Bone infection in jaw – causes, types and treatments

The bone infection in jaws occurs when Staphylococcus Aureus bacteria enters into the jawbone. When our jaw bones get infected, various serious problems associated with the bones of the face, neck and Temporomandibular joint arise. It affects the jaw and neck mobility that disrupts our activities like eating, speaking.

Factors that cause jaw bone infection

When a decayed tooth is left untreated, the bacteria present in dental caries infect the pulp and develop a pocket of pus in the tooth root. Then, the bacteria penetrate the gum tissues and infect the jaw bone beneath them.

Besides tooth decay, there are various factors with which introduce Staphylococcus Aureus bacteria to the oral region.

Periodontal Disease infection

The oral bacteria mix with saliva and produce a white sticky substance called plaque on the surface of the teeth. Bacteria present in it begins to spread under the gum line. Later the oral bacteria invades tooth bone, supporting tissues around gums. Jawbone is not an exception. It infects the jaw bone followed by weakening the jaw bone and jaw bone fractures.

Bacteria present beneath the gum line secrets a toxin which is effective to make our immune system stand against our health. It adds value to the infection and eventually leads to jaw bone loss.

It shows that people having Gingivitis and other periodontal diseases are highly prone to jaw bone infection.

Dental Surgery Procedures

Dental surgical procedures like tooth extraction, root canal treatment and others will be a source of jaw bone infection if they are embarked with unclean procedures.

It leads the bacteria or other infections present in the tooth root or end continue to infect. The infection persists through the surgical site in the mouth and affects the jaw bone.

Drugs and Medications

American Dental Association released a report in January 2009. It states "In rare instances, some individuals receiving intravenous (or oral) bisphosphonates (Fosamax, Actonel, Boniva) for osteoporosis and cancer treatment have developed osteonecrosis of the jaw, a rare but serious condition that involves severe loss, or destruction, of the jawbone.".

It shows that some medication we consume is also a reason behind the jaw bone infection. If you encounter a pain or swelling in the jaw after taking these kinds of medications for a while, visit your dentist for a dental checkup.

Types of Jawbone infection

Based on the depth of infection on the jaw bone, it is classified as:

• Simple jaw bone infection
• Osteomyelitis
• Osteoradionecrosis
• Bisphosphonate Osteomyelitis

Simple jaw bone infection

Simple jaw bone infection is caused when an infection on the root tip of a tooth spreads to the surrounding jaw bone. It causes some inflammation of the gums. Such swelling in gums causes a swollen face.

If the gums swell up a lot, then the infection may be very severe. It is also a sign indicating the tissues also get infected. Extracting the infected tooth is the appropriate way to get rid of this infection.

Osteomyelitis

Any infection on a bone is termed as Osteomyelitis. It actually occurs in the bones of our body. Osteomyelitis in the jaw is mainly caused due to accidents or others which traumatize the jaw bone.

The broken jaw bone present beneath the gum may tear the skin of gums. It leads the bacteria present in the gum to enter into the jaw bone. When bacteria enter into the jaw bone, they expand the inner space of the jaw bone that leads to pus build up followed by compressing the nerve of the infected bone. It causes numbness in the affected region.

The lower jaw bones are highly prone to Osteomyelitis of the jaw because the blood flow is quite less in the lower jaw bone.

Osteoradionecrosis

When a tumor around the jaw bone region like head, neck is treated with radiation therapy, the chances are higher for degradation of small blood vessels in the jaw bone. It eventually leads to the jaw bone dead. This condition is termed as Osteoradionecrosis.

The chances are very less to cure this but it is possible to prevent it with certain precaution measures like:

• Maintain the dose of radiation below 60 grays.
• Examine the person whether he/she has any injury in their mouth caused due to accident, extraction, denture irritation or gum diseases. This is because the bone gest exposed through the injury. Such exposure of bone to radiation leads to the death of jaw bone.

As the lower jaw bone has a limited blood supply, it is at higher risk of osteoradionecrosis. Similarly, the blood vessels are destroyed due to radiation, even antibiotics cannot flow to the traumatic area. Hence it is not possible to cure this infection.

Medication-related Osteonecrosis of the Jaw (MRONJ)

This is a serious condition which affects the jaw bone as a result of antiresorptive therapies with drugs like bisphosphonate m-TOR inhibitors, antiangiogenic drugs taken or injected for various bone related issues.

People who take higher doses of bisphosphonates and undergo dental surgeries like tooth extraction after bisphosphonate treatment have higher chances of MRONJ.

Diagnosis and Treatment

Symptoms like a pain in the jaw, face swelling, redness, etc help to identify the infection. The severity and depth of infection in the jaw can be diagnosed with the help of medical images like CT Scan, X-ray, Ultrasound and MRI. Similarly, a blood test is also required to check for white blood cell counts.

We can classify the treatment as surgical treatments and non-surgical treatments. After analyzing the medical images, a Dentist or Maxillofacial Surgeon suggest the right treatment to extract the infection and restore the natural movements of the jaw.

Surgical Procedures

In many cases, partial resection of the infected part and extracting the infected tooth is preferred but the chronic infection in the remaining persist to infect. Hence other surgical dental treatments like decortication with bone grafting, removing the infected issues, Sequestrectomy are done along with non-surgical treatments.

Non-Surgical Procedures

Medications, antibodies, steroids and Chemotherapeutic agents are useful in treating jaw bone to revamp the jawbone.

Along with these, Hyperbaric Oxygen Therapy is also utilized to oxygenate the infected tissues. It involves killing the bacteria that spread due to low oxygen levels.

Infections in jaw bone due to physical wear and tear are unexpected but the infection arises due to cavities are preventable. Take care of your mouth by following good oral hygiene routine to protect your jaw bone to avoid facial collapse.

Dr. Hussain Al Saleh is the Specialist Prosthodontist and Oral Implantologist in Oris Dental Centre , the dental clinic in Dubai.