Jaw Infection - Causes, Symptoms and Treatment

Overview:

It is surprising how tiny microorganisms cause the destruction of mighty structures in the body. Moreover, infections frequently occur despite immense efforts from the body’s immune system. For example, invading structures like muscles and bones is a cakewalk for the microbes when they can destroy the tooth’s enamel (the strongest tissue in the body that forms the tooth's outer covering). Likewise, the jawbones (maxilla and mandible) are prone to microbial invasion as they have an intimate relationship with the oral microflora.

What Are Jaw Infections?

Infections of the jawbones occur indirectly through the spread of infections from teeth, gums, and other oral structures. Untreated dental caries and gum disease (gingivitis and periodontitis) progress to infect the surrounding oral structures. The prevalence of jaw infections is slightly high in developing countries with low socioeconomic status, owing to poor healthcare and inadequate oral hygiene. When the infection reaches the jawbones, immediate medical attention and a multidisciplinary treatment approach are required. Conditions that are likely to cause jaw infections are discussed below.

What Causes Jaw Infections?

A. Gum Disease:

Periodontitis manifests as a result of chronic inflammation of the gums (gingivitis). This often results in the destruction and loss of the jawbones. In addition, periodontitis is associated with multiple factors such as the type of microbes, the body’s immune mechanisms, environmental factors, personal habits, oral hygiene, etc.

Progression of Gum Disease -

1. Plaque build-up around the tooth and gums.

2. Inflammation of the gums due to the toxins produced by microbes.

3. Spread of infection and inflammation and damage to surrounding structures.

4. Continued infection destroys bone and loosens teeth.

5. Advanced periodontitis leads to abscess formation and jaw infection.

Microorganisms Associated With Periodontitis -

Periodontitis is caused by:

• Porphyromonas gingivalis.

• Aggregatibacter actinomycetemcomitans.

• Prevotella intermedia.

• Fusobacteria.

• Tannerella forsythia.

B. Endodontic and Periapical Diseases:

Dental caries is one of the most common oral diseases that are globally prevalent. Microorganisms reach the pulp (mass of tissue present in the innermost part of the tooth) through a fracture, caries, and exposed tooth surface (endodontic infection). Through the pulp, the microbes reach tissues around the tip of the tooth root (periapical infection). If left untreated, these infections progress to cause abscess and bone destruction.

Progression of Endodontic Diseases -

1. Irritants enter the tooth through caries, fractures, or exposed surfaces.

2. Destruction of enamel and dentin (yellow-colored tissue that forms the bulk of the teeth).

3. Inflammation of the pulp.

4. Spread of infection to periapical tissues.

5. Abscess in the dentoalveolar (related to teeth, gums, and jawbone) region.

6. Jaw infection.

Microorganisms Associated With Endodontic and Periapical Infection -

• Fusobacteria.

• Porphyromonas species.

• Prevotella.

• Eubacterium.

• Peptostreptococcus.

• Actinomycetes.

• Campylobacter.

C. Dental Implant Infection:

Implants have gained popularity in the last decade because of their high success rate and esthetics. However, implants can fail due to poor oral hygiene and smoking habits. This pathology is called peri-implantitis, where the tissues around the dental implant get inflamed. Ideally, the implant surface should integrate with the surrounding jaw bone (osseointegration). When this fails, microorganisms have a higher chance of causing infection.

Progression of Peri-Implantitis -

1. Failure of osseointegration due to poor oral hygiene, systemic conditions, habits, etc.

2. Microbes infect the tissues surrounding the implant.

3. Inflammation of the tissues around the dental implant (peri-implant mucositis).

4. Spread of infection leading to bone loss and jaw infection.

Microorganisms Associated With Peri-Implantitis -

• Porphyromonas species.

• Prevotella.

• Tannerella.

• Fusobacterium.

• Enterobacteriaceae.

D. Osteomyelitis:

Osteomyelitis is the infection of jawbones that can be acute or chronic. These infections are common in developing countries with poor socioeconomic status. Osteomyelitis can affect a single site or spread to the bone marrow and surrounding soft tissues. Additionally, people with immunocompromised conditions such as diabetes and HIV (human immunodeficiency virus) are prone to the infection. Most osteomyelitis infection develops as a sequel to dental and periodontal diseases.

Occurrence of Jaw Osteomyelitis -

1. Spread of infection from dental or periodontal infection.

2. Direct inoculation of microbes into the bone (rare case).

3. Infection post-surgery or post-trauma.

Microbes Associated With Osteomyelitis of the Jaw Bone -

• Fusobacterium.

• Porphyromonas species.

• Prevotella.

• Actinomycetes.

• Staphylococcus (enters through the blood).

What Are the Signs and Symptoms of Jaw Infections?

A. Periodontal Disease:

• Throbbing and dull pain from the affected site.

• Bad breath.

• Loose teeth.

• Pain while chewing food.

• Pus discharge from gums.

• Fever.

B. Endodontic and Periapical Disease:

• Severe pain of the affected tooth. The pain can be sharp or dull and throbbing.

• Pain from the tooth radiated to other regions.

• Tooth sensitivity to hot or cold food and drinks.

• Swelling of the affected area.

• Fever and swollen lymph nodes.

C. Peri-Implantitis:

• Red-colored swollen gums and tissues around the implant.

• Bleeding while brushing.

• Pus discharge.

• Loosening of the implant.

• Pain around the implant.

D. Osteomyelitis:

• Fever, weakness, malaise, and headache.

• Swelling of the affected site and face.

• Inability to open and close the mouth.

• Pus discharge.

• Severe throbbing and radiating pain.

• Inability to chew food.

• Numbness or prickling sensation around the affected site.

What Is the Treatment for Jaw Infections?

A. Periodontal Disease:

• Surgically draining the pus from the abscess.

• Removing the plaque from the tooth and root surface (scaling and root planing).

• Gum surgery in case of extensive damage.

• Rinsing with Chlorhexidine mouthwash or Betadine gargle.

• Surgical curettage of the infected tissues.

• Antibiotics for controlling the infection.

• Over-the-counter (OTC) painkillers such as Ibuprofen.

B. Endodontic and Periapical Disease:

• Draining the pus from the abscess.

• Root canal treatment (removing the infected pulp and filling the tooth with a stronger artificial material).

• Removing the tooth (extraction) in case of poor prognosis.

• Antibiotics treatment and painkiller for reducing pain and inflammation.

C. Peri-Implantitis:

• Local debridement of the implant surface with floss or interdental brushes (ultrasound scaling should be avoided).

• Decontamination of the implant surface (with gauze dipped in saline or citric acid).

• Necessary antibiotics treatment.

• Mouthwash gargle with Chlorhexidine.

• Surgical correction with gum surgery for posterior teeth.

D. Osteomyelitis:

• Surgical debridement of dead tissues and pus.

• Resection of the infected jaw.

• Antibiotics and analgesics to manage pain and infection.

• Hyperbaric oxygen chamber (providing extra oxygen for tissues infected with anaerobic bacteria).

Conclusion:

Jaw infections involve infection and inflammation of the upper and lower jaws (maxilla and mandible) resulting from untreated dental and periodontal conditions. Many factors contribute to jaw infections, including oral hygiene, systemic factors, oral environmental factors, etc. Dental infections like periodontitis and peri-implantitis progress to infect the jawbones. Antibiotic therapy and debridement of the infected tissues are the primary treatment modalities. Jaw infections can be prevented by maintaining good oral health and visiting the dentist frequently.