Neuralgia Inducing Cavitational Osteonecrosis of the Jaw: Scientific Controversy or pseudoscience?

Jawbone cavities have had a long history in dentistry and for many years they have been described and studied under several different pseudonyms. These cavities are thought to be responsible for a wide range of disease processes and symptoms, including orofacial neuralgia. In this article the existence of jawbone cavities, and their role in the etiology of orofacial pain will be critically examined. The validity and significance of these cavities has been questioned in the literature and found to lack sufficient scientific validation, posing potential harm to patients. Treatments based on this diagnosis have been the subject of legal action brought by patients, by a Medical Insurance Company, which has claimed insurance fraud and by several professional organizations. Ethical, regulatory and financial issues have also been raised. Evidence based diagnostic criteria and clinical trials are needed to determine the scientific validity of this concept. Pain in the mouth and face is best diagnosed using current evidence based diagnostic criteria.