Jaw pain
The most frequent sign: in a cohort of 42 patients, 90% had pain.
CONDITION / JAWS, MOUTH AND NECK
Osteomyelitis of the jaw.
Osteomyelitis of the jaw is an infection of a bone, more often of the lower jaw, most often from a diseased tooth, less often - after an injury. As the infection continues, sequestrations—pieces of dead bone—and fistulae form, through which pus escapes. They treat with antibiotics, and the dead bone is removed.
CONCEPTUAL VISUALIZATION- What it is
- Infectious inflammation of the jaw bone and bone marrow inside it.
- From where
- The main causes are tooth infection and trauma.
- How we treat
- Antibiotics, and if there is dead bone, surgery to remove it.
- Who treats it
- Maxillofacial surgeon together with doctors who manage antibiotics and related diseases.
01 / WHAT IS ITWhat is
What is
osteomyelitis of the jaw.
Osteomyelitis is an inflammation of infectious origin that affects the bone and its bone marrow. In the jaw, there are two main reasons: tooth infection and trauma.
If the infection persists, part of the bone dies. Such dead pieces are called sequestra. The pus looks for an outlet and creates a channel - a fistula - in the mouth or on the skin of the face or neck.
Osteomyelitis of the jaw is now uncommon: according to surgeons, the incidence appears to have decreased significantly over the past 50 years thanks to oral hygiene, antibiotics and early detection. The lower jaw is mainly affected: in a series of 40 patients — 87%.
Doctors distinguish acute, secondary chronic and primary chronic osteomyelitis. Treatment depends on the form: acute can often be cured with antibiotics, and chronic with sequestration usually requires surgery.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
osteomyelitis presents.
In a cohort of 42 adult patients, the most common symptoms were pain, swelling, and a change in sensation of the lip or chin.
Swelling
Swelling of the cheek, corner of the jaw, or under the jaw — in the same cohort, 86%.
Fistula
An opening in the mouth or on the skin from which pus oozes from time to time.
Numbness of the lip
The lower lip or chin on the side of the pain becomes less sensitive: the infection affects the nerve inside the jaw. In the cohort of 42 patients — 50%.
Bare bone
A bone not covered by gums is visible in the mouth. In a study of 54 patients, this was associated with a worse outcome.
Osteonecrosis of the jawFracture without impact
A weakened bone can break on its own. In a series of 18 patients who underwent jaw resection, this was the most common complaint (39%), followed by abscess (33%).
03 / REASONSWhere does it come from?
Where does it come from?
infection in the bone.
The causative agents are mostly common oral bacteria. It is important how the bone was weakened before the infection.
Teeth
Most often, the infection comes from a diseased tooth or after dental intervention. In a series of 60 patients, the odontogenic cause was 76.7%.
Injury
The second most frequent cause in the same series is trauma, in particular jaw fractures.
Fractures of the lower jawOsteonecrosis
Osteonecrosis — the death of bone from drugs or radiation — can be complicated by infection. In a specialized center, among 47 patients with secondary chronic osteomyelitis, the most common cause was drug-related osteonecrosis (38.3%).
Osteonecrosis of the jawWhat burdens the course
In a study of 54 patients, severe complications were associated with alcohol, smoking, and exhaustion, and the authors consider osteomyelitis around a dental implant to be an aggressive variety.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Suspicion of osteomyelitis should be shown to the doctor on the same day: bone infection, which was started to be treated in the first 3-5 days, can often be cured completely. The most dangerous complications are edema that blocks the airways and sepsis: it usually develops within a few hours.
103 immediately if:
- it is difficult to breathe;
- difficulty swallowing or speaking;
- severe swelling in the mouth, in particular under the tongue;
- swelling of the neck grows rapidly;
- it is difficult to open the mouth;
- the eye is swollen or painful, vision has suddenly worsened;
- breathing is very frequent;
- the person is confused, speaks unclearly or illogically;
- the skin, lips, or tongue are bluish, pale, or mottled;
- a rash that does not fade when pressed;
- very high or very low temperature, the body is hot or cold to the touch, uncontrollable chills;
- in a child under 5 years old - weak, shrill or continuous crying;
- in a child under 5 years old - does not react as usual, does not eat, it is difficult to wake him up;
- in a child under 5 years of age, she did not urinate for 12 hours;
- a child under 3 months has a temperature of 38 °C and above, at 3–6 months — 39 °C and above.
See a doctor urgently if:
On the same day: pain, swelling, redness and heat above the jaw; pus appeared in the mouth or an opening on the skin from which it is released; gradually numb lower lip or chin on the side of the pain; you have already been treated for osteomyelitis and your symptoms seem to have returned. Planned: old fistula or sequestrum, which you already know about, without these signs - make an appointment with a CT scan.
05 / DIAGNOSTICSAs confirmed
As confirmed
diagnosis
- Discussion and review
What teeth have been treated, whether there was an injury, what medications you are taking or have taken (especially for osteoporosis or tumors), whether there was radiation to the head and neck.
- Pictures
The panoramic shot is taken first, although it misses some of the changes. Then CT, if necessary, MRI or radionuclide methods. In a meta-analysis of 5 studies, the combined SPECT/CT method was the most sensitive: it did not miss a single case, and the specificity was 85%.
- Sowing
Determining the causative agent is not easy: the sample is easily contaminated with oral bacteria. In a cohort of 53 patients, only 52% of cultures responded, and almost half of the bacteria found were resistant to amoxicillin.
- Biopsy
Finally, the diagnosis is confirmed by examination of the tissue under a microscope. It also helps to distinguish osteomyelitis from osteonecrosis, which can look similar.
06 / TREATMENTHow we treat
How we treat
osteomyelitis of the jaw.
The goal is to remove the source of infection and dead tissue, drain the pus, restore blood supply to the bone, and control the infection with antibiotics. Exactly how - depends on the form and prevalence.
01
Antibiotics
If possible - according to the result of sowing.
- Duration
- Usually 4–6 weeks, depending on the severity and age of the infection; with severe infection - up to 12 weeks.
- Sharp shape
- In a series of 60 patients, six weeks of antibiotics was sufficient for most of the 13 people with acute osteomyelitis.
- After surgery
- A systematic review of 45 retrospective studies questions whether a long course is always necessary after removal of the affected area. How much to take, the doctor decides.
02
Surgery
When the infection has damaged the bone, the damaged part is removed.
- Surgical treatment and sequestrectomy
- Sequestrations and the affected bone are removed, pus is released. In a cohort of 42 patients, treatment was 93%, and first treatment was successful in 86%; of the 6 patients in whom the infection remained, 4 were cured after retreatment, and 2 required resection.
- Decortication
- The affected outer layer of the bone is removed. In a series of 12 children treated with biopsy, decortication, and long-term antibiotics, osteomyelitis resolved without recurrence in 7.
- Resection of the jaw area
- The area of the jaw is removed together with the affected bone. Limited systematic review data suggest that resection may produce better results than other operations. In a series of 24 patients, after segmental resection, re-infection occurred in 1 out of 18, and after marginal (only the thickest part of the bone) symptoms remained in 3 out of 6.
03
Restoration of the jaw
- Bone graft
- The area that had to be removed is restored immediately or later. In a series of 18 patients, the graft took root in 15; in the three in which it did not take root, the defect was larger (average 13.1 cm vs. 7.1 cm).
- Lip sensitivity
- In the same series, despite preservation of the nerve, after 6 months, sensitivity did not recover significantly in 54% of patients.
04
Primary chronic osteomyelitis
Another form is, in particular, diffuse sclerosing osteomyelitis.
- What is known
- In a review of 48 publications, surgery had a low success rate and more complications, while conservative treatment and bisphosphonates had better results. Due to the high risk of research bias, the authors do not draw final conclusions.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Osteomyelitis of the jaw at Dr. Valikhnovskyi's Institute of Surgery is considered in the direction of "New face" - along with operations on the lower jaw and bone restoration after removal of the affected area. Teeth that became the source of infection are treated by a dentist; antibiotics are selected according to culture together with the doctor who administers them.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Consultation of a surgeon and CT scan — assessment of lesion borders, sequestrations and healthy bone reserve by computed tomography of the facial skull.
- Virtual planning and 3D printing — Mirror CT modeling and surgical templates to plan exactly which part of the bone to remove and what to replace it with.
- Fibula flap — restoration of the lower jaw with a fragment of the leg bone with its own vessels, if a section of the jaw had to be removed.
- Titanium plates and individual implants — fixation of the bone and restoration of the contour of the jaw according to the 3D model.
- Local patches — closing defects of the skin and soft tissues of the face and neck with tissues from neighboring areas.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Pictures onlineSend CT scans, discharges and photos - the doctor will pre-evaluate the situation.
- ConsultationExamination and CT scan; if necessary, biopsy and culture.
- PlanWhat to remove, whether reconstruction is needed and who administers antibiotics.
- TreatmentThe scope defines the plan; if a section of the jaw had to be removed, according to the indications, it is restored in the same or the next operation.
- RecoveryFor some time, the food is soft or liquid, without smoking; follow-up examinations and images so as not to miss a relapse.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Can osteomyelitis of the jaw be cured only with antibiotics?
The acute form is often possible: in a series of 60 patients, six weeks of antibiotics was enough for the majority of patients with the acute form. If the bone has already died and sequestrations have formed, surgery is needed to remove the dead bone.
What is sequestration?
A piece of dead bone separated from a living one. When the infection has damaged the bone, the damaged part is surgically removed.
Will the fistula close itself?
A fistula is a path through which pus exits the affected bone. Therefore, they treat the focus in the bone, not just the hole; whether to cut out the passage itself, the surgeon decides.
Will part of the jaw have to be removed?
Not always. In the cohort of 53 patients, sequestrectomy was performed in 75.5%, removal of a part of the bone thickness — 9.4%, removal of a segment of the jaw — 15.1%.
Can osteomyelitis return?
This is possible: in a cohort of 42 patients, the infection remained in 6 after the first treatment, and in a series of 12 children, 5 exacerbations were repeated. If pain, swelling, or pus reappear after treatment, see your doctor the same day.
How does osteomyelitis differ from osteonecrosis?
In osteonecrosis, the bone dies because of drugs or radiation, and infection can set in later. These conditions can look similar, so they are differentiated by history, imaging, and biopsy. About osteonecrosis - a separate page.
Does osteomyelitis of the jaw occur in children?
It happens. In a series of 12 children, after biopsy, decortication and long-term antibiotics, osteomyelitis disappeared without recurrence in 7; in others, exacerbations became less frequent and milder.
Sources
16 sources · reviews, meta-analyses, cohorts and the NHSshowCollapse
- Jaw OsteomyelitisInfectious Disease Clinics of North America, 2025doi:10.1016/j.idc.2025.02.015 ↗
- Chronic Osteomyelitis of the Jaw. OsteomyelitisJournal of Clinical and Experimental Dentistry, 2025doi:10.4317/jced.62596 ↗
- Assessing the optimal imaging modality in the diagnosis of jaw osteomyelitis. A meta-analysisBritish Journal of Oral and Maxillofacial Surgery, 2021doi:10.1016/j.bjoms.2020.11.012 ↗
- Necessity of antibiotics in the management of surgically treated mandibular osteomyelitis: A systematic reviewOral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2023doi:10.1016/j.oooo.2022.05.001 ↗
- Outcome of different treatments for chronic diffuse sclerosing osteomyelitis of the mandible: a systematic review of published papersBritish Journal of Oral and Maxillofacial Surgery, 2020doi:10.1016/j.bjoms.2020.01.012 ↗
- Management of osteomyelitis of the mandible — a 15-year case seriesBritish Journal of Oral and Maxillofacial Surgery, 2026doi:10.1016/j.bjoms.2025.08.012 ↗
- Chronic Osteomyelitis of the Jaws: Management and Outcomes in a Tertiary Maxillofacial Surgery UnitCraniomaxillofacial Trauma & Reconstruction, 2025doi:10.3390/cmtr18040043 ↗
- Acute and Chronic Suppurative Osteomyelitis of the Jaws: A 10-Year Review and Assessment of Treatment OutcomeJournal of Oral and Maxillofacial Surgery, 2018doi:10.1016/j.joms.2018.05.040 ↗
- Identifying Risk Factors Associated with Major Complications and Refractory Course in Patients with Osteomyelitis of the Jaw: A Retrospective StudyJournal of Clinical Medicine, 2023doi:10.3390/jcm12144715 ↗
- Osteomyelitis of the jaws: A retrospective series of 40 patientsJournal of Stomatology, Oral and Maxillofacial Surgery, 2017doi:10.1016/j.jormas.2017.04.007 ↗
- Chronic Osteomyelitis of the Mandible: Diagnosis and Management — An Institution’s Experience Over 7 YearsJournal of Oral and Maxillofacial Surgery, 2015doi:10.1016/j.joms.2014.10.017 ↗
- Management of Mandibular Osteomyelitis With Segmental Resection, Nerve Preservation, and Immediate ReconstructionJournal of Oral and Maxillofacial Surgery, 2019doi:10.1016/j.joms.2019.01.036 ↗
- Juvenile Mandibular Chronic Osteomyelitis: Role of Surgical Debridement and AntibioticsJournal of Oral and Maxillofacial Surgery, 2016doi:10.1016/j.joms.2016.01.027 ↗
- OsteomyelitisNHS, 2023nhs.uk/conditions/osteomyelitis ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Dental abscessNHS, 2026nhs.uk/conditions/dental-abscess ↗
The figures on the page are from these sources.
Jaw pain
does not pass?
Send CT scans, statements and photos. The doctor will tell you what is needed and in what sequence.