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What Causes Nico Lesions?

Frankly, we are not sure how all of these lesions develop. However, it is very obvious that many patients can trace the onset of their pain back subsequent to one or more extractions, perhaps decades ago. Notably, if patients had infections following their extractions or even dry sockets, there was a greater likelihood of NICO development. Some of these bone cavities have also been found around the roots of teeth that have had root canal therapy to save a “dead” tooth.

Generally, even though the surgical site appears to heal normally, a problem remains within the bone. Years later, and under normal and healthy appearing tissue and bone, an area remains which did not fill in with healthy tissue. When biopsied, the abnormal features of a NICO lesion are present.

Interestingly, a large number of biopsied bone cavities in pain-free subjects resemble NICO lesions microscopically! These patients may never develop pain! This is mentioned only to demonstrate that we don’t fully understand the complex metabolic interaction leading up to pain or the lesions causing pain.

Based upon laboratory findings, one or more of the following factors contributes to NICO development:

  • Immune system dysfunction or deficiency
  • Unususal microbial pathogens
  • Reduced blood flow to the affected jaws
  • Lack of (or potency of) one of several intra bony growth factors
  • Nerve dysfunction (3)
  • In our civilized culture, with notably decreasing levels of wellness, should we be surprised that one or more of these conditions might be widespread?


As we have discussed, NICO lesions can cause pain, mild to severe, in some, but not all people. What we haven’t mentioned is that NICO’s can refer to pain across the midline; that is, a lesion in the right jaw can cause pain on the left side of the face, head, neck, or body. Yes, NICO’s can refer pain to various areas of the body, including the neck, arms, and hands, legs and feet, groin, etc. (3) (4). In specific individuals, such referred pain patterns have been documented.

NICO lesions can also act as a focal disturbance, which is a chronically altered area of tissue that can cause systematic disease or a seemingly unrelated separate organ dysfunction. These “secondary disturbances”, as they are called, can include, e.g., the autonomic nervous system, which regulates our innumerable interrelated metabolic functions at a subconscious level. Hence, a generalized metabolic dysfunction could be secondary to a focal disturbance in one specific location.

A commonly accepted parallel to a focal infection, which is well-established within the conventional medical model is for a dentist to protect patients with specific heart problems and/or surgical implants against systemic infections caused by dental procedures by prescribing antibiotics. Infections from one site can “seed” the blood and are carried elsewhere in the body causing infections in remote sites! To not protect against this would be considered indefensible, legally and otherwise!


Obviously, the best treatment is prevention. Many practitioners now make special efforts to remove the soft tissue attachment (which holds the tooth into its socket) after extraction of the tooth. It is believed that this painless removal of tissue and up to 1 mm of the bony socket will help prevent MCO development and stimulate healthy bone healing. The fact that the outline of the socket can often be seen in conjunction with NICO lesions even 25 years after the date of extractions lends credence to this.

Some practitioners also use various medications, notably homeopathic remedies, to rinse the injection site and inject into the adjacent tissues, along with the extraction itself. The diagnosis generally involved radiographs and diagnostic injections, which are routine dental and/or intrabony injections of dental anesthetics. Confirmation of injection results may require more than one such diagnostic visit.

Other non-invasive techniques, such as applied kinesiology and electrodiagnostic machines are also utilized by some practitioners. Once diagnosed, NICO lesions are generally surgically cleaned out and biopsied to confirm the diagnosis. Various adjunctive modalities are utilized by different dentists or oral surgeons before, during, and after these surgeries. For example:

  • Herbs
  • Homeopathic Remedies
  • Trans Electrical Neural Stimulation
  • Antibiotics
  • Light Therapy
  • Neural Therapy

It is hoped that many NICO lesions will soon be treated non-surgically, as more research is being published regularly. For the time being, surgery appears to provide the most promising and predictable relief. Also, be aware that some NICO lesions may require more than one surgery! After all, systemic conditions which allowed the initial lesion(s) to develop may still be present!

Above all, don’t let yourself be talked into any treatment you do not feel comfortable with and have unanswered questions. Likewise, you must be comfortable with whoever is treating you! Remember IT’S YOUR BODY!

A growing number of professionals are becoming aware of NICO lesions and the importance of appropriate diagnosis and treatment. Improper handling of this problem may very likely contribute to the misdiagnosis and/or the need for retreatment. Be aware that even with appropriate training, these are challenging problems!

Several professional organizations have taken the responsibility to inform and train their members about NICO lesions. Their members include the following health professionals:

  • Medical doctors
  • Naturopathic Doctors
  • Chiropractic Doctors
  • Oseophatic Doctors
  • Dentists
  • Oral Surgeons
  • Researchers

Three such organizations whose members would be able to either treat or at least refer you to someone else who is qualified to treat are:

American Academy of Neural Therapy 505-988-3086
International Academy of Oral Medicine and Toxicology 407-298-2450
American Academy of Biological Dentistry 408-659-5385

(1) Mucke, L, and Maciewicz R: “Clinical Management of Neuropathic Pain” Neurol Clin, 1987, 5: 649-63

(2) Von Korff, M et al.: “An Epidemiologic Comparison of Pain Complaints.” Pain, 1988, 32: 173-83

(3) Bouquot, J et al.: “Neuralgia-Inducing Cavitational,” Osteonecrosis, Oral Surg, Oral Med, Oral Phaton, 1992, 73 (3); 307-319

(4) Ratner, E et al.: “Alveolar Cavitational Process and its Implications in the Causation of Chronic Pain,” J. Periodont, 1986, 57 (10); 593-603

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