You may have been told that the places where teeth were pulled years ago, often wisdom teeth, hide “cavitations”: hollow or dead areas of jawbone said to cause facial pain, fatigue or illness elsewhere in the body, and that they should be surgically cleaned out.
We don’t see many of them. And when someone brings the idea to us, two questions matter more than the label:
If an area of bone really never healed, why not? Bone that doesn’t heal is usually telling you something about the patient’s health, not just about how the tooth came out. And after cavitation surgery, who follows up to know whether it actually helped?
Both questions have answers worth knowing before anyone operates.
What the terms mean
The idea goes by several names. In 1979, a group of researchers described cavities at old extraction sites in patients with facial nerve pain, noting they were usually not visible on X-rays. In 1992 the term NICO, neuralgia-inducing cavitational osteonecrosis, was coined for these areas. More recently, a German group has used FDOJ, fatty degenerative osteonecrosis of the jaw, and links it to inflammation and illness throughout the body.
The claim, in each version, is the same: an area of bone that died or never healed after an extraction, hidden inside the jaw, causing problems that are hard to explain any other way.
Ratner EJ, et al. Jawbone cavities and trigeminal and atypical facial neuralgias. Oral Surg Oral Med Oral Pathol. 1979;48(1):3-20. Bouquot JE, et al. Neuralgia-inducing cavitational osteonecrosis (NICO). Oral Surg Oral Med Oral Pathol. 1992;73(3):307-319.
What’s real
Areas of lower bone density at old extraction sites are real, and common. In one study of 1,000 patients referred for 3D scans, 45% had such an area somewhere. The authors were clear that this is not the same as disease: a scan can’t show whether bone is dead or full of fat. A paper co-written by two of the best-known proponents of cavitation treatment acknowledges that these areas may simply be how a socket fills in after a tooth comes out.
There are also jawbone problems that are well established, with clear causes and accepted ways to diagnose them:
- Medication-related osteonecrosis of the jaw, linked to some osteoporosis and cancer drugs.
- Osteoradionecrosis, after radiation to the head and neck.
- Osteomyelitis, an infection of the bone itself.
- Dry socket, a painful, slow-healing socket in the days after an extraction. What it feels like, and when to call.
Those are real, they’re treatable, and they’re the reason a site that won’t heal deserves a proper look.
Dominiak M, et al. J Clin Med. 2026;15(17):6636. Ghanaati S, et al. Bioengineering. 2026;13(1):106. Ruggiero SL, et al. AAOMS position paper on medication-related osteonecrosis of the jaw, 2022 update. J Oral Maxillofac Surg. 2022;80(5):920-943.
What isn’t established
That these hidden areas are a disease, that they cause facial pain, or that they cause illness elsewhere in the body.
A 2022 systematic review found 29 studies, all observational and all rated poor quality, with no agreed way to diagnose the condition. A 2026 review of 41 studies found no randomized trials and no validated diagnostic tools, and noted that the inflammation marker often cited as proof has never been independently confirmed. Its authors suggested many patients may fit better with recognized facial pain disorders, which have their own treatments.
Diagnosis is a large part of the problem. Ultrasound devices have been marketed to find cavitations, but they haven’t been validated by independent research. The main study supporting one of them was run by a researcher who holds a patent used in the device. Some insurers classify cavitation diagnosis and treatment as experimental or unproven.
Sekundo C, et al. Neuralgia-inducing cavitational osteonecrosis: a systematic review. Oral Dis. 2022;28(6):1448-1467. Biancardi MR, et al. NICO: a scoping review of a controversial concept. Arch Oral Biol. 2026;186:106539. Lechner J, et al. Ultrasound Med Biol. 2021;47(11):3135-3146 (author disclosure). Aetna Clinical Policy Bulletin 0642.
The first question: why didn’t it heal?
If an extraction site truly never healed, that isn’t the end of the investigation. It’s the start. Healing depends heavily on the patient: smoking, diabetes, some osteoporosis and cancer medications, radiation, and the body’s general ability to repair bone all affect it.
That matters because cleaning out the bone doesn’t change any of those things. If the reason a site didn’t heal is something about your health, that reason is still there after surgery, and it may be the more important thing to find.
The second question: who follows up?
This is where the evidence is thinnest. Most of what’s published about results comes from the people performing the surgery, often as surveys or case series without a comparison group. In one of the earliest follow-ups, about two-thirds of patients reported pain relief, but nearly a third had their pain come back, and about a third developed new sites.
A 2025 review by a Harvard oral surgeon noted that no formal analysis of complications or poor outcomes from cavitation surgery has been published, and cited reports of infection, numbness, repeated surgeries and worse pain. Without independent follow-up, nobody can tell you how often the surgery helps, how often it hurts, or how often the pain would have improved on its own.
The American Association of Endodontists has said it cannot condone surgery to treat suspected cavitations, and that recommending removal of root-canal-treated teeth to prevent them is unethical.
Bouquot JE, Christian J. Long-term effects of jawbone curettage on the pain of facial neuralgia. J Oral Maxillofac Surg. 1995;53(4):387-397. Keith DA. Neuralgia inducing cavitational osteonecrosis of the jaw: scientific controversy or pseudoscience? J Pain Res. 2025;18:4275-4284. American Association of Endodontists, Position Statement: NICO Lesions.
What we would actually do
- Look at the site properly. If a 3D scan is needed, it’s read in full by oral and maxillofacial radiologists, who report on everything in it, not just the area in question.
- Ask why it didn’t heal. Health history, medications, blood sugar and smoking come first.
- Separate the pain from the picture. Facial pain has many causes, and some of them are best evaluated by an orofacial pain specialist before anyone operates.
- Treat what’s established. Infection, a failing tooth or a recognized jaw condition gets treated.
- Before any cavitation surgery, ask the surgeon how the diagnosis was confirmed, what results they track, and what happens if it doesn’t help. A second opinion is reasonable for any surgery, and especially this one.
Worth bringing up
If you’ve been told you have cavitations, or you’re living with facial pain nobody has explained, bring it in. We’ll look at it with you and tell you plainly what we see. Call 702-734-0776 or tell us what’s going on. If the concern started with an old root canal, that has its own article.
The research on cavitations consists mostly of observational studies and case series, much of it from practitioners who perform the treatment. Low-density areas on scans are common and are not, by themselves, evidence of disease. General information, not a substitute for an exam.