Physical Therapy Guide to Osteomyelitis of the Jaw
Osteomyelitis is an infection of the bone. The condition rarely affects the bones of the jaw, but when it does, it requires immediate attention. Lack of jaw and neck mobility may occur during and after infection. Physical therapy helps improve jaw mobility to restore your ability to eat, drink, speak, and perform actions like brushing your teeth.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Osteomyelitis of the Jaw?
Osteomyelitis is an infection of the bone. In children, it most often affects the long bones of the arms or legs. In adults, the feet, spine, and pelvis are most often affected. When an infection affects the temporomandibular joint of the jaw, or TMJ, serious problems with the face and jaw bones can result.
Usually, this type of infection results from bacteria entering the body through poor oral hygiene. It also can occur after oral surgery, such as a root canal procedure, or a jaw fracture. Osteomyelitis in the jaw occurs more in men than women. It more commonly affects the mandible (lower jaw bone) rather than the maxilla (bone where the top teeth are arranged). People with diabetes, alcoholism, or other diseases that affect the immune system are at greater risk. Having had another recent surgery before oral surgery or jaw trauma also may increase risk.
To heal the infected bone, the body sends white blood cells to the area. However, the persistent presence of white blood cells near the bone can cause the bone to break down. The infection can restrict blood flow to the area and cause bone death (necrosis). This is why it is important to treat the infected bone as quickly as possible.
Signs and Symptoms
Osteomyelitis of the jaw can cause:
- Fever.
- Jaw pain.
- Facial swelling.
- Tenderness to the touch near the infected area.
- Jaw stiffness.
- Sinus drainage.
- Tooth loss.
- Pus (thick, usually yellow-white fluid) in the mouth.
- A bump on the jaw bone that you can feel with your tongue or finger.
- Fatigue.
- Fever.
- Headache or neck ache.
During the early stage of osteomyelitis, jaw pain and sinus pressure may be constant and increasing. As osteomyelitis persists, your jaw and neck can feel stiff, and you may have trouble eating and talking.
How Is It Diagnosed?
Because its symptoms are like those in other jaw, skull, or face conditions, osteomyelitis of the jaw can be misdiagnosed. To aid in a diagnosis, your doctor may order a series of blood tests to detect elevated white blood cell counts. They also may order diagnostic imaging, which can show bone changes and inflammation.
If your doctor or dentist diagnoses osteomyelitis, they will prescribe antibiotics to clear up the infection. If you have difficulty opening your mouth due to tissue damaged by inflammation, physical therapy can help. Your doctor or dentist will inform your physical therapist of the specific area affected by the infection. Your physical therapist can help you restore the normal motion and mobility of your jaw, reduce your pain, and regain the ability to speak, eat and drink, and perform actions like brushing your teeth.
How Can a Physical Therapist Help?
Your physical therapist can help restore the natural movement of your jaw and decrease your pain. First, however, the antibiotics prescribed need to take effect. After you've finished your antibiotics, you might have pain and limited movement in your TMJ and neck. You also may have headaches.
During your first visit with your physical therapist, they will:
- Review your medical history. They may ask if you had surgery, fractures, or injuries to your jaw, head, or neck.
- Conduct a physical exam of your jaw and neck.
- Evaluate your posture and how your neck moves.
- Examine your jaw to find out how well your mouth can open. They also will check for abnormal jaw motion.
Your physical therapist may place their hand in your mouth to examine your jaw movement.
After the exam, your physical therapist will select the right treatments to improve your jaw movement and relieve pain.
Your physical therapy treatment program may include:
Hands-on therapy. Physical therapists use manual, or hands-on, therapy to increase movement and relieve pain in tissues and joints. Your physical therapist also might use manual therapy to stretch your jaw to:
- Restore normal joint and muscle flexibility (so that it won't feel "tight").
- Break up scar tissue (adhesions) that may result from a period of limited movement.
Mobility exercise. Your physical therapist may teach you special jaw exercises. These exercises won't exert a lot of pressure on your jaw joints. However, they can help to strengthen your jaw muscles and restore more natural, pain-free motion. Your physical therapist also will teach you exercises to help you increase the amount you can open your jaw and improve the way your jaw works.
Pain management techniques. Your physical therapist can provide treatments to help reduce your pain. These may include electrical stimulation or heat treatments. Physical therapists are experts at reducing pain without the use of medications, including opioids.
Can This Injury or Condition Be Prevented?
Preventing any infection starts with keeping a healthy lifestyle. Your body fights infections best when you have proper rest, nutrition, and personal hygiene, such as hand washing and tooth brushing.
If you need oral surgery, your dentist or doctor's technique may help to avoid infection. However, you should take your full dose of antibiotics as prescribed after any surgery.
After any procedure, you will receive instructions for how to care for the healing area. For instance, you can prevent infection by following directions for how and when to clean the surgical site and use gauze to pack the wound. You may need to change your diet to protect the area, until the open wounds in your mouth heal.
If you notice any signs and symptoms of infection, or something doesn’t seem correct with your mouth and jaw, contact your surgeon’s or dentist’s office. They can check your mouth, and, if needed, help you keep any possible problems from getting worse.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat patients who have osteomyelitis. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic or musculoskeletal problems. Some physical therapists have a practice with a focus on treating jaw and facial pain.
- A physical therapist who is a board-certified clinical specialist in orthopaedic physical therapy, or who has completed a residency or fellowship in orthopaedics.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your area.
General tips when you're looking for a physical therapist (or any health care provider):
- Get recommendations from family, friends, or other health care providers.
- Ask about the physical therapists' experience in helping people with osteomyelitis of the jaw when you contact a physical therapy clinic for an appointment.
- Be prepared to describe your symptoms in as much detail as possible and say what makes your symptoms better or worse.
The American Physical Therapy Association believes that consumers should have access to information that can:
- Help them make health care decisions.
- Prepare them for a visit with their health care provider.
The following articles offer some of the best scientific evidence for the treatment of osteomyelitis of the jaw. The articles report recent research and give an overview of the standards of practice in the United States and internationally. The article titles link either to a PubMed* abstract of the article or to the free full text. You can read them or bring a copy with you to your health care provider.
Andre CV, Khonsari RH, Ernenwein D, et al. Osteomyelitis of the jaws: a retrospective series of 40 patients. J Stomatol Oral Maxillofac Surg. 2017;118(5):261–264. Article Summary in PubMed.
Butts R, Dunning J, Pavkovich R, et al. Conservative management of temporomandibular dysfunction: a literature review with implications for clinical practice guidelines (Narrative review part 2). J Bodyw Mov Ther. 2017;21(3):541–548. Article Summary in PubMed.
Martins WR, Blasczyk JC, de Oliveira MAF, et al. Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: a systematic review with meta-analysis. Man Ther. 2016;21:10–17. Article Summary in PubMed.
Shaffer SM, Brismée JM, Sizer PS, Courtney CA. Temporomandibular disorders. Part 2: conservative management. J Man Manip Ther. 2014;22(1):13–23. Article Summary in PubMed.
Furto ES, Cleland JA, Whitman JM, Olson KA. Manual physical therapy interventions and exercise for patients with temporomandibular disorders. Cranio. 2006;24(4):283–291. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed holds millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
Expert Review:
Jun 12, 2023
Revised:
Aug 15, 2023
Content Type: Guide
Osteomyelitis of the Jaw
PT, DPT
Laura Thornton
PT, board-certified clinical specialist in orthopaedic physical therapy and fellow of the American Academy of Orthopaedic Manual Physical Therapists