While it can occur in different skeletal sites, its manifestation in the jaws is particularly significant in dentistry due to the potential impact on oral health and overall systemic stability.
Prompt diagnosis and appropriate treatment are critical to prevent severe complications.
Causes and Risk Factors
Odontogenic infections: deep caries with pulp necrosis, periapical abscesses, advanced periodontal disease, and post-extraction complications.
Surgical and implant-related factors: peri-implantitis, overheating of bone during osteotomies, presence of foreign bodies (retained root fragments, fixation devices).
Spread from adjacent infections: chronic maxillary sinusitis, cellulitis, or soft-tissue infections.
Hematogenous spread: more common in long bones and in children but can occur in the jaws through bacteremia (Staphylococcus aureus, anaerobes).
Secondary bone necrosis: following head and neck radiotherapy (osteoradionecrosis) or medication-related osteonecrosis of the jaw (MRONJ) associated with bisphosphonates, denosumab, or antiangiogenic drugs.
Predisposing systemic factors: poorly controlled diabetes, immunosuppression (HIV, corticosteroids, chemotherapy), smoking, alcohol abuse, malnutrition, sickle cell anemia, and advanced age.
Local risk factors: poor oral hygiene, ill-fitting prostheses, and chronic trauma to the oral mucosa.
Clinical Features
✔ Persistent, severe pain in the affected area, often exacerbated by chewing.
✔ Swelling, redness, and warmth over the infected site.
✔ Pus discharge and fistula formation (intraoral or extraoral).
✔ Mobility of adjacent teeth, especially in mandibular involvement.
✔ Neurosensory alterations, such as paresthesia or anesthesia of the lower lip when the inferior alveolar nerve is affected.
✔ Systemic signs: fever, malaise, regional lymphadenopathy.
✔ Chronic course: bone sequestration, necrosis, and recurrent flare-ups may occur if the infection persists.
Importance of Early Diagnosis
Diagnosis relies on a thorough clinical history, careful examination, and radiographic or CBCT imaging.
Early identification allows timely intervention with systemic antibiotics, surgical drainage, sequestrectomy, or debridement.
In advanced cases, hyperbaric oxygen therapy may be considered as an adjunctive option.
Key Message for Professionals and Patients
For dental and medical professionals: recognizing the early signs of osteomyelitis is crucial to prevent functional and esthetic sequelae.
For patients: persistent jaw pain accompanied by swelling or fever must not be ignored—early consultation with a dentist or oral surgeon can significantly improve outcomes.
Osteomyelitis of the jaws, although uncommon, remains a serious clinical challenge that requires an interdisciplinary approach involving dentists, oral and maxillofacial surgeons, and medical specialists to ensure optimal care.
References
- Cureus. 2025 Jun 24;17(6):e86667. Anterior Mandibular Osteomyelitis: A Narrative Review of Clinical Presentation, Diagnosis, and Management Strategies.
- J Clin Exp Dent. 2025 Mar 1;17(3):e324–e328. Chronic Osteomyelitis of the Jaw. Osteomyelitis.
