Reasons for Jaw Bone Loss and Deterioration
The following represents a list of the most common causes for jawbone deterioration – withering and loss that may require bone grafting procedures to correct:
Teeth are embedded within the jawbone and stimulate the bone through normal activities such as chewing and biting. When teeth are extracted, the jaw (alveolar) bone that anchors our teeth no longer receives the necessary stimulation and begins to resorb or wither. Our body senses a lack of stimulation and interprets it as a commensurate lack of need. Within days of a tooth being extracted, the jawbone starts to resorb and will over time simply wither away.
The rate the jaw bone deterioration, as well as the amount of bone loss that occurs can vary greatly dependent upon genetics, age, health status as well as local factors such as the specific location of the tooth. It’s important to be aware that most jawbone loss occurs within the first two to six months following tooth extraction, although loss continues to occur throughout life.
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Periodontal diseases represent chronic infections of the gums that can gradually destroy your teeth’s support. Periodontal disease is caused by the interplay of bacterial infection and our body’s inflammatory response. Overtime, the support to our teeth (gum and bone) is lost. If not successfully treated, inflammation and infection invade the body destroying the ligament that holds our teeth to bone and eventually, the surrounding jaw (alveolar) bone. Bacterial plaque-induced inflammatory infections are divided into two categories; gingivitis and periodontitis. Gingivitis represents the early phase of this inflammatory disease, is limited solely to the gums and fortunately, is entirely reversible. If untreated, infection and inflammation may progress to cause permanent destruction to the supporting structures that hold our teeth in place (periodontal ligament and surrounding jawbone) and is defined as periodontitis.
Research has determined that dental plaque, a sticky colorless film composed of a myriad of bacterial types that coexist in a symbiotic relationship represents the primary cause of gingivitis. The degree of gingivitis expression however, is profoundly affected by each individual’s genetic-susceptibility. Overtime, plaque adhering to our teeth spreads and infects below the gum line. Bacterial plaque continually forms on teeth, even within minutes after a cleaning. Fortunately, not all bacteria cause disease. It takes between 6 weeks (42 days) and 3 months (90 days) for a disease causing (pathogenic) bacterial ecosystem to become established. At that point, the bacterial ecosystem produces and secretes poisons (toxins) that infect the gums. Overtime, bacterial plaque penetrates to destroy the support to our teeth (periodontal ligament and bone). Gums can become red, swollen, and bleed easily. If untreated, the infection spreads resulting in the gums separating from our teeth causing pockets (spaces) to form. It is important to recognize that even well performed twice daily brushing and flossing can only clean above and perhaps up to 1mm below the gum line. This is the reason why all of us require regular Periodontal Supportive Maintenance Care therapy. Bacterial plaque can eventually harden into a rough, porous substance known as tartar (calculus) that continuously secretes toxins and poisons causing periodontal disease to become chronic. Calculus (tartar) can develop both above and below the gum line.
The severity of periodontitis is affected by the interplay between the specific types of bacteria that adhere to the tooth root surfaces and our body’s unique and potentially overly aggressive immune response to these bacteria. In periodontitis, the supporting gum tissue and bone that hold our teeth in place are permanently destroyed. This progressive loss of jaw (alveolar) bone can if untreated result in tooth loosening and subsequent loss.
Restorative – Prosthetic Dental Treatment
It has been known for centuries that bone resorbs when placed under pressure (Wolf’s Law). Dentures are designed to prosthetically replace some or all of a patient’s teeth. By definition, dentures sit over the gum and during function (chewing), pressure is applied to the existing jawbone ridge. Above and beyond the loss of bone that occurs immediately following tooth extraction, the continual pressure caused by wearing dentures results in further loss of the underlying jaw (alveolar) bone. Since dentures rely on the topography of the jaw bone to remain in place, patients tend to experience loosening of their dentures and ever worsening difficulties eating and speaking. Eventually, bone loss may become so severe that even with strong adhesives, dentures cannot be held in place.
Dentures that are partially held in place by the remaining teeth experience the same series of sequellae as the topography of the jaw bone withers (resorb) where teeth had been extracted. Overtime, dentures become increasingly unstable and the rocking of the denture under function in turn causes looseness to the remaining teeth. All too often, a tooth supported denture contributes to the remaining teeth eventually being lost. On the other hand, dentures supported by dental implants which exert a stimulatory effect on the underlying jawbone cause no such harm. Bone stability is maintained and excellent long-term function preserved.
In the appropriate instance, Dr. Novack can perform a bone graft procedure to restore the original jawbone form thereby reversing-correcting the effects of poor denture care.
A bridge represents a permanently cemented prosthetic approach to replace a missing tooth or teeth. Inherent in a permanently fixed bridge prosthetic approach is the requirement to whittle down the teeth on both sides of the missing tooth space or gap to enable crowns to be placed over top. Aside from damaging the teeth on either side of the missing tooth space, another concern is that the gap where teeth were lost receives no direct stimulation. Inevitability, irreversible bone loss will occur in the missing tooth area.
Profound functional and cosmetic deformities can occur as a result of trauma. Dependent on the severity of the traumatic blow, not merely can teeth be knocked out, but a significant portion of the surrounding jaw bone. In addition, the nerves to the teeth subjected to trauma may die. This can lead to root canal infection, tooth fracture and bone loss, sometimes even years after the initial trauma.
Bone grafting procedures may be necessary to restore the foundation lost due to trauma. By promoting new bone growth, the goal is to reestablish function and return the area back to the esthetic appearance that existed prior to the traumatic incident.
Teeth misalignment issues can cause a host of negative repercussions. Teeth that are severely rotated are often impossible to keep clean further predisposing to the development of periodontal disease and bone loss. When a tooth no longer has opposing teeth to bite against, the unopposed tooth can continue to erupt or drift. The results of misalignment can cause irreversible damage and deterioration to the underlying bone.
Jaw Joint-TMJ Problems
Grinding and clenching of the jaws can lead to abnormal tooth wear. Should treatment not be initiated in a timely manner, excessive grinding forces can compromise our chewing ability. It has been well established that accelerated bone deterioration occurs when teeth are loose. Finally, extreme biting forced can cause teeth to fracture. Subsequent loss of a tooth as noted above, can and does result in withering of the jaw bone which begins immediately following an extraction.
When the upper back teeth (molars) are extracted, air pressure from the sinus cavity can accelerate the resorption of the bone that formerly held these teeth in place. Over time, the sinus enlarges by dropping down into the space previously occupied by the upper back teeth. This condition is referred to as a hyperneumatized sinus.
Should a hyperneumatized sinus not be managed early, this condition can result in an extreme loss of upper jawbone. Even in these instances, Dr. Novack can perform a procedure called a sinus lift to treat enlarged sinuses, reconstruct the lost jaw bone and establish the foundation necessary to support dental implants. Please refer to the Sinus Augmentation Procedure Tab.
Congenital Birth Defects
Certain conditions or syndromes known as congenital birth defects are characterized by portions of the skull, facial bones, jaw, or teeth failing to develop. In these instances, Dr. Novack is often called upon to perform bone graft procedures to reconstruct the missing bone and in so doing, restore function and natural facial-oral esthetics.