Reasons for Jaw Bone Loss and Deterioration
The following are the most common causes for jaw bone deterioration and loss that may require a bone grafting procedure:
- Tooth Extractions
- Periodontal Disease
- Misalignment of Teeth
- Developmental Deformities
- Sinus Deficiencies
When an adult tooth is removed and not replaced, jaw bone deterioration may occur. Natural teeth are embedded in the jaw bone and stimulate the jaw bone through activities such as chewing and biting. When teeth are missing, the alveolar bone, or the portion of the jaw bone 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 jaw bone, so it deteriorates and goes away.
The rate that 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 will continue gradually throughout your life.
Periodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases that affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.
Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, that adheres to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produces toxins, or poisons, that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums will separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing is neglected, plaque can harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
Periodontitis is caused by bacteria that adheres to the tooth’s surface, along with an overly aggressive immune response to these bacteria. If gingivitis progresses into periodontitis, the supporting gum tissue and bone that hold teeth in place deteriorates. The progressive loss of this bone can lead to the loosening and subsequent loss of teeth.
Conventional dentures are placed on top of the gum line and they do not provide any direct stimulation to the underlying alveolar bone. Over time this 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 of dentures may be required. Proper denture care, repair, and refitting are essential to maintaining oral health. Not only do conventional dentures not preserve bone, they can hasten its resorptive loss by pressure resorption.
With bridgework or partial dentures, the teeth on either side of the bridge or partial denture provide stimulation to the bone, but the portion of the bridge or partial that spans the gap where the teeth are missing receives no direct stimulation. Bone loss can occur in this area.
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When a tooth is knocked out or is broken 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 through a resorption process years after the initial trauma.
Bone grafting procedures are 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. The unopposed tooth can over-erupt, causing deterioration of the underlying bone and alter the bite.
Misalignment also occurs when teeth are missing and not replaced because neighboring or adjacent teeth will drift into the space left by the missing tooth. When this occurs it may be necessary to undergo comprehensive orthodontics to realign the teeth. Sometimes additional extractions are necessary if the misalignment is not amendable to orthodontics. The remaining teeth in the arch need to be properly aligned so that dental implants can be oriented properly.
Osteomyelitis is a type of bacterial infection in the bone and bone marrow of the jaw. This infection leads to inflammation, which can cause a reduction of blood supply to the bone. Treatment for osteomyelitis generally requires antibiotics and the removal of the affected bone. A bone graft procedure may be required to restore bone function and growth lost during removal.
Benign facial or jaw tumors, though generally not life threatening, may grow large and require the removal of a portion of the jaw. Malignant oral tumors almost always spread into the jaw, requiring the removal of the affected section of the jaw. In both cases, reconstructive bone grafting is usually required to help restore normal function to the jaw. Grafting in patients with malignant tumors may be more challenging because treatment of the cancerous tumor generally requires removal of the surrounding soft tissues as well.
Some conditions or syndromes are characterized by missing teeth, facial bones, jaw or skull. Drs. Kienle, Steinkeler, Gunawardena and Inverso may be able to perform bone grafting procedures 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 keep the teeth in place. As a result, the sinuses become enlarged, a condition called hyperpneumatized sinus.
This condition usually develops over several years and may result in insufficient bone for the placement of dental implants. Drs. Kienle, Steinkeler, Gunawardena and Inverso perform a procedure called a “sinus lift” that can treat enlarged sinuses. A sinus lift is a bone grafting procedure that places bone between the sinus membrane and the sinus floor. This increases the vertical volume of bone to place dental implants.