What is it?
Osteomyelitis is inflammation of the jawbone and of the marrow inside it. Most of the time, bacteria from the mouth pass into the bone from an infection at the root tip of a tooth, from an extraction socket or along a fracture line. Once the blood supply to the bone is disrupted, the inflammation does not stay within its own borders and works its way deeper.
The lower jaw is affected more often than the upper jaw: its blood supply is more limited and its bone is denser. The pain comes from deep down and is constant. Numbness in the lower lip, pus coming from the gum, teeth becoming loose and the mouth opening less and less can all accompany the picture.
Diabetes, treatments that suppress the immune system, heavy smoking and a jaw area that has previously had radiotherapy all raise the risk. The condition can begin acutely, or it can advance quietly over months; in the second case the only complaint may be a dull ache that will not go away, with discharge that comes and goes.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
An untreated tooth infection
When inflammation at the root tip opens into the bone, the infection moves beyond the boundaries of the tooth. Teeth kept quiet with painkillers for long stretches, and root canal treatments left half finished, are the most common starting points.
- 02
Wounds after extraction and surgery
After a difficult extraction the bone surface stays exposed for a while. Where oral hygiene slips and smoking continues, inflammation that would be expected to stay on the surface can travel deeper into the bone.
- 03
Jaw fracture and trauma
When a fracture line opens into the mouth, the bone comes into direct contact with the bacteria that live there. A fracture that is fixed late, or left mobile, makes it easier for infection to settle in.
- 04
Conditions that weaken the bone's defences
Uncontrolled diabetes, treatments that suppress the immune system, heavy smoking and radiotherapy given to the area in the past all reduce the blood supply to the bone; infection takes hold more easily on this ground.
How does it progress?
- Acute
The first days and weeks
The pain builds quickly; fever, swelling of the face and feeling generally unwell can come with it. If numbness in the lower lip appears at this stage, pressure inside the bone is thought to be rising. Changes may not be obvious on imaging yet.
- Chronic
A quiet course spread over months
The severe pain eases and gives way to a dull discomfort. A discharge channel that opens and closes from time to time forms in the gum. On the X-ray the bone looks irregular and patchy.
- Sequestrum
A dead piece of bone separating
A piece of bone that has died separates from the tissue around it and can be felt under the gum as a hard, rough edge. Healing is not complete until this piece is cleared away.
- Spread
Opening into neighbouring spaces
The infection can spread into the spaces between the muscles and down towards the neck. Not being able to open the mouth, difficulty swallowing and fever are the signs of this stage; hospital assessment does not wait.
How is it treated?
The diagnosis is made with a clinical examination, a panoramic X-ray and, most of the time, a CT scan. The tooth at the source is treated or taken out; clearing away the infected and dead bone is the work of oral and maxillofacial surgery. Taking a sample from the area and culturing it is what allows the right antibiotic to be chosen.
Antibiotic treatment is not a short course in this condition. A programme spread over weeks may be needed, started through a drip into a vein and continued by mouth. The choice of drug, the dose and the length of the course are decisions for an infectious diseases doctor; whether you need to be admitted is also decided at the hospital.
The dentist's role in this picture is to find the source, to work alongside the hospital on sampling and surgery, and to rework the plan for a prosthesis or an implant once healing is complete. Waiting it out with painkillers and an antibiotic prescription alone lets the bone loss grow.
- Swelling on the face or under the jaw that is growing, together with a fever
- Numbness in the lower lip or chin that has just started
- The mouth opening less and less, and difficulty swallowing
- Pus coming constantly from the gum, and bone showing through
How is it prevented?
- Do not let teeth with infection at the root tip drag on; the longer the decision between root canal treatment and extraction is put off, the closer the infection gets to the bone.
- Follow the aftercare instructions you are given after an extraction or surgery, and keep your review appointment.
- In diabetes, how steady your blood sugar is has a direct effect on how a mouth infection runs; do not let your medical follow-up slip.
- Stopping smoking is one of the first steps that decides how well bone heals.
Frequently asked questions
- Is an antibiotic on its own enough?
- Most of the time, no. The drug cannot reach the part of the bone that has died in high enough amounts; unless the tooth at the source and the dead bone are cleared away, the infection would be expected to come back. Here the antibiotic completes surgical clearance rather than replacing it.
- Are osteomyelitis and dry socket the same thing?
- No. Dry socket is the early loss of the blood clot from an extraction socket; it starts within a few days, does not cause a fever and settles noticeably with a dressing. In osteomyelitis the infection has settled inside the bone, and changes in the bone structure show up on imaging.
- Can an implant be placed there once it has healed?
- That is assessed once the bone has healed and the follow-up images come back clear. If there is enough bone and its blood supply is good, the option can be discussed. This decision is made case by case at an examination and cannot be given in advance.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.