Jaw Bone Infection


A simple Jaw Bone Infection is quite common, but thankfully it is usually treated quite simply with standard antibiotics.

BUT sometimes, an infection in the jaw bone can become more difficult to treat, more stubborn and more aggressive.

What types of jaw bone infection are there?

How do you know if you have a serious infection that needs treatment?

How can it be treated and what is the outlook?


First, we need to look at what types of jaw bone infection exist.

  • Simple jaw bone infection; where there is a small infection on the tip of a tooth that has died. This is very common, and stays localised around the tip of the root.

  • Osteomyelitis; this is a more serious infection, and involves the bone that is NOT within a millimetre or two of a tooth root.

  • Osteo radio necrosis; This is a very serious condition where the bone in the jaw has lost it’s ability to resist simple infections, due to radiotherapy (radiation treatment) for jaw cancer.

  • Bisphosphonate osteomyelitis; This is a similar condition, but this time the bone has reduced resistance to infection due to bisphosphonate treatment for osteoporosis.

A jaw bone infection like those listed above is different in several ways from bone infections in other bones of the body, like the thigh bone (doctors call them “long bones”).

The bone in the jaws is special, due to the relatively compact dimensions, complicated structures it contains and the close proximity of complicating factors like teeth, nerve canals and sinus spaces.

If you are having pain in your jaw, and you think it MIGHT be an infection, I recommend you should also look at Jaw Bone Pain to find out about OTHER possible causes of pain in your jaws.

Jaw Bone Infection

SO, let’s take a look at these different jaw bone infections one by one.

1. Simple Jaw Bone Infection. Here is a small X-ray of a tooth with an infection on the tip of the root.

                         jaw bone infection from a tooth

And here's another one of a molar tooth with infection on the root tips - the dark shadows at the ends of the roots:

                jaw bone infection from a molar

This is really more correctly described as a dental infection. It comes from the infection in the tooth, but has spread to the bone at the tip of the root. It usually stays close to the root tip.

If it causes some swelling of the gum then it can be called an abscess. There are 2 possible treatments for this situation - remove the tooth, or try to save the tooth with root canal treatment. Read more about this at Alternatives to root canal.

Sometimes, a short course of antibiotics will be needed. Take a look at Tooth abscess antibiotics.

A simple infection around a tooth root can occur on any tooth, in the upper and lower jaws. It may cause a swollen face, like the photo below.


                jaw bone infection causing swollen face


2. Osteomyelitis. This is an infection in the jaw bone that is not in direct contact with a tooth. The infection MAY HAVE STARTED on the root of a dead tooth, but in osteomyelitis it has spread away from the tooth root, to infect the neighbouring bone mass.

This is the most common cause of osteomyelitis. The other cause is infection from a traumatic jaw bone fracture, usually where the overlying skin is torn or the gum inside the mouth is ripped by the broken bone. This lets bacteria from the skin surface or from the mouth into the traumatic wound.

Osteomyelitis usually occurs more frequently in the LOWER JAW. This is because the upper jaw has a better blood supply, and the bones are thinner. The better blood supply means that your immune system has a better chance of fighting any infection. The thinner bone means that infections can get to the bone surface more quickly, and break out into the soft tissues.

In the lower jaw, the general blood supply is less good, so infection has a better chance of getting established. Also, the surface bone of the lower jaw is quite dense and tough. Once an infection gets going, it can expand within the space of the lower jawbone, and is contained by the tough and dense surface bone.

What happens then is that pus from the infection builds up, putting pressure on blood vessels and reducing the blood supply (which was poor in the first place). Next, the main nerve running inside the lower jaw bone gets compressed, causing “pins and needles” or even numbness in the lower lip and chin on the affected side.

Treatment is with antibiotics. A sample of the pus needs to be tested so that the correct antibiotic is used. This may change as treatment progresses, as the bacteria involved may change.

Sometimes surgery is required to remove dead bone, and allow new bone to re-grow. If this happens, the jaw bone is quite weak for a while until re-growth is complete. Patients must avoid excessive pressure or trauma as the jaw could fracture more easily than usual.

Finally, oxygen treatment may be used (“hyperbaric oxygen”). This is basically breathing and bathing the area involved in very high percentage oxygen. Our normal breathing air contains around 20% oxygen; increasing this concentration has been shown to be very effective in helping infected wounds to heal.

3. Osteo radio necrosis. This is normally written as one long word, but I have written it broken down into the three words that describe the condition.

It is a condition of the jaw bone (osteo) caused by radiotherapy for cancer (radio), where the bone dies (necrosis). This is “bone death”.

When a tumour around the jaws is treated with radiotherapy, the radiation destroys some of the very small blood vessels within the bone.

Remember, the lower jaw has a relatively poor blood supply to start with. If enough of the small vessels are destroyed by radiation, then less oxygen and nutrients can get through to supply the living bone.

Generally, the jaw bone can get by, as long as nothing else happens. BUT there has been a significant reduction in the bone’s ability to heal. If there is some infection or some trauma to the jaw bone, such as gum disease or tooth extraction, bone is easily infected and dies. Bone death.

The best treatment for this condition is prevention. This means that if a person is scheduled for radiotherapy to the jaw bones, they must be screened beforehand for gum disease, and any questionable teeth must be removed BEFORE the radiotherapy treatment.

If osteoradionecrosis gets a foothold, antibiotics are usually useless, because there is not enough blood supply to the area to carry the antibiotic where it is needed.

The first line of defence is hyperbaric oxygen treatment. This saturates the area affected in oxygen, aiding the bone to heal. The high concentration of oxygen helps to stimulate new blood vessel formation and growth.

After hyperbaric oxygen treatment, the area involved must also be treated surgically, to remove dead bone which would otherwise be a centre for later infection.

Again, the lower jaw is much more commonly affected than the upper jaw, and most cases occur within 3 years following radiotherapy.

4. Bisphosphonate osteonecrosis. This is a relatively rare condition, where bisphosphonates (i.e.. Fossamax) are prescribed for osteoporosis or Paget’s disease of the bone.

The lowest risk is for patients who have only taken bisphosphonates orally (by mouth) as opposed to by injection (intra-venously); ALSO it’s very rare in patients who have not had cancer.

The highest risk patients are those who have had cancer treatment, and received bisphosphonates by injection for longer than 2 years.

Other factors that increase risk are gum disease, mouth infections, diabetes, old age, and some other chronic disease status. Tooth extractions must be avoided as far as possible.

Bisphosphonate osteonecrosis is a genuine bone infection, and therefore can be treated with antibiotics. If a tooth must be extracted in a patient with a history of bisphosphonate medication, a high dose of antibiotics should be given BEFORE the extraction and for up to two weeks afterwards.

HOW DO YOU KNOW IF YOU HAVE A JAW BONE INFECTION?

There are several signs to look for;

  • Pus oozing from a sore around the jaw line.
  • Some teeth becoming loose or wobbly.
  • Numbness or “pins-and-needles” of an area of the jaw.
  • Bone-hard swelling of the jaw.
  • Pain in the jaw across an area of several teeth.

If you have had a tooth extracted recently, or suffered a traumatic injury to the lower jaw, then you should be suspicious if you have 2 or 3 of the 5 signs listed.

HOW CAN A JAW BONE INFECTION BE TREATED?

This falls into 4 categories -

1. prevention by improving oral hygiene and treating gum disease.

2. removing any doubtful teeth as soon as possible

3. antibiotics (usually Clindamycin)

4. hyperbaric (ie. concentrated) oxygen therapy.

You can read more about improving your oral hygiene at how to cure gum disease.

I hope my guide to jaw bone infection has been useful. If you think you may have a jaw bone infection, you should see a dentist as soon as possible.