Hi GRKzoo,

I will re post your red comments and answer them in bold type.

<<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.>>

THE ABSCESS ATTACHED TO THE TOOTH WAS ACTUALLY A CYST THAT HAD FORMED. WHICH IS SIMILAR TO A CYSTIC PIMPLE THAT WOULD FORM ON THE SKIN AFTER A HAIR FOLLICLE WAS INFECTED FOR AWHILE. EITHER CONDITION REQUIRES A THOROUGH DEBRIDEMENT OF THE SURROUNDING AREA TO HELP PREVENT A RECURRENCE OF THE CYST.

<<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. >>

YES, THE GUM TISSUE COULD HAVE TEMPORARILY HEALED OVER EXISTING FISTULAS. THEN WHEN THE FISTULAS COME TO A "HEAD", LIKE A PIMPLE, THEY SHOW THEMSELVES AGAIN. EACH TIME THEY FORM IT IS A SIGN THAT BACTERIA IS STILL PRESENT AND TRYING TO RELEASE ITSELF.

<<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).>>

YES, THE BACTERIA AND INFLAMMATION BUILD UP CAUSING THE BUMP TO FORM AND THEN THE PRESSURE OF BACTERIA IS RELEASED AGAIN AND AGAIN. THE POINTY TOP IS THE OPENING TO THE FISTULA AND THE BODY KNOWS TO KEEP THAT OPEN SO THE BACTERIA CAN DRAIN. IF THAT OPENING CLOSES, THEN THE BODY KNOWS TO FIND ANOTHER AREA TO DRAIN FROM. THIS IS WHY YOU KEEP GETTING "NEW FISTUALS". HOWEVER, IF THE AREA BECOMES OVERWHELMED WITH BACTERIA, THE FISTULAS MAY STOP FORMING AND THE BACTERIA WILL BUILD UP BUT IT WILL NOT DRAIN.

<<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. >>

SILVER FILLINGS ARE JUST ANOTHER NAME FOR MERCURY FILLINGS. THEY CONTAIN AT MINIMUM 50% MERCURY AND THEN A MIXTURE OF OTHER BASE METALS TO HELP SET THE MERCURY TO A SOLID STATE.

THE TOOTH WAS COMPROMISED BY THE LARGE RESTORATIONS. MEANING WITH EACH NEW FILLING PUT IN OR ON THAT TOOTH, MORE TOOTH STRUCTURE HAD TO BE REMOVED. SO WHAT YOU REALLY HAD LEFT AT THE TIME THE TOOTH FRACTURED WAS A SHELL OF A TOOTH WITH A HEAVY MERCURY FILLING(S) IN IT. FREQUENTLY THESE HEAVILY RESTORED TEETH EVENTUALLY FRACTURE FROM THE WEIGHT OF THE FILLING AND FROM THE CONSTANT CONTRACTION OF THE METAL.

<<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). >>

SO ONE OF THE UPPER LEFT MOLARS, 14 OR 15, WHICH IS JUST ABOVE TOOTH #19 IS ALSO ROOT CANALED AND IT HAS A HISTORY OF A SEVERE INFECTION. IT IS IMPORTANT TO NOTE HERE THAT ONCE A TOOTH BECOMES INFECTED AND/OR IS ROOT CANALED, THE TOOTH WILL NEVER RETURN TO A HEALTHY STATE. THE RC PROCEDURE IS NOT ABLE TO REMOVE ALL DISEASED TISSUE FROM THE HUNDREDS OF MICROSCOPIC CANALS SO THAT NERVE TISSUE REMAINS INFECTED. TEETH THAT HAVE BEEN INFECTED FOR A LONG TIME AND/OR HAVE HAD SERIOUS INFECTIONS, ABSCESSES, ARE MORE LIKELY TO CAUSE A SYSTEMIC OR MORE WIDESPREAD PROBLEM DUE TO THE SEVERITY AND LONGEVITY OF THE INFECTION. JUST LIKE AN UNRESOLVED INFECTION WOULD CAUSE IF IT WERE ANYPLACE ELSE IN OR ON THE BODY.

MOST ORAL INFECTIONS HAVE INTERMITTENT SYMPTOMS, VAGUE SYMPTOMS, OR NO OBVIOUS SYMPTOMS UNTIL THE BACTERIA TAKES HOLD IN SOME OTHER WAY OR MOVES TO ANOTHER AREA.

<<As of today, the fistula has shrunken enough so that it is hard to feel with my tongue (although there was some blood last night when I brushed my teeth). I have not made any calls today to have it looked at (figuring it best to have an active condition for diagnosis).>>

YES, THE FISTULA IS SUBSIDING AS THE BACTERIA RELEASES ITSELF. IT MAY EVEN SUBSIDE FOR AWHILE ESPECIALLY SINCE BEING ON THE ANTIBIOTIC, BEFORE IT SHOWS ITSELF AGAIN.... OR THE BACTERIA MAY MOVE TO A DIFFERENT LOCATION.

I HOPE I HAVE EXPLAINED THE RECURRENCE OF THE PROBLEM CLEARLY ENOUGH. I KNOW IT IS HARD TO IMAGINE WHAT COULD BE GOING ON IN PLACES THAT YOU CANNOT SEE ESPECIALLY IF THE "SYMPTOMS" KEEP SUBSIDING.

THE TRANSFER OF GOOD AND BAD BACTERIA FROM ONE AREA OF THE MOUTH TO ANOTHER IS NOT A MAYBE, IT IS SOMETHING THAT CONTINUOUSLY OCCURS. SO ANY AREAS HARBORING INFECTIOUS BACTERIA ARE GOING TO COMPROMISE THE OVERALL HEALTH STATUS OF THE REST OF THE MOUTH. WE CAN MINIMIZE THE BAD AND ACIDIC BACTERIA CIRCULATING IN OUR SALIVA WITH THOROUGH ORAL HYGIENE, NUTRITIOUS EATING, AND A HEALTHY LIFESTYLE BUT WE CANNOT REACH THE BACTERIA THAT LIVES INSIDE OF AN INFECTED OR NON VITAL TOOTH.

IF YOU ARE SEEKING A DIFFERENT AND MORE OF A WHOLE BODY PERSPECTIVE OF YOUR ORAL HEALTH, THEN I SUGGEST THAT YOU HAVE A COMPREHENSIVE EVALUATION BY A BIOLOGICAL OR HOLISTIC DENTIST.

I HOPE I HAVE BEEN OF SOME HELP TO YOU. CHECK BACK IN WITH ANY OTHER CONCERNS OR QUESTIONS THAT YOU MAY HAVE.