[CFS] and Bone Marrow Defects of the Jaw – A Case Report on Additional Dental X-Ray Diagnostics with Ultrasound, 2021, Lechner & Schick

Full title: Chronic Fatigue Syndrome and Bone Marrow Defects of the Jaw – A Case Report on Additional Dental X-Ray Diagnostics with Ultrasound

Purpose: This paper aims to demonstrate the additional benefit of ultrasound in the diagnosis of chronic osteolysis and osteonecrosis (bone marrow defects) of the jaw shown in a clinical case report.

Patients and Methods: A case of chronic fatigue syndrome (CFS) in a young man presenting the typical, ambiguous symptoms, which were accompanied by headaches and tinnitus. X-ray techniques, namely panoramic radiographs (OPG) and cone beam computed tomography (DVT/CBCT), failed to produce any remarkable findings of bone marrow defects (BMDJ) in the jawbone. However, the measurement of bone density using trans-alveolar ultrasound (TAU) indicated a possible bone marrow defect in the lower left jawbone.

Results: Surgery was undertaken at the conspicuous area. Additional to softened, ischemic, fatty tissue, a black area was revealed, which was surprisingly subsequently identified as aspergillosis by histopathological analysis. In addition, the excessive local RANTES/CCL5 expression found in the affected area confirmed the necessity for surgical debridement and additional findings of TAU.

Conclusion: In contrast to radiography, complementary TAU imaging of the BMDJ revealed chronic inflammatory signaling RANTES/CCL5 pathways and fungal colonization. This case report supports the need for additional diagnostic techniques beyond radiographic modalities, which can help to elucidate the diagnostic composition and knowledge of the bone manifestations of systemic diseases.

Open access, https://www.dovepress.com/chronic-f...ash-a-ca-peer-reviewed-fulltext-article-IMCRJ

 

i wonder if the patient in this report actually had an improvement in their overall health it would be nice to know considering many people with m e have dental problems . not in anyway suggesting that his infection caused m e but it may have made symptoms worse .

 

@alktipping when you say many PWME have ‘dental problems’, it is a very general claim. I wonder whether it has been scientifically documented. Do PWME have higher rate of ‘dental problem’ compared with general population and of course one would need to define ‘dental problem’. As we all age, there is higher chances of such problems.

i am absolutely cognizant that PWME may have less access to regular hygiene care, that perhaps due to medication used in our population that mouths may be drier than others, which in term makes one prone to dental cavities. Those who are housebound or bedbound may be more likely to floss, brush. It is simply multifactorial, but my thinking is that there are no significant medical risks to ‘dental problems’ to the ME population than the general population.

This case report is N=1 of course.

 

i was merely wondering if having an extra inflammatory condition has significant effect on the symptoms of m e .

 

I have read a bunch of anecdotal reports of recovery following “cavitation surgery”. Coincidentally, I had all four wisdom teeth out maybe a year or so prior to my onset.

I tried to investigate this for myself but the entire field was so full of quackery and woo. I was offered the surgery by one dentist (whose office was full of crystals and homeopathics...) and yet another dentist told me that my scans did not show evidence of any issue.

 

Yeah, to clarify, I think this is an interesting concept and I am simply commenting on the impossibility for me, as a patient, to be able to distinguish between something I should be concerned about and something that is not really a problem.

I haven’t been able to read past the abstract yet.

From memory, I believe the “CaviTau” is the newer version of the “CaviTat” , a device that was supposed to help diagnose these cavitations but was ultimately taken off the market. (I want to say it had something to do with the FDA but again I am going off memory here....)

 

N=1... as some of you may know already, I had surgical extraction of two left wisdom teeth at the end of March. The top one healed fine - the bottom one not so good! I had been having pain for several months - multiple courses of antibiotics and certainly this led me to feel more exhausted than usual. The tooth itself was totally impacted and not visible. It was black when they removed it. I then developed a dry socket.... over 5 weeks on, and it is healing slowly. I felt awful for a month.

I’m now better in terms of energy than I have been for some time - many months in fact - although the socket isn’t yet fully healed - the surgeon is not worried about any residual infection now. It’s been a long road, and for me, it has highlighted how much an issue such as a decay process in a tooth can affect my general functioning, as well as how long it now takes me to recover from things. It’s been 6 months in total with problems and I’m hoping that another month may see me right in terms of the healing of the area and getting to a better baseline health-wise. I would have dealt with it more quickly if I could have but as I needed a general anaesthetic and the problems started about a month before Xmas, the whole process was rather slow. I’m sure that the grumbling tooth dragged me down generally.

 

It does seem relatively common in chat rooms for people with ME to report a perceived link between dental issues and their ME. However these are self selected cohorts so may in no way be representative. Also if there is any association it is hard to know whether there is any direct causation and what if any the direction of causation is.

My experience from my first abscess during the acute glandular fever (EBV) associated with the onset of my ME though to dying teeth and impacted wisdom teeth has been of dental problems arising at the time of relapse, which are though also periods of poorer dental hygiene, problems visiting the dentist, poorer diet and of potentially disturbance in the immune system. Then periods of relative remission involve time devoted to remedial dental work.

Though the situation for me is further confused as pain indistinguishable from abscesses or root canal issues but without any identifiable organic basis is now a feature of my shorter term PEM and of more long term relapses. Unusually this pain happens at periods when visiting a dentist is low down on my list of priorities, so it is only a year or two or may be even more time later that I get to try to work out what was pain associated a specific infection and what was presumably idiopathic.

So it is hard to know if we are looking at something specific to ME, or something that relates to access to dental care and support provision, that is down to our society’s failure to meet the care/support needs of people with ME.

It is also worth asking what happens in relation to other conditions. For example, it was not uncommon some fifty or sixty years ago for teenagers and young adults with cerebral palsy in residential care to have all their teeth removed as a preventative measure, though I do not know if this was a misguided response to a real issue or just plain misguided ‘accepted wisdom’.

 

Interesting - what made them pick this patient? Were there others previously that had nothing abnormal (and this gets technique into a journal)?

Usually when nothing shows up you are left to get on with it- no further investigation necessary. What made this different?

My daughter has jaw isssues - has had for 4 years and ths has got progressively worse. A maxifacial consult 4years ago just noted it as being relate to ME. So no furher input neededotherthan a couple of exercises.

We visited the dentist this week and she was concerned and has referred us again. She was lovely and acknowledged that she dosn't know enough but feels it needs an MRI to take in tissue too, and has worded the referral to basically plant this seed.

Interested as she is prone to fungal infections.

 

Difficult even with peer reviewed research to know if the issue in question, and the treatment described would apply to oneself. A difficulty and issue we are all very painfully aware of.

I have found trying to sort out what's reliable treatment info and what's not, quite confusing at times. As we are also aware, we cannot always rely on practitioners with impressive CVs. In my experience no amount of prestigious trappings will guarantee a successful treatment outcome.

It seems all we can do is try to look at the upsides and downsides of a treatment. Get opposing opinions. Keep in mind that favorable case studies are only that. And even when things supposedly work for many, do they really? PACE can teach us much in this regard.

 

I would also say we know that therapies purported to help may not.

In my own experience this has unfortunately been true in both the biomedical field, as well as the BPS field.
Maybe this is because of ME, or just my own system.
It would be interesting, and perhaps useful to gather data on failed biomedical procedures for pwME, to see if there is anything to be learned there.

 

Further, I have found that my reaction or resolution of signs and symptoms does not meet the expectations of practitioners.
This sounds like, yeah so what? We know this already.
However, for pwME more new to this, I have found it frustrating for both practitioners and myself to expect a given, standard # of treatment sessions will bring results, and still ultimately see the problem unresolved.
This of course is a perfect situation for the practitioner to blame the patient, and cast doubt on their sincerity to recover.
And, this despite the patient working very hard, and cooperating to recover, while having only very minimal, to no control over the biomedical treatment.

 

This is probably the best question that they could answer. Given N number of patients with abnormal imaging, how many of them had abnormalities discovered during surgery?

From what I was told by a more "traditional" oral surgeon, there is basically no way to know from the imaging what is inside one of these "cavitations". It could be a bacterial colony, or aspergillosis (ew!), or just... empty space.

At the time I wasn't ready / desperate enough to schedule exploratory surgery.

Also, nobody ever mentioned to me that an MRI could be used to aid in diagnosis. (I had a cone beam CT)

 

With my limited knowledge of dentistry, I would agree with the traditional oral surgeon you consulted. I have been told by careful surgeons they won't know what's in there until they open it up. And, then there is the pathology report for final analysis.

About the desperation, I've been there more times than I can count. I would hazard a guess most of us have. This drive to have our old life back can sometimes cause even more problems: irreversible harm, financial woes etc. It is outrageous that we are continually painted as lazy benefit scroungers by the BPS Brigade.

 

Here is a bit of history on the Cavitat on quackwatch: https://quackwatch.org/related/cavitation/

Basically it is an ultrasound device. It's supposed to be superior for detecting jawbone cavitations over an x-ray. I have no idea if it's true or not. The idea of this silent infection causing systemic but minimal local symptoms is pervasive.

Last year, in attempting to link osteonecrosis to cancer, the author argued

I have no idea if any of that is true or not. He has 2 previous studies on this subject, but no specific disclosures.

The obvious question I have is, why is this so restricted to holistic/natural dentists? I suspect the truth is somehwere in the ansewr to that question.

 

Yes, @dreampop. Sort of like if you're so smart, why aren't you rich? If it really, really worked, many doctors and dentists would be doing it.

 

Desperation, and trying many various alternative therapies seems to be seen as a form of mental or emotional failing. What are we supposed to do? Mainstream medicine can offer nothing that helps; what it does have may harm. Some alternative treatments may help - or not. They are unproven and expensive. And, they may provide false hope. It's another vicious circle.

 

The authors of this are part of the team behind this paper

Undetected Jawbone Marrow Defects as Inflammatory and Degenerative Signaling Pathways: Chemokine RANTES/CCL5 as a Possible Link Between the Jawbone and Systemic Interactions?

Background: Cytokines, especially chemokines, are of increasing interest in immunology. This study characterizes the little-known phenomenon of “bone marrow defects of the jawbone” (BMDJ) with known overexpression of the chemokine RANTES/CCL5 (R/C).

Purpose: Our investigation clarifies why BMDJ and the intensity of local R/C overexpression are challenging to detect, as examined in patients with seven different systemic immunological diseases. Specifically, we investigate whether R/C overexpression is specific to certain disease groups or if it represents a type of signal disruption found in all systemic immunological diseases.

Patients and Methods: In a total of 301 patients, BMDJ was surgically repaired during clinical practice to reduce “silent inflammation” associated with the presence of jaw-related pathologies. In each case of BMDJ, bone density was measured preoperatively (in Hounsfield units [HU]), while R/C expression was measured postoperatively. Each of the 301 patients suffered from allergies, atypical facial and trigeminal pain, or were diagnosed with neurodegenerative diseases, tumors, rheumatism, chronic fatigue syndrome, or parasympathetic disorders.

Results: In all BMDJ cases, strongly negative HU values indicated decreased bone density or osteolysis. Consistently, all cases of BMDJ showed elevated R/C expression. These findings were consistently observed in every disease group.
Discussion: BMDJ was confirmed in all patients, as verified by the HU measurements and laboratory results related to R/C expression. The hypothesis that a specific subset of the seven disease groups could be distinguished either based on the increased presence of BMDJ and by the overexpression of R/C could not be confirmed. A brief literature review confirms the importance of R/C in the etiology of each of the seven disease groups.

Conclusion: In this research, the crucial role played by BMDJ and the chemokine R/C in inflammatory and immune diseases is discussed for seven groups of patients. Each specific immune disease can be influenced or propelled by BMDJ-derived R/C inflammatory signaling pathways.

Open access, https://www.dovepress.com/undetecte...rative-sig-peer-reviewed-fulltext-article-JIR