Hi Bryanna,

I have a Fistula tooth problem and this started 2 years ago after a deep cavity filling. Pain went away after 2 weeks of the filling. However, every 5 months there is a "bubble" on my gum. It's exactly 5 months!

I went to see one of the best Endodontist in my city and he recommended to save the tooth (root canal). I'm not really concerned about saving the tooth but more concerned if it will solve the Fistula problem. My question is...if I were to proceed and perform this root canal procedure...will the Fistula problem go away?

I'm just afraid that these Endodontist is doing it to make money. Then, the Fistula problem will come back. Then, I will have to extract the tooth in the end.

What do you suggest? I went to several dentists and I was referred to the same Endodontist in my city. He is probably the best of the best.

Hello,

Very simply to answer your question ..... no the root canal will not cure the fistula problem because the source of the fistula comes from the bacteria/infection that resides inside of the tiny canals that the Endodontist cannot clean out. So irrelevant of how "great" he is at performing root canals, there is no access to these tiny canals.

The second issue here is that you have had an infection for at least 2 years. The recurrent fistula simply means that when the inflammation from the infection builds up, the bacteria from the infection burrows a hole through the bone as a release for the pressure. It does not mean the infection has left the tooth... it just means the infection has spread.

Endodontics is known as the "cash cow" in dentistry because most people are under the impression that the procedure will "save" their tooth when in fact it only allows the patient to "retain" an infected tooth. When the symptoms of infection resurface, the patient is told some odd story about failure and to have it re treated. Cha... Ching!!

You are wise to think twice about retaining this infected tooth. I think you should go with your intuition on this one.

Keep us posted...
Bryana

Thanks for taking your time to reply. I'm still debating if I should take a risk.

#1) Should I wait for exactly 5-6 months to make sure the Fistula problem is gone then to put a crown? (assuming that I proceed with root canal procedure) or does the dentist make me put a crown right away?

#2) If I ask the Endodontist to perform a root canal and the Fistula problem returns...will it be easy for them to extract my tooth? I'm thinking that it might crack in half when they start pulling it out.

#3) From your experience and knowledge, were there any successful patients that really solved this Fistula problem? or 80% of patients have the Fistula problem after root canal?

'Thanks
I don't understand why my Fistula problem will come back EXACTLY 5-6 months. For example, January 2013 there will be a bump then it disappears. In June 2013, it will come back. Once it is gone. It will be January 2014.

Thanks

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

Bryanna,

Thanks for your advice. My Endodontist examined the tooth beside it and it's still OK. I have some questions:

1. Does extract the tooth guarantee 100% the Fistula problem will be gone and spread stops?

2. What happens if I extract the furthest back tooth (fistula tooth)? but infection has spread already? Does it mean I need to keep extracting each tooth? My Endodontist examined the tooth beside it and it's still fine at the moment.

3. So far, I have asked many people and they suggested to me to extract tooth because:
- This tooth has been infected for 2 years already
- The gums of the Fistula tooth don't look healthy compared to other areas
- A dental hygienist recommended me to extract because she said my tooth is weak. For example, if I wiggle the tooth, it moves more than my regular tooth.

I kind of decided to extract the bottom back molar tooth...but I don't intend to do TOOTH IMPLANT. Is it a big risk? My mom extracted her molar back tooth at 15 years old and tells me that it's OK.

If anyone else is reading, please provide suggestions/or your experience.

Thank you for your advice,

Hi fistula_help,

This thread has gotten buried so it could be that Bryanna missed these last few questions. If you are still looking for answers to these questions, perhaps you could start a new thread. Or if you ended up getting the information you required, then no problem.

Best,
Carleton2013

Hi fistula_help,

I will answer your questions in bold print to make it easier to follow.

<<1. Does extract the tooth guarantee 100% the Fistula problem will be gone and spread stops?>>

EXTRACTING THE TOOTH MEANS TO REMOVE THE PROBLEM CAUSING THE FISTULA. THE BONE THAT HAS BEEN LOST DUE TO THE INFECTION CANNOT BE (FULLY) REPLACED. REGARDING THE SPREAD OF INFECTION ....IT IS NOT POSSIBLE TO CLINICALLY SEE THE MICROSCOPIC BACTERIA RESIDING IN THE BONE AFTER THE TOOTH IS REMOVED. BUT IT IS IMPORTANT TO REMOVE THE ORIGINAL SOURCE OF THE INFECTION TO GIVE THE IMMUNE SYSTEM AN OPPORTUNITY TO DEAL WITH IT. LONG TERM INFECTION IS ALWAYS A HUGE RISK WHEN WE HANG ON TO AN INFECTED TOOTH. REGARDING THE GUM TISSUE... IT MAY BE PERMANENTLY SCARED OR THE DISCOLORATION MAY LESSON IN TIME.

<<2. What happens if I extract the furthest back tooth (fistula tooth)? but infection has spread already? Does it mean I need to keep extracting each tooth? My Endodontist examined the tooth beside it and it's still fine at the moment.>>

ANYTIME YOU HAVE A CHRONIC, LONG TERM ORAL INFECTION THERE IS RISK OF IT SPREADING TO OTHER AREAS OF THE MOUTH. THIS BACTERIA MAY NOT MAY NOT BE SEEN AT THE TIME OF THE EXTRACTION OF THE ORIGINAL TOOTH. SOMETIMES IT DOES MEAN OTHER TEETH WILL NEED TO BE REMOVED AT SOME POINT IN TIME. AGAIN THIS IS WHY IT IS UNWISE TO RETAIN AN INFECTED TOOTH IN THE FIRST PLACE.

<<3. So far, I have asked many people and they suggested to me to extract tooth because:
- This tooth has been infected for 2 years already
- The gums of the Fistula tooth don't look healthy compared to other areas
- A dental hygienist recommended me to extract because she said my tooth is weak. For example, if I wiggle the tooth, it moves more than my regular tooth.>>

ALL OF THESE SYMPTOMS INDICATE A LONG TERM INFECTION. THERE IS NO BENEFIT TO KEEPING THIS TOOTH AND YOU MAY BE RISKING YOUR HEALTH THE LONGER YOU HANG ON TO IT.

<<I kind of decided to extract the bottom back molar tooth...but I don't intend to do TOOTH IMPLANT. Is it a big risk? My mom extracted her molar back tooth at 15 years old and tells me that it's OK.>>

THE IMPORTANT THING TO KEEP IN MIND IS THAT IT IS INFECTED AND YOU WILL CONTINUE TO HAVE PROBLEMS SO LONG AS YOU KEEP IT. YOU DO NOT HAVE TO REPLACE IT IF YOU DON'T WANT TO. IF THIS TOOTH IS BITING AGAINST THE TOP TOOTH, THEN THE TOP TOOTH MAY DRIFT DOWN BECAUSE IT WILL NO LONGER HAVE SOMETHING TO BITE AGAINST. ALSO DEPENDING ON WHICH TOOTH THIS IS.... THE ADJACENT TEETH MAY MOVE IN TOWARDS THE OPEN SPACE ONCE THE TOOTH IS REMOVED. EVERYONE IS DIFFERENT. BUT THE BIGGEST CONCERN AT THIS TIME IS THE INFECTION, NOT THE WHAT IF'S.

I hope this information can help you make an informed decision.
Let us know how things are going.
Bryanna

Bryanna, thanks for your advice. I will give updates to see what I will do next.

Hi guys,

I came across your thread on the internet after trying to research what could be going on in my mouth. After reading various posts I am convinced I have a fistula and am a little comforted by the fact that there is an answer to what I am going through and it's not mouth cancer. Okay, here is my situation: I had a root canal done on what I think is called tooth 32. I also had the tooth capped this was in November 2012. Around Christmas I started experiencing pain in the tooth. I went to the dentist in january. He xrayed and said he couldn't see anything odd but put me on a course of antibiotics saying if the tooth responded it was likely to be bacterial and he could open the crown and clean the tooth. I didn't like the sound of that so kinda ignored the problem. Now, the fistula has grown and I need to do something about it. I am on a course of antibiotics and will be returning to the dentist on Tuesday. Please advise me what I should do? From your posts it seems that the best option is to extract? I appreciate your help.

Hi malawi,

I am in the dental field and can offer you some factual information here.
The fact that your dentist couldn't find any odd on this tooth is irrelevant. The tooth is root canaled, therefore, it is infected. All root canaled teeth harbor bacteria that is infectious. The most serious side to what you have has to do with the location of this tooth. Infection and/or any type of oral swelling from an infection in the lower posterior region of the jaw can literally travel to your throat which could close off your airway. So it is imperative to have this tooth removed asap.

There is no "curing" this infection other than to remove the source of the infection which is the tooth. To keep the tooth means to keep the infection.

In your case, it is best to extract this tooth while you are on these antibiotics because there will be quite a bit of infection at the site and you will want to be covered by the antibiotic.

Please don't way to take care of this. You will be okay. Keep us posted.......
Bryanna

PS.... See an oral surgeon to remove this NOT a general dentist.