Disclaimer for All Information on Dental Cavitations and NICO and Ischemic Bone Disease contained in this page:
Its important for any person or patient reading this page to note that each and every patient is responsible for doing their own research on the said procedure and understanding whether its something that could potentially benefit them and their health conditions. The compiled information on this page is for illustrative purposes only and is not intended to treat, diagnose or inform any patient about a potential diagnosis or treatment. The effectiveness of cavitation surgery varies from patient to patient and is not without risks. Cavitation surgery is not intended to treat, resolve or benefit any specific condition or ailment and patients should understand that they may not experience benefits to their health after undergoing such a surgery.
If you are a traveling patient, we see patients from all over the USA and abroad and you can find travel information for your trip here
What is a cavitation in the jaw bone?
A cavitation is a jaw bone abnormally typically in an area of extraction, like a wisdom tooth, where the bone doesn’t form normally and the jaw area doesn’t heal properly. A dental cavitation is common term for “ischemic bone disease” or “sites of alternate healing” which means either an active infection or abnormal tissue growth in the bone of the maxilla or mandible. Ischemic Bone Disease aka “IBD” or cavitations are also called Chronic Ischemic Jawbone Disease – “CIBD”. At Natural Dentistry, we often diagnose areas of abnormal bone as Fatty Degenerative Osteonecrosis of the Jaw – “FDOJ” Chronic ischemic bone disease is a name used to describe a disease process involving pathological changes in the bone tissue related to impaired blood flow (ischemia). In the jawbones these pathological changes are usually triggered by a combination of systemic and oral factors.
Depending on the severity and extent of the disease process, various names have been used to describe pathological changes that can occur in CIBD such as:
Aseptic Osteomyelitis | Avascular Osteonecrosis | Ischemic Osteonecrosis | Hole in the Jaw Bone | Bone Marrow Oedema | Regional Ischemic Osteoporosis | Fatty Degenerative Osteonecrosis of the Jaw
Additional terms include: osteomyelitis, osteonecrosis, Neuralgia-Inducing Cavitational Osteonecrosis (NICO), Chronic Osteitis, Ratner’s Cyst, Robert’s Cyst, Osteocavitations.
While these jaw infections can be acute such as osteomyelitis (a highly dangerous, virulent tissue necrotizing bacteria – emergency room is warranted!) we rarely see acute forms; those are immediately referred to an oral surgeon or hospital. The majority of our biological patients exhibit chronic based bacteria-based (and other pathogens) abnormalities that arise due to necrotic or abnormal tissue in the jaw bones. For the purpose of this exploratory article, Ischemic Bone Disease will be interchangeable with IBD / CIBD / cavitation / jaw bone infection / FDOJ / NICO.
Read about the History of Cavitations <= coming soon
Cavitation of the Jaw – Ischemic Bone Disease “IBD” or Chronic Ischemic Jawbone Disease “CIBD” or Fatty Degenerative Osteonecrosis “FDOJ”
In the jaws NICO can be complicated by the presence of chronic infections that can be related to periodontal and dental infections, including chronically infected root-canaled teeth. The fact that the jaws contain branches of the 5th cranial nerve ( trigeminal nerve) is also an situation unique to the jawbones. The frequent use of local anesthetics and specifically nerve blocks with high concentrations of vasoconstrictors (drugs that shrink blood vessels, specifically epinephrine found in most dental anesthetics) can also exacerbate the problem, in addition to the use of other pharmaceutical drugs such as corticosteroids. Toxins such as heavy metals (lead, mercury, nickel, cadmium) and acetaldehyde are contributory factors and trauma in any form can also play a role.
Over time a number of other names have also been used by various dental clinicians for jawbone with chronic ischemic damage such as:
Chronic Osteitis, Ratner’s Cyst, Robert’s Cyst, Osteocavitations and Neuralgia-Inducing Cavitational Osteonecrosis (NICO), the latter being more specific for cases when neuralgia is a dominant feature of the disease process since there are many cases where pain is either absent or a minor symptom.
How is dental cavitation diagnosed?
Dental cavitation infections are diagnosed primarily with a 3D CBCT Conebeam Scan which is the current standard of care tool that can identify jaw bone abnormalities by examining each cross-section millimeter by millimeter of the affected infected jaw cavitation area and observe changes in bone density fluctuations, tissue changes and adjacent anomalies such as infected root canals. Importantly, while the 3D Conebeam Scan is the only tool that can properly diagnose a cavitation lesion, it MUST be interpreted by someone highly experienced in both radiological interpretation of the jaw bone cavitation but also experienced in the surgery itself. not just a holistic dentist, but specifically, a holistic dentist who ALSO performs surgery for dental cavitations. Often times, a holistic dentist who does NOT do the surgery and merely diagnose actually MISdiagnose since they are not properly experienced or trained in dental radiology nor can they correlate the radiological findings to real life bone and tissue that Dr. May sees regularly in surgery while performing cavitation surgery. Another tool that is used BEFORE an official diagnosis by a holistic surgery dentist is Thermography, which is a pre-diagnostic tool that can help identify areas of ischemia in the jaws and lymphatic abnormalities which can lead patients to explore whether they actually have dental cavitation by seeing the holistic dentist. Many patients ask about the Cavitat, and sadly, the Cavitat has been removed from the USA market by the FDA in 2016 after lawsuits claiming it cannot be a dependable diagnostic tool. Old cavitat machines are far and few between today, and are difficult to find in holistic offices. They are no longer supported by any technology company and are out of date – this is not a recommended tool for diagnosing dental cavitations and any results should be corroborated by a legitimate 3D dental scan conebeam and interpreted by a qualified surgical holistic dentist.
Below is the scan of a typical Natural Dentistry patient (this is a 3D Scan that is exported into 2D format ONLY for illustrative purposes – it is housed on the server and accessed by Dr. Yuriy May in 3D format for all clinical purposes) The importance of getting a 3D Conebeam scan cannot be overstated, as it is the only diagnostic tool to identify root canal infections, titanium implant failures, dental cavitations, sinus abnormalities, abnormal bone grafts and other pathological processes which CANNOT be identified on xrays, PAs or 2D panos.
Why do Dental Cavitations develop? The Etiology of Ischemic Bone Disease
Bacteria and tissue death are the simple and short answers to why cavitations or IBD ischemic bone disease develops. Bacteria that is poorly handled by the body’s immune system colonizes, feasting on existing cellular structure thusby destroying bone and blood supply to the surrounding bone. The term Ischemic Bone Disease medically means “no blood flow to the bone” which thereby creates dead, or “necrotic” tissue. As in many instances of generalized necrosis, which is cellular death, infection is a byproduct which can turn into systemic issues such as gangrene and sepsis.
(What is Necrosis? Think of frostbitten toe during a hike into the Himalayan Mountains – the toe is purple because it lacked blood supply, as in the toe underwent ischemia – thereby resulting in cellular death, as in necrosis of the toe, and required amputation to prevent gangrene or even worse, sepsis.)
Where does the bacteria come from? There are several known and debated reasons for the development of alternative healing sites or otherwise knowns as cavitation in the jaw.
- Tooth extractions: Bacteria During tooth extraction surgery (wisdom teeth included) the bacteria is not properly neutralized or adequately flushed out after an oral surgery or extraction. Once the traditional dentist sutures the extraction site, the bacteria multiplies and makes its way into the bone where it begins its onslaught of destroying tissue and bone. Once trapped inside the post-surgery cavity these bacteria can incubate for years, potentially releasing toxic infection residue [bacterial debris and tissue waste (necrotic cells)] into the blood, circulating through the circulatory system and ultimately negatively impacting all the cells of the the body. This of course can cause a host of health issues, both local to the jaw and other areas of the body that we often observe for those patients positively diagnosed with alternative healing sites or IBD.
- Tooth Extractions: Periodontal Ligament While this remains controversial, it is the belief some oral physicians that upon extraction of a tooth, if the periodontal ligament is not removed along with the tooth, it can cause abnormal healing which results in abnormal tissue and is more likely to develop bacteria. The periodontal ligament supplies the tooth with blood and serum, and upon removing the tooth, the periodontal ligament will die and resorb. However, when the body rejects the left behind periodontal ligament, infection can occur which is thought to potentially turn into IBD, or infections in the jaw bone (aka cavitations.) This scenario can happen under what dentists consider the “normal” extraction situation: the tooth is removed but the ligament that holds the tooth in place is left behind and the area isn’t properly cleaned, and consequently toxins remain within the ligament that slowly seep into the body, potentially creating chronic health issues and other symptoms most doctors can’t diagnose (such as fibromyalgia, heart issues, endocrine issues, neurological issues, among others).
- Root Canal Infections: Root canaled teeth no longer have an active blood supply, and in the biological and holistic communities are referred to as “ischemic teeth” or “necrotic teeth” because essentially the tooth is a dead appendage due to lack of blood supply. Depending on the strength of the individuals immune system countered by oxidative stress on the cells and overall biological disease processes, individuals can develop secondary infections underneath root canaled teeth. Root canaled teeth with no dynamic pain receptors are especially dangerous because typically the individual does not feel any pain or discomfort until the infection is so large that it can spread to the adjacent teeth, tissues and bone can develop a massive abccess (pus filled infection). The infection in a root canaled tooth can also move vertically into the bone, with the bacteria “eating away” all tissues in its path, regardless of direction. Once the infection from a secondary infection in a root canaled tooth moves into the bone, it can become a case of IBD. While this process doesn’t happen overnight, once the infection has moved into he jaw bone, the patient may still not experience acute discomfort and only may exhibit symptoms of overall health decline.
- Overuse of Poorly Chosen Local Anesthetic: Ischemia Dr. Yuriy May is EXTREMELY selective about the anesthetic that he uses for all patients, and most notably, rarely uses local anesthetic with epinephrine. Most educated patients know that epinephrine, is a vasoconstrictor and therefore reduces blood supply to the anesthetized area during surgery. This is precisely the reason Dr. May prefers not to use vasoconstrictor, as for healing and tissue regeneration the biological system NEEDs blood flow. But stifling blood flow, some dentists are risking reducing the blood supply by such a degree that the result is “ischemia” which is “lack of blood flow.” Like the brain or any other part of the brain, without blood flow, there is no oxygen delivered to the cells, and without oxygen, our cells, like our brain, will being to die. At Natural Dentistry we specifically use shorter half life anesthetics like Carbocaine (Mepivicaine) and Prilocaine (Citanest) which are epinephrine free. While epinephrine free anesthetic made surgery messier as they do not reduce the flow of blood to the surgical sites, in biological surgery that is precisely the desired effect – increased blood flow to the surgical site to heal trauma and prevent or treat cavitational lesions. While cheaper local anesthetics like lidocaine can be purchased and used without epinephrine, the toxic byproducts formed by use of lidocaine are considered undesirable relative to other local anesthetics and thus avoided by the best biological dentists like Dr. May during surgical processes. By using shorter acting anesthetics with lower toxic byproduct creation and avoiding the use of vasocontrictors like epinephrine, Dr. May is able to not only avoid the formation of ischemia in patients but also reverse and regenerate ischemic disease processes such as cavitations in the jaw.
In-Depth Knowledge Section: Epinephrine Usage in a Nerve Block in the Lower Jaw and their Potential Long Term Effects after Wisdom Tooth Removal:
Some specific nerve block methods when combined with vasoconstrictors like epinephrine can cause more side effects especially during mandibular wisdom tooth removal which can lead to ischemia in the lower third molar (“L3M”) extraction sockets precipitating the condition of cavitations and jaw bone abnormalities long term. Orofacial anesthetic (numbing) techniques can be classified into three main categories: local infiltration, a field block, and nerve block. As long as the dental surgeon or dentist removing the wisdom teeth doesn’t overload the patient with vasoconstrictors (aka epinephrine), local infiltration is the safest method. Once the oral surgeons move into nerve blocks with epinephrine, specifically in the lower jaw, a notable correlation between lack of blood flow to the area of surgery and long term effects of cavitations are suspect. Specifically, the mandible (lower jaw) anatomically has less blood flow than the maxilla (upper jaw) and the only blood supply that the lower jaw bone receives is supplied by the alveolar artery (Exhibit: light blue line), which is in extremely close proximity to the alveolar nerve (Exhibit: yellow lines), which is the target of the injection with epinephrine in preparation for the wisdom tooth extraction (Exhibit: See red target injection site). In the Exhibit, note that proximity of the artery to the alveolar and lingual nerve which is where the anesthetic like lidocaine with epinephrine is targeted – the problem is the epinephrine affecting the alveolar artery and constricting blood flow. Overall, cavitation surgery dentists observe a higher prevalence of cavitation NICO sites in the lower jaw than the upper jaw, and thus it is hypothesized by experienced biological surgery dentists like Dr. May USA and Dr. Volz Switzerland that the Inferior Alveolar Nerve Block (“IAN” or “IANB”) with epinephrine is implicated in potential prolonged ischemia in the lower jaw after wisdom tooth removal surgery, leading to reduced alveolar arterial blood flow, causing a generalized reduction of blood flow, lack of bone formation and long term chronic bacterial overload at the mandibular 3rd molar extraction sites. From a 2018 Research Article (4) “The conventional inferior alveolar nerve block is the most widely used method. However, its success rate is not high and it may lead to complications, such as aspiration and nerve injury….(assumption is that ephinephrine based anesthetic is always used in conventional IANBs)
- Infection & Lowered Immune System: Bugs In addition to bacteria and infections arising from necrosis (a byproduct of several items on this list) other systemic secondary co-infections can thrive in the ischemic bacteria rich environment. It has been documented in many surgeries that resolve cavitations, that upon surgically opening up the “festering hole in the jaw” oral physicians have observed other harmful elements including viruses, fungi and parasites which were also verified by biopsies. This complication can potentially be due to the lowered immune response, as the body is already embroiled in trying to fight against the chronic jaw bone infection. The immune system cannot keep up fighting the opportunistic pathogens and therefore an overgrowth of fungi, viruses and parasites can occur in addition to neurotoxic bacteria. During such complications, it has been documented that bacteria from within the cavitation site may produce very strong chemicals that are highly neurotoxic. Research has shown these toxins can then combine with chemicals or heavy metals, such as mercury, and form even more potent toxins. These neurotoxins can over time be released into the bloodstream where they destroy many otherwise critically important enzymes within the body.
- Low Vitamin Levels, Ineffective Immune Systems, Lyme Disease: With the inability to form healthy bone, strong angiogenesis (vascularization development) and overall low ability to heal and defend against inflammation, creates the perfect opportunitistic environment for cavitations to form where the wisdom teeth once grew. After the wisdom tooth extractions, which are often complicated by use of strong ischemia causing drug like lidocaine with epinephrine and conducted at inappropriate ages, a low vitamin D3 combined with the inability if the body to heal is the potential to help establish the very problem we aim to treat, ischemic bone disease which becomes a chronic source of infections, disease and malaise for patients. In addition, with such high diagnosis rates of Lyme Disease and various other Borrellia infections, it has been observed that the Borrellia virus tends to live and proliferate locally in the in the areas of cavitations, which have no ability to fight the Lyme infections as the immune system is not able to reach the areas of ischemia due to limited blood flow.
Risks & Dangers of Ischemic Bone Disease & Cavitations
You might think it’s bad enough to think about having neurotoxic bacteria, fungus and other unsavory creatures swimming in the open spaces between your teeth and gums, but there actually is one thing worse; cavitations (also called osteomyelitis, osteonecrosis, or a “hole in the bone”). Now, cavitations are exactly what they sound like they are; a hollowed out area or hole – and in this case, a cavern occurs when all too active bacteria has successfully departed the original post-surgical site and has somehow begun to impress itself into the actual jawbone. Every additional hole created by this process is filled with decaying bone and tissue that leaves behind an ever greater potential for bacteria (and their unsavory cohorts and associated neurotoxins) to flourish and grow. Eventually this caustic soup of poison leaks into the blood stream where it can cause or exaggerate other existing health issues in the body.
Diagnosis Jaw Cavitations and Ischemic Bone Disease Diagnosis
Although cavitations can go undetected for years in an otherwise healthy person, jaw pain sometimes occurs in patients suffering from bone lesions and sometimes jaw pain will manifest after a sinus infection, which can then also lead to the discovery of a cavitation. But it seems that the vast majority of people seeking to discover whether or not they have cavitations are those also suffering from other chronic health issues. It is the overriding health condition that has brought them back to the dentist seeking ways to cut down on potential toxins flowing into the bloodstream.
The first step in successfully diagnosing cavitations can be made using a variety of diagnostic tools which can include a unique ultrasound device developed specifically for this purpose called a Cavitat, CAT scans and MRI’s. The best method of detection is through a ConeBeam CT Scan (CBCT) with additional oral maxillofacial radiology reports prior to a final diagnosis and any recommendation for interventional treatment and therapies. As an adjunct applied kineseology (AK) or muscle testing can be used as well.
Cavitations & NICO Diagnosis – Why don’t traditional dentists diagnose dental cavitations? Are cavitations real? Where is the research?
Like osteoporosis, Ischemic Bone Disease is frequently not diagnosed and even less frequently treated. In many instances it is the symptoms of IBD that are treated rather the disease process itself and its causes. For example a patient with cavitations in the lower jaw may experience atypical facial pain (pain of an unknown origin) and will be prescribed medication for the pain. Another patient with a tooth located in bone tissue with cavitations may experience pain in that tooth because of pulpal ischaemia (ischemic pulpitis) and endodontic therapy (root canal treatments) will be performed to removed the inflammed pulp. In other cases antibiotics may be prescribed with temporary relief, as this does not treat the underlying issue of dead tissue and anaerobic bacteria present and festering in the jaw bone.
In order for you to understand that dental cavitations are real (published on PUB MED) in numerous articles and actually affect the body seriously and in many unpredictable and debilitating ways, here is a snap shot of a few articles by doctors and scientists exploring the detrimental effects of dental cavitations if left untreated, including the 30 fold increases in RANTES, a regulated-on-activation normal T-cell expressed and secreted is a chemotactic cytokyne (read: inflammation!) that plays a key role in recruiting immune cells to inflammatory sites.
Ischemic Bone Disease Diagnosis – Why is it so difficult to diagnose cavitations?
Mainly because it is difficult to see on x-rays and because there is a lack of awareness of the disease process itself. Of course there are cases where the disease process becomes so severe that it is difficult to miss. For example in the last 5 years there has been severe cases of osteonecrosis of the jaws associated with the use of bisphosphonates (Bisphosphonates are a class of potent pharmaceutical drugs used to inhibit bone resorption) Such cases not only involve the cancellous bone but also the cortical bone, leading to some of the cortical bone being exfoliated through the oral mucosa. This makes the disease process very obvious.
Cavitations Top Dentist & Cavitations Sugery
Cavitation Dentists – How to Select a Top Expert in IBD Surgery
Coming soon! PDF of Questions Available… Call the patient concierge to learn more 860-554-1130 (only after you fill out the form here….)
Cavitation & Ischemic Bone Disease Treatment, Therapy & Surgery
Once properly diagnosed, treatment for a cavitation commonly starts by a series of ozone treatments, followed by surgically removing any dead bone, tissue and other debris. Additional treatment options include the use of lasers and ozone treatments as well as probiotics and other natural products/techniques. Once applied, these methods help to create a clean and sterile environment that promotes healing at the site, and ultimately throughout the body. As you read the section below, you will see immediately you aren’t just selecting a top dentist in Connecticut to perform your cavitation surgery, but you are selecting one of the most experienced and serious dental experts in the world (USA and Abroad) for your surgery along the likes of Dr. Volz in Switzerland, with whom Dr. May trained directly and uses some of the exact protocols for jaw infection remediation surgery and therapy.
- Begin taking Vitamin D3-K2 & Bone Building Supplementation Protocol Kit. This is mailed out to traveling patients or purchased by local patients 2-4 weeks prior to surgery date
- Anti-Inflammatory Diet is recommended 2 weeks prior to surgery (gluten free, diary free, grain free, sugar free, meat free, organic, unprocessed, highly alkalizing diet)
- Ozone Injections Prior to Surgery + Procaine Injections Prior to Surgery (1st set)
- Surgery of ALL implicated FDOJ/NICO/cavitation sites (the patient needs to be educated why its suboptimal to break up surgeries and perform surgery for one site at a time, and will understand clinically it is ideal to address all areas of disease in one surgery)
- Ozone Injections + Ozone Insufflation (Nose & Ears) AT SURGERY time (2nd set)
- Ozone Injections Post Surgery (3rd set)
- Ozone Injections + Procaine Injections Post Surgery (4th set)*
- Ozone Injections + Procaine Injections Post Surgery (5th set)*
- Biomodulation with Dr. Tennent’s Biomodulator with Infared Therapy Post Surgery
- Significantly Reduced WIFI and Bluetooth Exposure Post Surgery
- Anti-Inflammatory Diet Continues a minimum 2 weeks post surgery (gluten free, diary free, grain free, sugar free, meat free, organic, unprocessed, highly alkalizing diet)
*For Traveling Patients the timeline for ozone injections #1-3 is condensed to 3 days and post-operative injections #4 and #5 are done with a local physician of Dr. May’s choosing whom Dr. May will direct in protocol, ozone concentration and specificity of injection site and technique. Dr. May has dental ozone partners in California, Texas, Florida, Illinois, Ohio, Michigan, Oregon, Washington, Arizona, Colorado, Virginia and just about every state with some exceptions and we will locate and choose an ozone provider prior to patients’ scheduled surgery date.
Ozone Therapy & Procaine Therapy for Cavitations
At Dr. May’s office, we take ischemic bone disease seriously, and for the patients who travel to us from all over the globe, they don’t come to see the top dental cavitations expert in the world just for surgery, the patient seek Dr. May out due to his all-encompassing and life altering protocols. Sad to say, Natural Dentistry has even experienced patients traveling for their 3rd or 4th ischemic bone disease surgery as the prior surgeries they had were unsuccessful. Luckily, the patients who select Dr. May for their first procedure win the jackpot, in a lucky way. The cavitation protocols do not get any more serious, robust or proven than that of Natural Dentistry Center’s Dr. Yuriy May.
At least 2 weeks before the surgery scheduled date, all patient are highly recommended to start an aggressive anti-inflammatory diet as outlined in Dr. May’s Cavitation Surgery Protocol at least 2 weeks before surgery. (Diet Protocol: gluten free, diary free, grain free, sugar free, meat free, organic, unprocessed, highly alkalizing diet) The patients must have vitamin D3 levels that are above the minimal healing threshold as determined by Dr. May’s ischemic bone disease remediation protocol, and have usually been supplementing with his regiment of vitamins and supplements for 2 weeks prior the surgery date.
1 week prior to surgery, every patient starts with a series of ozone injections in to every single affected cavitation site. In addition, the injections of ozone are followed with procaine therapy injections. Why are we doing more at Natural Dentistry Center than any other biological dentist performing the “same” cavitation surgery procedure? Well simply put, for extraordinary results, Dr. May has put together an extraordinary protocol. After all that time and energy and investment, do you want to approach your cavitation surgery from an average protocol – or do you want to do it RIGHT?
The day of surgery, the patient will again undergo a series of ozone injections into each of the NICO sites, followed by procaine injections that maybe also mixed with sterile homeopathic compounds from Europe. After the surgery is completed, the patient will undergo a 40 minute nose and ear ozone insufflation. This part of the protocol is designed to fill all sinus and ear canals with a mix of ozone and oxygen, to continually fight the bacteria/infection/viruses/fungi that have been displaced and removed by the surgery. Another words, all the pathways of the head and neck are infused with ozone to help heal and create blood flow.
One Week after the surgery, the patient will come in post-surgery evaluation, and another series of ozone and procaine injections. After the injections, another 40 minutes of ozone insufflation for the ears and nose will follow.
Three weeks after the surgery, the patient will come in for their next series of ozone and procaine injections. A discussion about transitioning from the anti-inflammatory to a less restrictive diet, but still maintaining gluten free, diary free and low sugar components. Patients will be asked to complete a health evaluation on any changes you’ve experienced since the surgery – either positive or negative, in your health.
Five weeks after the surgery, the patient will come in for their next series of ozone and procaine injections. Patients will be asked to complete a health evaluation on any changes you’ve experienced since the surgery – either positive or negative, in your health.
6 Months post surgery, a CBCT will be taken to assess healthy bone formation in the healed surgical sites. Patients will be asked to complete a health evaluation on any changes you’ve experienced since the surgery – either positive or negative, in your health.
Cavitation Surgery by Top Biological Dentist Dr. Yuriy May in CT
Call the patient concierge to learn more call (860)554-1130 (Responses available only after the new patient form request is filled out, click here
Post-Cavitation Surgery Therapies, Healing & Rehabilitation in Connecticut
Call the patient concierge to learn more call (860)554-1130 (Responses available only after the new patient form request is filled out, click here
Citations & Research on Cavitations & Chronic Health Diseases
(1) IAOMT Position Document – 2014
(2) IAOMT Position Document – 2007
(3) Dr. Klinghardt’s Presentation
(4) Kim, Chang & Hwang, Kyung-Gyun & Park, Chang-Joo. (2018). Local anesthesia for mandibular third molar extraction. Journal of Dental Anesthesia and Pain Medicine. 18. 287. 10.17245/jdapm.2018.18.5.287.
5) Ratner EJ, Person P, Kleinman DJ, Shklar G, Socransky SS. Jawbone cavities and trigeminal and atypical facial neuralgias. Oral Surg Oral Med Oral Pathol. 1979 Jul;48(1):3-20. doi: 10.1016/0030-4220(79)90229-9. PMID: 287984.