The Importance of Teeth for Jaw Bone Health

When one or more teeth are missing, it can lead to jawbone loss at the site of the gap. This loss of jawbone can develop into additional problems, both with your appearance and your overall health. You may experience pain, problems with your remaining teeth, and altered facial appearance, and eventually even the inability to speak and eat normally.

In that same way that muscles are maintained through exercise, bone tissue is maintained by use. 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, 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.

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:

Tooth Extractions:
Periodontal Disease:
Dentures/Bridgework:
Trauma:
Misalignment:
Osteomyelitis:
Tumors:
Developmental Deformities:
Sinus Deficiencies:

Tooth Extractions:

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 (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 at which 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 Disease:

Periodontal disease is an ongoing infection of the gums that gradually destroys the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. The majority of Periodontal disease that affects the tooth-supporting structures is a plaque-induced inflammatory lesion.  Periodontal disease is 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 not treated, the gums may 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 also 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 hold the teeth in place deteriorates. The progressive loss of this bone, the alveolar bone, can lead to loosening and subsequent loss of teeth.

Dentures/Bridgework:

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. Because this type of denture relies on the bone to support it, 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 bridge receive 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.
In some cases, Dr. Benedon is able to complete a bone grafting procedure that may restore the deteriorated ridge.

Trauma:

When a tooth is knocked out or broken to the extent that no biting surface is left above 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:

Misalignment issues can create a situation in the mouth where some teeth no longer have an opposing tooth. The unopposed tooth can over-erupt and cause 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 due to loss of stimulation.

Osteomyelitis:

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 grafting procedure may then be required to restore bone for and function.

Tumors:

Benign facial tumors, though generally non-threatening, may grow large and require removal of a portion of the jaw. Malignant mouth tumors almost always spread into the jaw and require 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.

Developmental Deformities:

Some conditions or syndromes known as birth defects are characterized by missing portions of the teeth, facial bones, jaw or skull. Dr. Benedon may be able to perform a bone graft procedure to restore bone function and growth where it may be absent.

Sinus Deficiencies:

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 hyperneumatized sinus.

This condition usually develops over several years, and may result in insufficient bone for the placement of dental implants. Dr. Benedon can discuss 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