Hello, I had a root canal in number 30 over 25 years ago. 4 mos ago developed an abscess/fistula.

3weeks ago had a root canal re treat begun, cleaned out and medication in place with temporary filling. The plan is to return in a few weeks to pack with gutta perca and permanent filling, later on new crown.

The fistula closed up after 10 days and I thought I was doing ok. 2 days ago the gumboil reappeared. It seems to have drained again and there is no discomfort.

My endo. says this is normal, the fistula may close and reappear several times?? That sounds weird to me.

I'm not sure I want to fool around with this retreat any longer if the prognosis is poor. My endo seems to think there is a good chance to save the tooth.

I'm feeling like I want this infection out of my mouth NOW.
What is the worst case scenario if I just have the tooth extracted and do not replace with an implant or bridge. I am 60 years old.

Please help, thanks so much.

Note: I am not a dentist or a health professional but I would like to share my fistula tooth experience with you.

Here is my story: I had a deep cavity filling done around Dec 2010. I experienced pain and was lying on bed for 1.5 weeks. I ate antibiotics and the pain disappeared. Initially, I knew nothing about fistula. I thought it was gone for good. After 6 months, a fistula grew on the gum of the bad tooth. I thought it was a canker sore and it disappeared after a week. I ignored this issue again and it went on and off for 2-3 years because I was afraid to lose a tooth and wanted to keep it.

I started to re-consider options when my mouth began to stink even though I brush twice a day + using tongue scraper. What I noticed was that my bad tooth was interfering with my tongue and felt uncomfortable. Also, the bad tooth became loose each day. I noticed that my side face near the jaw started to develop small pimples.

I got scared because I heard this issue can lead to bigger problems like spread to the next tooth or somewhere else. After extraction, my mouth no longer smells, tooth no longer interfere with my tongue, and pimples disappeared. The oral surgeon said there was too much bone loss. He cleaned it and I am back to normal.

thanks so much for your reply. I'm planning to call an oral surgeon tomorrow to schedule an extraction. My next dilemma is do I then get an implant? It is an important tooth, but I don't want to take a chance that the implant does not take or it gets infected.

Anybody out there with a similar story, having an implant after an infected root canal and extraction, tooth number 30?

I can't provide any advice as to what you should do. My oral surgeon said there was too much bone loss due to infection in my situation (on and off fistula for 2 years). My tooth was pretty much moving. I remember him telling me that if I wanted to do implant, I will probably need to do bone graft first. I think everyone is different. But, do visit a couple oral surgeons for advice before extracting tooth/or perform implant since it is your important tooth.

An implant depends on the amount of bone loss. Since this did go into the bone, only a specialist can tell if you are a candidate for a implant. Bone rebuilding can occur in some cases. Good that you are getting this tooth out. Do that, heal up, then maybe seek that specialist that can address it. I wish you all the best. ginnie

Hi azaleagal,

I am in the dental field and can offer you some information here.

The most important thing for you to know is that ALL root canaled teeth are chronically inflamed and infected simply because it is not possible to remove all of the infected nerve tissue from inside of the tooth. Therefore this tooth has been unhealthy for over 25 years. Re treating the tooth with another root canal procedure will not make this tooth healthy again.... as the same infected nerve material will still be present inside of the microscopic canals after the second procedure.

The infection inside of the tooth eventually proliferates and moves into the jaw bone. At which time some people will get pain and/or swelling.... others will develop a fistula. For the fistula to form, the bacteria had to burrow a hole through the bone leaving a path or void of deterioration in the bone resulting in permanent bone loss.

Your endo is correct.... the fistula may close and reappear several times. He also should have told you that with each occurrence you will lose more bone and the infection will have spread even deeper.

When a dentist uses the term "save a tooth" when referring to endodontic treatment it does not mean "cure" the problem. It simply means "retain" the tooth (and the problem) until the inevitable removal of the tooth.

It is very important for you to know that this infection is not just limited to this tooth. In addition to the fact that the bacteria has spread to the jaw bone, your immune system has been fighting this infection for 25 years. From a health standpoint the wiset option is to rid yourself of source of the infection which is the tooth.

Regarding the replacement of this tooth...
Anytime a root canaled tooth is extracted, especially one with a long term history of being root canaled, there is always a chance that the bone will not heal to a completely healthy state. This means the bone would remain in a compromised state and/or there may be significant permanent bone loss.
Replacing a root canaled tooth with a dental implant is risky due to those factors. Adding bone graft material to unhealthy bone carries a very high risk of failure.

Tooth #30 is a tooth that is used to chew with and if it is not replaced with something then the adjacent teeth will eventually drift towards the open space. You should discuss your replacement options with your restorative dentist. Other than an implant, you may be a candidate for a 3 unit permanent bridge.... a small removable one tooth appliance called a Nesbit.... or a removable partial denture.

I hope this information is helpful. Please let us know how you're doing!
Bryanna