Reasons for Jaw Bone Loss and Deterioration
The following are the most common causes for jawbone deterioration and loss that may require a bone grafting procedure:
When an adult tooth is removed and not replaced, jawbone deterioration may occur. Natural teeth are embedded in the jawbone, and stimulate the jawbone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jawbone that anchors the teeth in the mouth, no longer receives the necessary stimulation, and begins to break down, or resorb. The body no longer uses or “needs” the jawbone, so it deteriorates and goes away.
The rate the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most loss occurs within the first eighteen months following the extraction, and continues throughout life.
Periodontal diseases are chronic infections of the gums that gradually destroy the support of your teeth. Periodontal diseases affect one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, and gingiva.
While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal diseases. Dental plaque is a sticky colorless film, composed primarily of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins which irritate the gums. The gums may become red, swollen, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing are neglected, plaque can harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line and exacerbates the irritation to the gums and bone surrounding the teeth.
Periodontal diseases can be divided into two categories: gingivitis and periodontitis. Gingivitis, the least advanced of the periodontal diseases, affects only the soft tissue (gums) surrounding the teeth. If untreated, gingivitis will usually progress to periodontitis. Periodontitis affects the gums and bone supporting your teeth. In later stages of periodontitis, the supporting bone is destroyed and the teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak but also spoil your smile.
Periodontal diseases are often painless and symptomless. 80% of Americans will be afflicted with some form of periodontal disease by age 45, and 4 out of 5 patients with the disease are unaware they have it.
Unanchored dentures are placed on top of the gum line, and therefore do not provide any direct stimulation to the underlying alveolar bone. Over time, the lack of stimulation causes the bone to resorb and deteriorate. Because this type of denture relies on the bone to hold them in place, people often experience loosening of their dentures and problems eating and speaking. Eventually, bone loss may become so severe that dentures cannot be held in place even with strong adhesives, and a new set may be required. Proper denture care, repair, and refitting are essential to maintaining oral health.
Some dentures are supported by anchors, which do help adequately stimulate, and therefore preserve bone.
With bridgework, the teeth on either side of the appliance provide sufficient stimulation to the bone, but the portion of the bridge that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area.
By completing a bone graft procedure, our surgeons are now able to restore bone function and growth, thereby halting the effects of poor denture care.
When a tooth is knocked out or broken to the extent that no biting surface is left below the gum line, bone stimulation stops, which results in jaw bone loss. Some common forms of tooth and jaw trauma include: teeth knocked out from injury or accident, jaw fractures, or teeth with a history of trauma that may die and lead to bone loss years after the initial trauma.
A bone grafting procedure would be necessary to reverse the effects of bone deterioration, restoring function and promoting new bone growth in traumatized areas.
Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth structure. The unopposed tooth can over-erupt, causing deterioration of the underlying bone.
Issues such as TMJ problems, normal wear-and-tear, and lack of treatment can also create abnormal physical forces that interfere with the teeth’s ability to grind and chew properly. Over time, bone deterioration can occur where bone is losing stimulation.
Osteomyelitis is a type of bacterial infection in the bone and bone marrow of the jaw. The infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and removal of the affected bone. A bone graft procedure may then be required to restore bone function and growth lost during removal.
Benign facial tumors, though generally non-threateningly, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw, requiring removal of a section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of surrounding soft tissue as well.
Some conditions or syndromes known as birth defects are characterized by missing portions of the teeth, facial bones, jaw or skull. Our surgeons may be able to perform a bone graft procedure to restore bone function and growth where it may be absent.
When molars are removed from the upper jaw, air pressure from the air cavity in the maxilla (maxillary sinus) causes resorption of the bone that formerly helped the teeth in place. As a result, the sinuses become enlarged, a condition called pneumatization of the sinus.
This condition usually develops over several years, and may result in insufficient bone for the placement of dental implants. Our surgeons can perform a procedure called a “sinus lift” that can treat enlarged sinuses.
Potential Consequences of Tooth and Jawbone Loss
- Problems with remaining teeth, including, misalignment, drifting, loosening and loss
- Collapsed facial profile
- Limited lip support
- Skin wrinkling around the mouth
- Distortion of other facial features
- Jaw (temporomandibular joint [TMJ]) pain, facial pain, and headaches
- Difficulty speaking and communicating
- Inadequate nutrition as a result of the inability to chew properly and painlessly
- Sinus expansion
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