Hi GRKzoo,
<<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?**
This tooth had never been root canaled before. He did suspect a crack (and an abscess) but could not see one and since there was no discomfort I chose to wait it out (and yes, the insurance was a big factor). When the tooth did split it cracked along a line that could only have been seen from between the teeth. When he pulled the tooth it was in several pieces and the abscess was still attached to its root.
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?**
The extraction occurred on 11/24 and recovery alone took a couple of weeks (if I include the stitches dissolving and all). During this period it was hard for me to tell if the fistula completely resolved as I had never had an extraction before and all of the textures and sensations were new to me. I suspect they hadn't resolved and that the healing from the extraction perhaps temporarily cover them. I noticed 2 new fistulas, perhaps a few days before Christmas, as they were growing up from the gum from where the tooth was extracted. (The one earlier in the year was on the exterior side of the gum). By Christmas, I noticed that they had become quite tall, perhaps 2 mm or more. One had a white cap and the other was still red.
<<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?**
The bumps tend to grow over a few days and go through a cycle of growth from red to a white head, popping and minor bleeding. I have also noticed for some of them that for about a day after initially popping they become quite pointy on top, with a small white peak. (I can feel the point with my tongue as well as see it).
<<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? **
Before all of this I had not been having any problem with #19. Again, it had never been root canaled. There was no crown, but the restorations took up a lot of the tooth volume and when the tooth finally cracked on 11/24 a chunk of the amalgam actually fell out. I'm sure that the initial filling in 1963 was mercury but through the 1980s and 90s I did have quite a few of those fillings replaced as the dentist (not the same guy as I had moved several times by then) found issues with them. I don't know whether they were still using mercury in fillings then but they were silver. I'm not sure what you mean by "mobile" but I do not have a lot of gum recession and have never had periodontal disease. Several dentists and hygienists over the years have actually told me I have very healthy gum tissue.
<<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?**
I've answered the questions on the root canal and fillings above. My other root canaled and crowned teeth are all in different quadrants from this problem in the upper right and left and lower right. I'm sure the lower right is #31 because I can see it but the uppers are hard to see in the mirror. Back in 2008, the root canal on the upper (probably 14 or 15) left did result in a very bad infection (massive facial swelling) that took about a week to get fully under control but there was never a fistula and no problems since. (I do still have all my wisdom teeth).
<< 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!
You bet!!
<<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.