
• Fatigue and jawbone infection link

Additional CBCT Findings – Tooth UR6

The CBCT scan also revealed a periapical infection affecting the mesiobuccal, distobuccal, and palatal roots of tooth UR6, with associated thickening of the sinus floor lining—suggestive of odontogenic sinusitis.

Diagnosis:

• Chronic apical periodontitis (Tooth UR6)
• Odontogenic maxillary sinusitis