What is a dental fistula?

Patients sometimes present with a bump in their gums. I can be open and draining or it can be closed with red granulation tissue (a early healing response). Usually it means the patient has a dental infection of either endodontic or periodontal origins. If it's cause is a non vital pulp than it will be  classified as endodontic type infection . If its cause is a perio abscess, than it's periodontal. Other possible causes can be a root fracture and much less frequently a tumor.

Usually an attempt should be made to "track" the source of the fistula and it often helps to place a small gutta percha point  in to the fistula's opening and see where it goes. Once in place a periapical radiograph can show where the radioopaque gutta percha ends up going. Also this type of x-ray will ofen show if there is a periapical radiolucency (evidence of an infected pulp) . It may also show the location of any bone loss around a tooth. The position of bone loss offers further clues about the cause of the fistula.

Only after determining the cause of a fistula can a dentist recommend and provide appropriate treatment, and whether its to recommend a root canal, perio scaling , an extraction or a biopsy of the affected tissue at the origin of  the fistula. Root fractures causing a fistula often result in a tooth being extracted, since often this sort of fractured tooth is not restorable. If the fistula is caused by bacteria from an periodontal infection , root planning followed with a course of antibiotics may manage and resolve the infection. If the cause is endodontic, then root canal treatment is often the indicated treatment, unless the tooth is deemed a poor candidate for restoration. In that cause an extraction is usually the recommended treatment. 

If you are experiencing a tenderness of the gingiva, often slightly away from the gingival margin of the tooth, you may have a fistula and the best thing to do is visit a dentist. The dentist will be able to determine whether it is fistula or an ulcer ( no fistular tract will be present) and recommend any appropriate treatment.



from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2020/02/what-is-dental-fistula.html - http://lspindelnycdds.blogspot.com/

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