Hi GRKzoo,

I am so sorry that I missed your post! I do try to keep up as best that I can.... but sometimes a few fall through the cracks... :/

I will re post some of your thread and answer you in bold type to help keep things clear.

<<Sometime late in the spring of 2014 I first noticed a bump on the outer surface of my gums by #19. It popped and bled a little but there was no discomfort and I waited until my October check-up to discuss it with the dentist. He called it a fistula and expressed concern that the root may be cracked. He took an x-ray after inserting a point in the fistula and did not see damage at the root. Since I had already maxed out my dental benefit on a root canal and crown earlier in the year on #31 (I really wish I had found this sight and learned about root canals before that) and had no pain I opted to wait and do nothing until after the new year. It didn't take that long; in late November #19 broke right down through the root and the tooth extracted (with a socket preservation). At the follow up on December 8 my dentist said the healing looked real good and I made plans for an implant in a few months.>>

OKAY SO THE INITIAL FISTULA APPEARED SPRING OF 2014 NEAR TOOTH #19. IT WAS STILL PRESENT IN OCT 2014 AND THE DENTIST CONFIRMED THE FISTULA DIAGNOSIS BUT NO FRACTURE. ** HAD THIS TOOTH BEEN PREVIOUSLY ROOT CANALED OR DID HE RECOMMEND A ROOT CANAL AND YOU WERE GOING TO WAIT TIL YOUR INS KICKED IN AFTER THE NEW YEAR?**
IN NOVEMBER #19 BROKE BIG TIME AND WAS THEN EXTRACTED. OBVIOUSLY THE TOOTH WAS FRACTURED BUT NOT DIAGNOSED. SOMETIMES THE FRACTURE CANNOT BE SEEN CLINICALLY OR ON THE XRAY IF THE ANGLE OF THE FILM DOES NOT PICK IT UP.
IN DECEMBER THE POST OP APPT WAS NEGATIVE FOR SIGNS OF ANY PROBLEMS. ** HAD THE FISTULA COMPLETELY RESOLVED ITSELF AFTER THE EXTRACTION?**

<<Around Christmas I noticed a couple of bumps on the gum where the tooth was. Again there was no pain and the dentist was closed for the holidays so I did nothing. These actually got quite long and popped (again with a little blood), but bumps have reappeared a couple of times now.>>

**DID THOSE BUMPS SUDDENLY APPEAR OR WERE THEY JUST GROWING IN NUMBER AND SIZE?**

<<Yesterday I went back to the dentist who confirmed the fistula and took an x-ray which he said showed no visible problem under the gum. Right now I am on a one week course of penicillin.>>

THE PROBLEM IS NOT REALLY ASSOCIATED WITH THE GUM BUT RATHER THE BONE AND BONE TISSUE. A FISTULA OR FISTULAS THAT NEVER COMPLETELY HEAL OR SEEM TO KEEP REAPPEARING INDICATE A DEEPER BACTERIAL SITUATION THAT USUALLY STEMS FROM A LONG STANDING INFECTION.
**WHAT WAS THE HEALTH OF TOOTH #19 PRIOR TO IT BREAKING? HAD IT BEEN ROOT CANALED? DID IT HAVE A LARGE RESTORATION OR CROWN ON IT? WAS IT MOBILE OR DID IT HAVE A LOT OF GUM RECESSION? DO YOU HAVE PERIODONTAL DISEASE? **

<<Reading various posts at this site has made me concerned and raised a lot of questions. In addition to the root canal last spring I have had two others but this is the first one on the lower left side so my thinking is that the infection really stemmed from the problems with #19 (which was first filled in 1963).>>

WELL I AM GLAD THAT THE INFORMATION I PROVIDE ON THIS FORUM IS HELPING YOU BECOME BETTER INFORMED SO THAT YOU ARE QUESTIONING THE CAUSE OF THE PROBLEM. IF TOOTH #19 WERE FILLED IN 1963, THEN IT WAS MOST LIKELY A MERCURY FILLING.
**WAS THAT FILLING STILL PRESENT IN THAT TOOTH WHEN IT WAS EXTRACTED? SO AGAIN WAS #19 PREVIOUSLY ROOT CANALED? WHERE ARE YOUR OTHER ROOT CANALED TEETH LOCATED?**

<< Is that logical or is it more likely that could rogue bacteria from the two upper root canals or the one on the lower right have spread, indicating a wider scale problem?>>

BACTERIA IN THE MOUTH, WHETHER IT IS ABOVE OR BELOW THE GUM LINE DEFINITELY TRAVELS THROUGH THE VAST BLOOD VESSELS AND NERVES. SO YES, THE BACTERIAS FROM A DEAD AND/OR INFECTED TOOTH TRAVEL ALONG THIS PATH ALSO. DEPENDING ON THE OVERALL PHYSICAL AND ORAL HEALTH OF THE PERSON, THE BACTERIA MAY BE KEPT UNDER SOME CONTROL BY THE IMMUNE SYSTEM FOR AN UNCERTAIN AMOUNT OF TIME BEFORE IT TAKES HOLD IN ANOTHER AREA.

<< I am otherwise in good health (for age 63 at least) and have never had problems with immunity issues.>>

HEY 63 IS QUITE YOUNG ;-) I AM HAPPY TO HEAR THAT YOU ARE IN GOOD HEALTH AND HAVE A HEALTHY IMMUNE SYSTEM AND I'M SURE YOU WANT TO KEEP IT THAT WAY!

<<If these new fistulas cannot be cleared up with antibiotics should I even be considering an implant?>>

THE ANTIBIOTICS MAY ONLY TEMPORARILY SUBSIDE THE FISTULA IF IT IS BEING CAUSED BY A CHRONIC BACTERIAL INFECTION TUCKED IN THE BONE. THE DENTAL HISTORY OF TOOTH #19 MAY HELP DETERMINE THE CAUSE AND LONGEVITY OF WHY THE FISTULA IS PRESENT. IT IS IMPORTANT TO KNOW THAT IDEALLY DENTAL IMPLANTS SHOULD ONLY BE PLACED IN HEALTHY JAW BONE. ANYTHING SHY OF HEALTHY, INCREASES THE RISK OF INFECTION AND FAILURE OF THE IMPLANT.

<<Can x-rays do an adequate job of evaluating the condition of the bone and identifying an infection?>>

DENTAL X-RAYS ARE ONLY 2 DIMENSIONAL. SO THE ANGULATION OF THE FILM DETERMINES WHAT SHOWS UP ON THE XRAY IMAGE. GENERALLY A DENTAL CT SCAN IS BETTER AT EVALUATING THE HEALTH OF THE JAW BONE. IT NEEDS TO BE SPECIFICALLY "DENTAL".

ONE MORE INSIGHT... IT IS BEST TO HAVE AN ORAL SURGEON EVALUATE YOUR TOOTH #19 SITE RATHER THAN YOUR GENERAL DENTIST. THE SURGEON IS THOROUGHLY TRAINED AND MUCH MORE EXPERIENCED IN DEALING WITH CASES LIKE YOURS.