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.

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. 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.

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). 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? I am otherwise in good health (for age 63 at least) and have never had problems with immunity issues.

If these new fistulas cannot be cleared up with antibiotics should I even be considering an implant? Can x-rays do an adequate job of evaluating the condition of the bone and identifying an infection?

Thank you for any insights you can offer.

I'm sort of disappointed that there has been no response at all after more than a week on this board. Perhaps my situation is not unusual or has been answered somewhere else? Since there is so much discussion here about extraction being the best way to prevent long term problems with infection I'd like to try and understand the best options when an extraction has been done and fistulas are recurring at the same site.

Being on penicillin for a week seemed to have shrunk the fistula but a day after completing the course it reappeared. My dentist has indicated that further antibiotic therapy would not likely help and if it hasn't cleared up by Monday he will open it up and see what is causing the problem.

I'd love to hear another opinion or two. Bryanna, you have such good insights; do you have anything to offer here?

I thank you for any comment you can make.

Hello GRKzoo,

Welcome to NeuroTalk.

I'd love to help with your questions but I have absolutely no idea how to advise someone about technical dental matters. I'm sure many members here are in the same situation. I hope you are able to get some help when you go back to the dentist on Monday.

take care.

Hi GRKzoo,

I am so sorry that I missed your post! I do try to keep up as best that I can.... but sometimes a few fall through the cracks... :/

I will re post some of your thread and answer you in bold type to help keep things clear.

<<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?**
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?**

<<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?**

<<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? **

<<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?**

<< 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!

<<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.

Bryanna,

Thank you so very much for responding and the insights you offer. I'm sorry it has taken me 2 days to get back to this. (I try to reduce my time in front of the computer on weekends to maintain sanity). I'll also address your questions in the order of your reply. I've elected to make them in red.

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).

Thank you again, Bryanna, for answering my questions and the service you do here.

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.

Bryanna,

Thank you very much for the thorough explanations. I can understand all that you are saying.

I'd like to report that I just this moment returned from the dentist for another look at the problem. He went in and removed several very small pieces of bone that were were apparently left behind from the extraction. Very much the way one's body tries to push out a splinter or other foreign object out mine was trying to push these out of my gum. There does not appear to be any infected tissue so I am happy and hopeful that the problem has been resolved.

Thank you again for your help. You are doing a great service here!

Gary

Hi Gary,

It is common to have some splintering of the bone after a tooth extraction. This bony fragments can be very irritating to the gum tissue. However, they do not cause fistulas to form unless there is an underlying problem. Perhaps the bumps you were experiencing post the extraction were not true fistulas, they were more like blisters from the irritation of the splinters of bone.

Let's hope that was it!
Bryanna