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Tooth Infection Spreading to the Bone: 6 Definitive Causes


Dr. Andreas

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Written by

Q.F. Nayibe Cubillos Morales


Medically Reviewed by

Dr. Gustavo Assatourians D.D.S

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Tooth infection spreading to the bone has multiple causes, such as genetic conditions, having a disease that compromises the immune system and weakens it, metabolic diseases such as diabetes and dental extraction, or gum disease not treated on time.

An infection is a process during which pathogens such as bacteria, fungi, or viruses invade a vulnerable area of the body, multiply, and cause a disease.

Tooth infections in most cases are caused by bacteria infecting the innermost layer of the tooth called the pulp or dental nerve. It also occurs when there is an accumulation of plaque at the gum line, generating gingivitis, which later worsens and becomes periodontitis.

When tooth infection is not treated early, it can spread rapidly from the tooth to the surrounding bone, causing a serious and life-threatening condition known as osteomyelitis.

Tooth infection is alarming especially when it can spread to the whole body. We have a comprehensive guide about the symptoms of tooth infection spreading to the body. Also, the complications and treatments are explained well in this article.



Causes of a Tooth Infection

The increase in bacteria that cause tooth infections can occur for a variety of reasons, including:

1. Advanced dental caries

The acid produced by bacteria destroys the hard tissues of the tooth (enamel and dentin) and leaves the dental nerve exposed.

2. Fractured or cracked teeth

Bacteria easily enter the dental pulp through any opening.

3. Gum disease (gingivitis and periodontitis)

Accumulation of plaque or tartar in the space between the gum and the tooth that generates inflammation. Check this article about gum diseases. This will help you understand the signs, symptoms, and treatments for gum diseases.

4. Dental trauma (blows, falls)

During trauma, the dental pulp can be injured, causing nerve death or making the tooth more susceptible to infection. 

5. Tooth extraction

The extraction of a tooth can cause infection, possibly due to poor oral hygiene or no antibiotics given after the extraction.

6. Dental implants

The infection associated with regeneration surgery done with bone grafting can be generated, due to the excessive use of cement during the placement of a crown on an implant, which does not allow for adequate healing and bone recovery. We have a complete guide about dental implant procedures to help you understand more.

Some conditions can be triggers for tooth infections, including:

• Poor dental hygiene: The main reason for an infection in the mouth is poor oral hygiene. It is described as not brushing your teeth at least 2 times a day and not using dental floss.

• Food with a high sugar content: Contributes to the formation of dental caries.

Dry mouth or Xerostomia: When saliva is decreased, protection against bacteria is lost. This condition is associated with the use of some medications, aging, or systemic diseases.

• Smoking

• Weakened immune system: is associated with some diseases, such as HIV, diabetes, lupus, etc. when the body cannot effectively fight bacteria.


Signs and Symptoms of Tooth Infection


 The most common symptoms of a tooth infection are: tooth sensitivity to acid, cold, heat, and a sweet taste

Unpleasant odor and taste

Severe, throbbing pain, which may spread to the ear and/or neck on the same side as the tooth and worsens when lying down

Swelling of the face

Gum redness


• Fistula: purulent discharge

When a tooth infection spreads to the bone or other parts of the body, the following symptoms may occur:

 general malaise, fatigue, ear and headaches, dizziness, and lightheadedness.

 fever, sweating or chills, reddening of the skin, or rashes.

intense swelling of the face, difficulty in opening the mouth, swallowing, and breathing correctly.

 severe gum swelling, pain, and bleeding.

 diarrhea, vomiting and abdominal pain

 increase of cardiac heartbeat frequency

increase of respiratory frequency



Tooth Infection Spreading to the Bone

In general, when there is a tooth infection, an accumulation of pus in what is known as an abscess appears. The stages are:

1. Gingival: an infection develops in the gums but it does not affect the tooth or bone structures.

2. Periapical: an infection that forms at the tip of the root of a tooth when a cavity or fracture touches the dental nerve and it dies. The infection spreads to the bone in that area and an abscess forms.

3. Periodontal: The tissues that support the teeth are affected by an infection, and the gum disease known as periodontitis appears.

When the infection has advanced to the bone, osteomyelitis may occur.


What is Osteomyelitis?


It is an infection of the bone tissue caused by bacteria. It occurs as a consequence of a chronic periapical infection or disease that obstructs blood flow, causing bone death or necrosis. It is classified as:

1. Acute suppurative osteomyelitis

Intense pain, inflammation, sensitivity, increased temperature, mobility of the teeth involved in the osteomyelitis area, and pus secretion.

2. Chronic suppurative osteomyelitis

It is usually asymptomatic and presents fistulas through which pus comes out with bone particles detached from the bone.

3. Chronic Focal Sclerosing Osteomyelitis

It is asymptomatic and occurs in a specific area of the bone. It is more common in young patients.
Chronic diffuse sclerosing osteomyelitis: Its origin is associated with a weakened immune system. It is more common in older adult patients.


When to seek professional help?

It is important to visit the dentist at the first signs of a tooth infection. Depending upon the level of advancement of the infection and the causes of its appearance, the dentist may order tests such as X-rays, computed tomography, histopathological examination, and thermal tests.


Treatment of a Tooth Infection Spreading the Bone


To treat the symptoms of a tooth infection that spreads to the bone, it is necessary to eliminate the cause of the infection. Some treatment options are:

1. Root canal treatment or endodontics

The procedure involves the extraction of the infected pulp inside the tooth, followed by a thorough cleansing of the canals. The resulting space is then filled with a specialized material to seal the tooth and eliminate the infection. This treatment is administered in cases where the infection has not yet spread to the underlying bone. This information is relevant when discussing root canals and their relationship to cancer.

2. Apical surgery

Consists in uncovering the root of the tooth and cutting part of it at the same time that the abscess and the infected bone are removed surgically, then the root is sealed.

3. Drainage of the abscess

An incision is made and the pus is drained. Sometimes an elastic band is placed to keep the perforation open so it can continue to drain. The abscess can also be drained at home. Click the article to find out more.

4. Tooth extraction

When it is not possible to save the tooth, it is extracted along with all the tissue affected by the infection. 

5. Medicines

Depending on how advanced the infection is, the dentist will prescribe antibiotics to manage it while performing other types of treatments. It may be necessary to perform a biopsy and a histopathological study of the affected bone area to determine what type of bacteria causes the infection and send an antibiotic that attacks it directly. In more serious cases, it may require hospital management.


How to Prevent a Tooth Infection from Spreading to the Bone?


To avoid tooth infections, some useful tips to follow include:

 Proper oral hygiene: use fluoride toothpaste, a good toothbrush, and dental floss at least 2 times a day; also use mouthwash after brushing.

 Change the toothbrush every 2 or 3 months and when it looks or feels deteriorated.

 Maintain a balanced diet with lots of fruits and vegetables, and reduce the consumption of sugars.

 Avoid habits such as cigarette smoking or alcohol.

 Schedule periodic visits to the dentist at least 2 times a year for checkups and professional cleanings.

A tooth infection can be easily treated in its early stages, so try to visit the dentist at the first signs of alarm or pain. In this way, you will avoid complications such as the spread of infection to the bone and even to other areas of the body.

On our site, you will find an article titled Best Antibiotic for Tooth Infection“. There, when to use those antibiotics and the possible side effects are explained. Thanks for reading our article.



1. Abscess Tooth: Symptoms, Causes & Treatments. (Reviewed: March 27, 2023). Cleveland Clinic.

2. Agarwal, A., Kumar, N., Tyagi, A. K., & De, N. (2014).Primary chronic osteomyelitis in the mandible: a conservative approach. Case Reports.

3. Assatourians, G. (Updated: April 3, 2023). 4 Useful Tips to Avoid Tooth Infection Spreading to The Bone. Channel Islands Family Dental Office.

4. Frothingham, S. (May 28, 2019). What Are the Symptoms of Tooth Infection Spreading to Your Body? Healthline.

5. Newman, T. (December 4, 2017). What’s to know about dental abscesses? Medical news today.

6. Nezafati, S., Ghavimi, M. A., & Yavari, A. (2009).Localized osteomyelitis of the mandible secondary to dental treatment: report of a case. Journal of dental research, dental clinics, dental prospects.

7. Osteomyelitis – Symptoms and causes. (November 8, 2022). Mayo Clinic.

8. Tooth abscess – Symptoms and causes. (June 29, 2022). Mayo Clinic.

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