Hi,

With or without doing a root canal..... the fistula on the outside of the gum represents a much larger issue under the gum. The infrequent flare ups are actually due to the pressure of the infection building up and then releasing itself through the gum. Then when it builds up again, it releases itself. This does not mean the infection is going away or that it is less each time this occurs. It actually means the infection is constantly present and is spreading in intensity. It may or may not continue to visibly flare up from time to time ... but one day the flare up will not go away and/or the area will become severely swollen.

The way the fistula formed in the first place was as a result of the infection in the tooth spreading from the tooth into the jawbone. The infection then burrowed a hole from the tooth into the bone eventually breaking through the bone and gum tissue. Clinical perspective of this area of bone is black to dark brown in color, necrotic and decrepit with a very pungent decayed odor. This bone is not able to be rejuvenated due to the bacteria and necrosis. Obviously the longer this infection goes on the more decayed the bone will become resulting in extensive bone loss. Which makes replacement of this tooth very complicated if at all possible.

If you go through with the root canal procedure, you are "retaining" the same infection process that you have had for 2 yrs. Nothing will change regarding the infection. The longer this goes on the more complicated the whole situation becomes .... including the extraction... the removal of decayed bone .... and replacement of this tooth.

You are concerned about the tooth cracking when it is removed. That is always possible and quite common for teeth that are internally decayed due to infection. However, the bigger concern has to do with waiting to remove this tooth which could result in quite a bit of bone loss during the extraction due to the bone being so diseased as I explained above.

In my 35 yrs of experience working with dental patients..... every one that has had a fistula due to a tooth infection has ultimately had their tooth or teeth removed. The patients who had them removed before the infection became severe had the best healing outcome. Those that waited, were not so fortunate. There are no exceptions and there are many clinical reasons for this but the one easiest to explain is regarding the tiny canals inside of the tooth which are not accessible meaning they will always harbor infected tissue resulting in bacteria continually migrating into the jawbone.

Endodontists know that root canals are a temporary measure to retain an unhealthy tooth. The term "save" only means "retain"... it does not mean "cure". It is a treatment option only because people will pay to have it done .....because they have been taught to fear the removal of their teeth.

If you are concerned about the systemic risks associated with infected and root canaled teeth... take a peek at this...
http://articles.mercola.com/sites/ar...ot-canals.aspx

I wish you well.
Bryanna