Reasons for Jawbone 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, and as the saying goes, “Use it or lose it”.
The rate the bone deteriorates, as well as the amount of bone loss that occurs, varies greatly among individuals. However, most lost occurs within the first eighteen months following the extraction, and continues throughout 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 which 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, 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 or poisons that irritate the gums. Gums may become inflamed, 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 is neglected, plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
Periodontitis is affected by bacteria that adhere 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 holds teeth in place deteriorates. The progressive loss of this bone, the alveolar, can lead to loosening and subsequent loss of teeth.
Unanchored dentures are placed on top of the gums, 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. In fact, by resting on the gingiva dentures actually accelerate bone loss. Addionally, since dentures rely on the bone to hold them in place, people often experience loosening of their dentures and problems eating and speaking as bone is unavoidably lost. Dentures generally have to be remade every few years in order to fit well, and eventually, bone loss may become so severe that dentures can no longer be worn or be held in place comfortably, even with even strong adhesives. Proper denture care, repair, and refitting are essential to maintaining oral health.
Dentures can often be supported by dental implants, serving as 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 and does occur in this area. As bone and gum tissue shrink in between the teeth on either side, their part of the bridge becomes more difficult to clean. This leads to decay on these teeth and often to their loss.
By completing a bone graft procedure and including dental implants, Dr. Nail is now able to replace missing jaw bone restore jaw function, thereby preventing or reversing the effects of denture wear.
When a tooth is knocked out or broken to the extent that it must be removed, tooth stimulation of the bone in that area stops, which results in jaw bone loss. Some common forms of tooth and jaw trauma include: teeth being knocked out from injury or accident, jaw fractures, or teeth with a history of trauma that fail and lead to bone loss years after the initial trauma.
A short bone grafting procedure that is performed in the office can reverse the effects of bone deterioration, and a dental implant at that site can maintain the new bone volume and restore normal chewing function in these traumatized areas.
Misalignment of the jaws or missing teeth 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 and damage 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 the function and volume of the diseased bone that has been removed to treat the infection.
Benign facial tumors, though generally non-threatening, may grow large and require removal of a portion of the jaw. Malignant tumors of the oral cavity often spread into the jaw, requiring removal of the tumor and 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, commonly called “birth defects” are characterized by the absence or incomplete development of parts of the facial bones, jaws, skull, and/or teeth. Dr. Nail can often perform bone graft procedures to restore bone function and volume where it may be absent or deficient.
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 held the teeth in place. As a result, the sinuses become enlarged, a condition called ”sinus pneumatization”.
This condition can develope over years or even months, and may result in insufficient bone for the placement of dental implants. Dr. Nail can perform a procedure called a “sinus floor graft” in a short office procedure to replace the bone that was lost where the roots of molar teeth previously resided.