Dental malpractice cases involving osteomyelitis of the jaw are some of the most severe cases we have ever seen. If left untreated, osteomyelitis can require multiple surgeries, and it can cause pain, suffering, disability, and disfigurement. In the most severe cases, osteomyelitis can cause death. If you have undergone a dental procedure and developed an infection in your jaw as a result, you may be entitled to compensation through a dental malpractice claim.
What is Osteomyelitis of the Jaw?
Osteomyelitis of the jaw is fancy way of describing an infection of the jaw that can develop after a dental procedure. The word “osteomyelitis” literally means inflammation of the bone marrow. Osteomyelitis is more likely to develop in the lower jaw or mandible, but it sometimes develops in the upper jaw or maxilla.
Bone tissue is generally resistant to infection. However, once the infection sets in, it can be extremely difficult to treat. This issue is compounded by the fact that osteomyelitis of the jaw occurs near the mouth and near the teeth, and thus the infected area is constantly surrounded by bacteria. Accordingly, complications from osteomyelitis can be extremely severe and can even cause death if the infection spreads from the bone to other parts of the body.
What is the Dentist’s Responsibility?
Whether a dentist is liable in dental malpractice will depend upon the standard of care, which is unique to different procedures and can vary, depending on the circumstances. In cases involving osteomyelitis of the jaw, a dentist can breach the standard of care by failing to timely recognize, diagnose, and treat the osteomyelitis. Essentially, there is a certain point at which any reasonable dentist would have diagnosed the patient’s osteomyelitis or referred the patient to a specialist for treatment of the osteomyelitis.
There are other ways the dentist could negligently cause osteomyelitis. For example, the dentist may cause osteomyelitis by using instruments that were not properly sanitized. Additionally, a patient may develop osteomyelitis because the dentist did not properly study the patient’s medical history and risk factors prior to performing surgery.
Osteomyelitis of the jaw is an inflammatory disease of the mandible that typically begins as an infection. The infection in the jaw can result from bacteria entering the bone because of a dental procedure or oral surgery. There are so many different dental procedures that can cause an infection, and every person has a different health profile and a different susceptibility to infection. Thus, each osteomyelitis of the jaw case will be somewhat unique. However, there are several common causes of osteomyelitis of the jaw, including the causes listed below.
Osteomyelitis from Fractured Jaw
During the extraction of back molars and wisdom teeth, a dentist may apply enough force to fracture the patient’s jaw. If the dentist fails to diagnose and treat the fractured jaw, the patient may go home and develop an infection. That infection can grow into the fracture and develop into osteomyelitis. This is an extremely dangerous situation and often involves IV antibiotics and extensive surgery to tame the infection, remove the necrotic bone tissue, and reconstruct the jaw.
Osteomyelitis of the Jaw After Tooth Extraction
An infection that develops after the removal of a tooth can become severe if left untreated. Sometimes, a doctor will prescribe antibiotics or an antimicrobial oral rinse after removing teeth. However, if the infection existed prior to the removal of a tooth, the doctor may prescribe antibiotics prior to surgery to tame the infection and decrease the odds of a subsequent infection. Where an infection develops after an extraction and is left untreated, the infection can grow into the socket and down into the bone. This is how osteomyelitis of the jaw can develop after a tooth extraction.
Osteomyelitis from Dental Implants
Osteomyelitis from dental implants is a rare occurrence, but it happens. Dental implant procedures require a dentist to drill a hole into the patient’s bone and screw the titanium post into that hole. Because the inside of the patient’s bone is exposed to bacteria, there is a possibility that the patient can develop osteomyelitis at the site of the implant. The infection may be due to a contaminated dental implant, or it may stem from an infection in the socket that existed prior to insertion of the implant. These are some of the more common ways osteomyelitis can develop as a result of a dental implant procedure.
Osteomyelitis from Medications
Osteomyelitis can develop as a result of medications. For example, drugs used to treat bone conditions, like osteopenia or osteoporosis, can increase a patient’s risk of developing osteomyelitis of the jaw. Bisphosphonates are notorious for causing bone related problems in dentistry. These drugs inhibit the ability of bone tissue to heal. As a result, the bone is more susceptible to infection and osteomyelitis.
Dental Osteomyelitis Symptoms
Dental osteomyelitis symptoms can vary, depending on the patient and the location and severity of the infection. There are some common symptoms of osteomyelitis that tend to occur in most cases. Some of the more common dental osteomyelitis symptoms, including the following:
- A bump on jaw;
- Stiffness of the jaw;
- Difficulty eating or talking;
- Suppuration or draining of pus;
- Draining of the sinuses;
- Swelling of the throat;
- Swelling of the face;
- Loss of teeth; or
Pain and swelling after dental procedures is quite common. Most of the time, the pain and swelling will go away, and everything will get better. However, there are times when the normal symptoms of a dental procedure turn into something much more severe, like osteomyelitis. Thus, a patient should closely monitor his or her symptoms and contact a medical professional right away if anything seems unusually severe.
How to Diagnose Osteomyelitis of the Jaw
Diagnosing osteomyelitis may require a combination of tests, like imaging, blood tests, biopsies, or bone scans. Typically, a combination of tests can help to maximize accuracy of the diagnosis. Below are some of the more common methods for diagnosing osteomyelitis of the jaw.
Imaging Tests for Osteomyelitis
The treating doctor will likely be able to see bone loss, dead bone tissue, inflammation, and other indications of osteomyelitis on radiographs or other images. Typically, the most useful images are cone beam or CBCT images because they provide a 3D picture of the patient’s jaw. However, osteomyelitis is often diagnosed through panoramic x-rays, CT scans, MRI, and oral cavity photography.
Blood Tests for Osteomyelitis
In addition to imaging, osteomyelitis can be diagnosed with blood tests. For example, the treating physician may order a series of blood tests to check for higher white blood cell count. Although these tests can indicate that there is a problem, they do not provide conclusive evidence of osteomyelitis on their own. Thus, blood tests are typically used in combination with images to diagnose and evaluate osteomyelitis.
A biopsy involves sending a sample of the infected tissue or bone to a lab for testing. This process can identify the exact bacteria that is causing the problem in the patient’s bone. Armed with this knowledge, a doctor can treat the osteomyelitis with the antibiotic that is most effective against the bacteria causing the problem. Therefore, a biopsy should be done right away if at all possible.
Bone Scan Testing
Bone scan testing uses a small amount of radioactive material to help illuminate infections and fractures during radiology. This process is sometimes called “bone scintigraphy,” and it is very useful in diagnosing and assessing osteomyelitis.
Treatment for Osteomyelitis of the Jaw
A patient with osteomyelitis of the jaw typically responds better to treatment if the osteomyelitis is caught and treated early. However, if left untreated, the osteomyelitis can spread and cause serious damage or death. Thus, it is critical for the dentist to diagnose the osteomyelitis as early as possible to prevent unnecessary damage.
Treatment for osteomyelitis of the jaw can also depend upon the health and physical condition of the patient. Clearly, an immunocompromised patient will be much more likely to suffer severe damage from osteomyelitis than an extremely healthy patient. Therefore, treatment for osteomyelitis will largely depend upon the particular facts and circumstances in a given case.
Common Treatments for Osteomyelitis
Although treatment for osteomyelitis will be dependent upon many factors. There are some treatments that are commonly utilized. Here are some of the more common ways to treat osteomyelitis of the jaw:
- Antimicrobial therapy;
- PICC line antibiotics;
- IV antibiotics;
- Hyperbaric oxygen;
- Steroid medications;
- Analgesic medications; and
- Surgical debridement.
Antibiotic Treatment for Osteomyelitis of the Jaw
The treatment for osteomyelitis is complicated because of the proximity to teeth and the mouth where bacteria flourish. Therefore, antibiotic therapy often needs to weeks or even months. Additionally, because the infection is so difficult to stop, oral antibiotics may not be strong enough. Therefore, treatment for osteomyelitis of the jaw often involves intravenous antibiotics or a PICC line. Additionally, in some circumstances, hyperbaric oxygen treatment can improve healing and increase the effectiveness of antibiotics in treating osteomyelitis of the jaw.
Surgery After Osteomyelitis of the Jaw
Osteomyelitis of the jaw can require multiple surgeries, depending on the severity of the infection. In cases where the patient has a fractured jaw and where the dentist allowed the infection to spread into the fracture, the osteomyelitis will grow and spread into the surrounding bone tissue. Then, the osteomyelitis will quickly eat away living bone in the affected area, causing the surrounding bone to die. This dead bone provides the perfect environment for more bacteria, which will further exacerbate the infection.
By the time the antibiotics tame the infection, the patient has often lost a significant amount of bone around the fracture. Accordingly, the patient must undergo surgery to remove the dead bone tissue, which is sometimes referred to as “debridement.” Also, the patient may require a mandibulectomy or a resection of the jaw. This essentially means that the surgeon will cut off each of the infected ends of the jaw at the site of the fracture. Clearly, a mandibulectomy procedure is reserved for the most serious circumstances, such as when oral cancer spreads into the jaw or when osteomyelitis is left untreated.
Debridement and mandibulectomy can leave a significant amount of space between the fractured ends of the jaw. If these ends were left unattached, the patient’s jaw would be completely unstable. Therefore, the patient will often need some sort of titanium implant to bridge the gap and hold the jaw together while it heals.
Additionally, the patient may need new bone tissue to fill the space where the osteomyelitis killed the bone tissue. Thus, the mandibular reconstruction may involve bone grafting. Bone graft material could come from the patient, or it may come from a cadaver, depending on the circumstances. Autogenous bone is bone harvested from the patient, and it may be harvested from the hip or ribs.
Can a Person Die from Osteomyelitis?
Osteomyelitis of the jaw is potentially lethal. There is a possibility of serious and life-threatening complications when the infection spreads to other parts of the body. Some of the notable causes of death as a result of osteomyelitis of the jaw include the following:
- Blood infection or sepsis;
- Brain abscess;
- Blood vessel infection; and
- Respiratory complications.