Jawbone cavitations—also known as FDOJ (Fatty Degenerative Osteonecrosis of the Jaw), BMDJ (Bone Marrow Defects of the Jaw), or historically NICO (Neuralgia-Inducing Cavitational Osteonecrosis)—are areas of chronically compromised jawbone that may not resemble typical infections yet display disturbing biochemical and structural abnormalities.
Although conventional dentistry often dismisses these lesions due to their subtle appearance on standard imaging, biological and holistic dentists view them differently. They examine the mouth through a systems-biology lens, acknowledging that oral structures may influence the immune system, chronic inflammation, and whole-body health.
Biological researchers have found that many jawbone marrow defects (FDOJ/BMDJ) do not show the classic “hot inflammation” markers dentists expect. Levels of TNF-α and IL-6—molecules associated with redness, swelling, and acute inflammation—are often low or downregulated.
However, these same lesions frequently release extremely high levels of RANTES/CCL5, a chemokine associated with:
chronic immune cell recruitment
persistent inflammatory signaling
long-term dysregulation of immune pathways
migration of T-cells, macrophages, and other mediators
This pattern of low visible inflammation but high biochemical activity explains why cavitations are considered “silent inflammatory zones.”
Key research includes:
Ghanaati et al. (2025) — Demonstrated significant overexpression of RANTES/CCL5 in BMDJ/FDOJ tissue through quantitative RT-PCR analysis.
Lechner et al. (2019) — Identified intense RANTES/CCL5 expression within FDOJ lesions using immunohistology.
Lechner et al. (2021) — Explored how RANTES signals from cavitations may correlate with systemic inflammatory disorders.
Together, these findings support the idea that:
A jawbone defect may look normal on an X-ray, feel quiet inside the mouth, yet still function as a chronic inflammatory generator affecting the body.
After a tooth is removed, the jawbone should form stable, healthy bone. However, healing can be disrupted by:
inadequate blood supply
surgical trauma
retained ligament remnants
local ischemia
chronic infection
immune dysfunction
Extraction sites—especially wisdom teeth—are among the most common locations where cavitations form.
Although cavitations do not always show acute infection, some studies suggest that bacterial toxins, residual microbial activity, or altered immune reactions may contribute to impaired healing.
Root canal procedures remove the nerve but leave the tooth structure and surrounding ligament. Some theories propose that immune-challenged or ischemically stressed bone around previously treated teeth may be more prone to degenerative remodeling.
FDOJ/BMDJ lesions often exhibit poor blood flow, which contributes to fatty degeneration of bone marrow and inadequate remodeling.
Low-grade immune dysregulation, chronic inflammatory load, or hormonal stress may reduce the jawbone’s ability to repair itself after trauma.
Jawbone cavitations do not always cause local pain. Many patients report non-specific or distant symptoms. These are not diagnostic but are often discussed in biological dentistry:
deep, dull, or pressure-like jaw discomfort
intermittent or unexplained facial pain
ear or sinus pressure
nerve disturbances
tingling or burning sensations
difficulty localizing the pain source
history of chronic pain after extractions
pain in areas where no tooth exists
persistent discomfort after root canal or extraction
sensitivity with no dental cause
worsening jaw pain during stress or illness
persistent fatigue
chronic inflammation
headaches or migraines
joint pain
neuropathic symptoms
autoimmune flares
unexplained facial neuralgia
These symptoms do not prove a cavitation is present. They indicate why biological clinicians explore broader patterns and patient history.
Traditional dentistry typically views the mouth as a localized mechanical system. Diagnostic focus tends to remain on:
visible decay
periodontal bone loss
abscesses
cysts
fractures
radiographically confirmed pathology
Because FDOJ/BMDJ lesions may:
look normal or subtle on 2D imaging
lack acute signs like swelling
cause non-local symptoms
have an unclear microbial component
not match established diagnostic categories
…they fall outside the standard diagnostic framework.
Additionally:
AAE (2012) states that NICO remains poorly defined and its treatment is not evidence-based.
Gandhi (2019) describes NICO as a controversial entity requiring further research.
All of this contributes to a conservative, skeptical stance in mainstream dentistry.
Biological and holistic clinicians, however, examine cavitations through a broader systems perspective that integrates:
patient symptoms
immune system response
osteoimmunology
trauma history
chronic inflammatory load
Conditions such as bone infection often require a more detailed evaluation. Biological dentistry takes a comprehensive approach that includes CBCT imaging, identifying oftentimes hidden oral infection, microbiome awareness, and conservative removal when necessary.
At Virginia Biological Dentistry in Glen Allen and serving patients throughout Richmond and Virginia we help individuals understand root causes and how their dental conditions relate to systemic health, and long-term wellness.
If you suspect an unresolved dental issue, have autoimmune concerns, or simply want a biological perspective, we welcome you to schedule a consultation.
Click here to make an appointment now or call (804) 381-6238 or email at info@virginiabiologicaldentistry.com to learn more.
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