Fistula
 

Hello, I had a fistula in 10/12. The dentist, a oral surgeon, did a procedure (apicoectomy)and fixed it. However, in 3/14 I had another fistula in the same tooth - same root. I did not find out it was the same tooth until the insurance company denied coverage due to "frequency". Now, I call the dentist and he says oh yeah it was the same tooth as last time and it is not uncommon for the fistula to reoccur in the same tooth. Had I know that it was the same tooth and likely to recur, I would've had it pulled the first time. This tooth has been through a rot canal and two apicoetomies!!
Is a recurring fistula common? What happend to me? Thanks, Ilona

Hi Ilona,

I am in the dental field and can offer you some information here. I know you are baffled by what is happening and scared about what is going to happen. I am going to give you information that your dentists have probably neglected to share with you. It is not pleasant for me to tell you these things or pleasant to hear them, but you have the right to be properly informed. So do not panic when you read this. Just know that you need to take action asap with an oral surgeon to remove the source of the infection which is your tooth as this is the only means of attempting to eradicate the infection.

It is very common for a root canaled tooth to end up with a fistula and for that fistula to keep returning, irrelevant of the apicoectomies, because there is a chronic infection brewing inside of the tooth. There are many hundreds of tiny canals inside of every tooth that contain nerve tissue. These canals are not accessible during the root canal procedure so their contents remains the source of the chronic infection. When the infectious bacteria proliferates beyond these small canals it travels into the jawbone often resulting in a fistula. Because the bacteria is not able to be removed from the tooth, the infection never really goes away. The rc and apico procedures may temporarily subside the acute symptoms but they do not cure the problem. Thus the recurrence of the fistula.

It is important for you to know that with every fistula occurrence and with every apicoectomy you permanently lose more of the jaw bone. This type of bone loss is generally not successfully replaced with graft material because the surrounding bone is often unhealthy too. The fistula is the result of bacteria that has burrowed a hole (tunnel) from the tooth, through the bone and through the gum tissue. In it's path it creates infected, necrotic, diseased bone.

Another thing you should know is that the bacteria is not limited to just this one area or your mouth. Infection in the bone, anyplace in the body, is considered a serious infection as the bacteria travels through the bloodstream. This can result in a systemic infection elsewhere in the body, cause or contribute to chronic illness and more.

After 30+ yrs in dentistry I still find it unbelievable how many dentists do not inform their patients of these facts. They treat jaw bone infection as if it were a scraped knee. Ask an orthopedic surgeon about jaw bone infection and he will tell you exactly what I have told you here.

The only way to attempt to cure the infection is to remove the source of the infection which is the tooth. There is no procedure or medication that will cure or stop this infection from proliferating. It is wise to have the adjacent teeth evaluated thoroughly prior to the extraction of this tooth to rule out infections in those teeth. By any chance are the adjacent teeth currently root canaled?

I am sorry to deliver this news to you.... I apologize for the lack of information that you have been given by your dentists. They are completely aware of all of this but as I said..... they treat it like a scraped knee.

Please do not delay in the removal of this tooth. If you can, please check back with us and let us know how you are doing.

Bryanna

Wow. I had no idea. Thank you for such a thorough response. What an education. I've got to think this through. Thank you, Ilona

Bryanna, just a quick question on this. If someone had an infection in their body from infected teeth then blood work should show it correct ? Otherwise how would you know ? I read you reply and was just wondering about this. Tom

Hi Tom,

I received your personal message... glad the extraction is done :)

There are various blood markers that indicate inflammation and infection in the body. Unfortunately, unless you were bit by a snake or had acute appendicitis or something else similar happen that would immediately get into the blood stream or other organ, the bacteria has to be prevalent enough at the time of the blood draw to indicate an unhealthy or abnormal level.

Oral infections can progress slowly over time and not show up in the blood work until enough of the bacteria has entered the blood stream. This does not mean however that the bacteria is not filtering into the blood, because it is. Routine blood work is not sensitive enough to pick it up until it's severe. There are specialized blood tests that are more sensitive than those routinely done, but many doctors are not even aware of them and they are very expensive and most insurance companies do not cover them. I would have to do some research into what they would be but you are probably not going to find someone to do them. Unless you went to an infectious disease specialist.

It can be difficult to determine when an oral infection has caused you ill health or when it has settled in an organ, a joint, or a bone elsewhere. Sometimes the bacteria shows up "unexpectedly" when someone has surgery in another area of their body and pathological cultures identify and confirm the strain of bacteria(s) as being most prevalent in the mouth. I have known many people who went in for a hip or knee replacement and the surgeon found osteomyelitis (bone inflammation and infection often found in the jaw bone with root canaled teeth or long term infected teeth) brewing in the joint which compromised the new replacement. I have known people and actually had a friend of mine succumb to brain cancer called Glioblastoma Multiforme which the tissue cultures of the tumors confirmed the same strains of bacteria as what was found in his extracted root canaled teeth and jaw bone.

This is why I cannot stress enough on this forum how important it is to not retain dead or infected teeth. Pain is not always a symptom until the problem has progressed. We have to rely on our dentists to inform us of any early signs of infection and there often are many, but sometimes they are more visible to the dentist than to ourselves. We also all need to do our part and become wiser patients about the common sense risks associated with keeping dead or infected teeth. Agree...?

I know you are trying to keep yourself healthy and are concerned about your dental health. It's been several days since your extraction, how are you feeling?

Bryanna




QUOTE=threeputt;1091333]Bryanna, just a quick question on this. If someone had an infection in their body from infected teeth then blood work should show it correct ? Otherwise how would you know ? I read you reply and was just wondering about this. Tom[/QUOTE]

I am doing great Bryanna. :D

Bryanna...what you just said in the above post, especially about your friend with the glioblastoma and the biopsy showing the sames strains of bacteria as in rc teeth is so upsetting. But, if these things have been discovered and are well known, why are root canals still being done routinely? I have only encountered one dentist (actually he is a dental surgeon well respected in my area for working on implants) locally who even indicated to me that he felt that rc's should be limited to only certain situations. That's it. I've met many other dentists over the last few years and none seem to be slowing down their referrals for root canal. Why is this issue so not discussed or even denied if the evidence of great problems is common knowledge among dental professionals? Seems to me the story you just reported would be major news for any dentist or oral surgeon. It is huge.

Hi Tom,

Woo Hoo!! So glad to hear that!
I sent you a reply to your personal note.

Bryanna ~'.'~

Hi Vowel Lady,

You would think that the serious health risks associated with retaining dead and infected teeth would be shared by every dentist in every dental office. The sadness of that is the dental profession has been covering up this information for decades for two main reasons. One, monetary. Endodontics is the most lucrative form of dentistry on the planet. It allows dentists to rc a tooth several times, crown a tooth several times... then extract it and replace it. Two, for dentists to candidly admit to this information would open up the biggest can of worms you could imagine. It would also create a huge stir amongst the dental associations that "creatively control" the dental profession.

Unfortunately, the idea of healthcare in general has changed for the worse over the last several decades in that it has become a "profitable industry" making the $$$ the primary reason for getting into the profession in the first place. This does not behoove anyone looking from the patient aspect as it only serves those providing the treatment. It is hard for doctors and dentists who want to put their patients well being first to even survive in today's healthcare profession because of the things they are forced to comply with if they want to stay in business. I know this to be fact as I have been in dentistry for over 3 decades and I am not blind to what the changes have been nor am silent to them.

The information regarding the serious health risks about rc teeth is beyond upsetting.... unfortunately it is a well kept secret amongst the dental profession. More and more people like myself are starting to step out and make people aware of it. People need to be their own health advocate and need to take their dental health into consideration as it connects intricately to the rest of the body. The only way people are going to do that is if they become aware of the importance in the first place.

Vowel Lady, in 36 years I have come to know many, many dentists. I can count on one hand how many of them have been forthright with information about the risks and toxicities associated with dental care. Some of the most respected dentists are endodontists. Why? Because they are the top earners and achievers of the profession and their work generates lots of work for their peers. It sounds harsh when you talk about this being amongst the HEALTHCARE profession but it is a fact that we all have to deal with.

I have plenty of stories similar to my friend who died of Glioblastoma Multeforme. Some people died, others became seriously ill or incapacitated until their rc teeth were removed and their body healed. Some never fully recovered, others did. If you are really interested in this whole issue, buy the book called The Roots Of Disease, Connecting Dentistry to Medicine by Dr Robert Kulacz and Dr Thomas Levy. This gives all the information you need to understand the entirety of the problem. Dr Kulacz includes many factual stories of his dental patients. He is a brave man for putting this information out there and he has paid the price for doing so.

The initial work of Dr Weston Price back in the early 1900's regarding the rc issue as well as nutritional connections to dental health was astounding and it shook up the dental profession even at that time. His work has been smothered and harshly criticized by the dental associations until only the past 10 years or so. Change will only come when the consumers start to demand it. This is why the consumer needs to be educated on it.

Here is a little blib sharing some of the things that I talk about here...
http://www.anh-usa.org/are-root-canals-safe/

I wish I could confidently tell you to trust your dentist to offer you this information and that he would never think of not disclosing it to you. But f he cares more about his reputation amongst his peers, then in all probability he will dismiss this topic as much as he can. It is up to us, the patient, to become better informed on our own and be knowledgeable enough to feel confident in bringing the subject up and insist on answers.

Bryanna

As I sit here in physical pain from facial nerve damage which perhaps I'll never know exactly what went wrong, but I know for sure it is related to dentistry in one form or another (rc teeth perhaps making me more prone, dentists giving me poor tx, dentists doing unneeded work in my mouth.....etc.) I also feel emotionally distraught reading your post. One would like to think that people going into the medical field wish to help others. Once we reach adulthood, we realize that many go into these field for the money. But to think these same people are hurting others and know that they are doing so, is extremely upsetting. To think that there is a "shared" effort in hiding facts from patients is sickening. Thank you for your clear, well worded post explaining the situation. I will re-read it when I feel better. I do wish to learn more. Thank you for the work you do here.

ETA: book ordered, site read and bookmarked.

Vowel Lady,

It is very disturbing to know what really goes on. Even for me and I work in the profession. In an ideal world all people, irrelevant of their profession, would have the best of intentions and money would not be their motivating factor. However, there is no industry in the world that I can think of that is not driven by money.

The education that dentists receive goes into anatomy, biology, etc but it mainly delves into the carpentry of dentistry. Dentists are not educated to become physicians. They are educated to be doctors of dental science or doctors of dental medicine. Therefore many stay focused on the "carpentry" aspect of what they do much more so than the biological or pathological aspect. This does not mean they are not knowledgeable about the risks or toxicities of dead or infected teeth. It just means those topics are not their top priority. For that reason, they will continue to sell rc procedures under the notion that they are "saving" the teeth. The term "saving" simply means to "retain" not "cure" and they know that.

The other side of this is the lack of knowledge that the average person has regarding what a root canal procedure is and what it isn't. I blame the dental profession for withholding the truth but at the same time, when a person presents with a severely broken, deeply decayed or infected tooth and they want to "save" their tooth... the only options a dentist has to offer is root canal or extraction. I personally believe every patient has the right to be informed of the health risks associated with keeping dead infected teeth and the risks associated with extracting their tooth as well as replacement options. If someone is in an emergency situation and their pain is preventing them from making a clear decision, most of the time a pulpotomy can be done and antibiotics can be prescribed giving the patient a day or so to think about what they believe is in their best interest. Then time should be spent on educating the patient about the risks of both procedures.

Because dentists are basically taught to be tooth carpenters, many of them do not give a second thought to the rc issue and for that reason they do not feel they are doing any harm.

I never want to upset anyone and there is no denying that it can be disturbing. But there is no easy way to deliver this information and I try to give the facts in ways that most people would understand. I urge people to educate themselves on the basic anatomy of a tooth and the obvious connection to the blood vessels and beyons will become obvious. This information allows people to be able to communicate with their dentists much more effectively.

I hope I was able to explain myself clearly. I know you are in a difficult situation and I wish I had a remedy to your problem. Please let me know what you think of the information offered in that book. I hope you find it helpful!

Bryanna

Fistula and returning infections in root canaled teeth
 

Bryanna -

You are providing an incredible service here, so thank you! I have a similar situation which I wanted to run by you, although I think I know what you are going to say. Here is my somewhat unusual(?) story.

9 months ago, I had a fistula form above tooth 2 which has three roots. The tooth already had a root canal. My dentist diagnosed an infection and we tried a conservative treatment of cleaning it out along with antibiotics but a few weeks later, the fistula returned. My dentist then performed exploratory gum surgery and discovered a hole in one of the roots that he said was causing the infection. He amputated most of the root leaving just a little nub for stability. This solution worked well and the tooth was pain free after healing. He believed that my body was reacting to a foreign body and that this would be the most conservative treatment.

Fast forward 9 months when I developed pain in the gum above the tooth. Upon examination, my dentist says I have another infection as evidenced by a hole in the gum (pictured) which is emitting puss when prodded. He says another fistula would have already formed except the puss is draining. I've attached a picture of the hole and an X-Ray of same where you can see the amputated root. Based on the puss, he has concluded that the original procedure failed and that my body is still treating the tooth as a foreign object. He also said there is a 6mm pocket around the gum.

He has offered two options:

1) We can repeat the original gum surgery and remove the rest of the root.
2) We can extract the tooth and replace it with an implant.

He is strongly recommending the extraction, so my question to you is whether that is reasonable.

Based on everything you've written, I'm betting yes, but I wanted to post the info anyway. Picture follows.

Thank you again.
MS7356

PS A secondary question would be - what caused the infection in the first place. Why don't all root canaled teeth develop infection if bacteria is prevalent in the tooth structure?

Hi MS7356,

I will re-post your questions and answer them in bold type.

First let me clarify that your case in not unusual. In fact it is typically seen in dental offices all the time.

<<<9 months ago, I had a fistula form above tooth 2 which has three roots. The tooth already had a root canal. My dentist diagnosed an infection and we tried a conservative treatment of cleaning it out along with antibiotics but a few weeks later, the fistula returned.>>

CONTRARY TO WHAT YOU MAY HAVE BEEN TOLD, THE ROOT CANAL DID NOT CURE THE ORIGINAL INFECTION IN THE TOOTH. THE TOOTH HAS BEEN CHRONICALLY INFECTED THE WHOLE TIME. THE BACTERIA WAS PROLIFERATING FROM THE TINY CANALS INSIDE OF THE TOOTH, TO THE REST OF THE TOOTH, TO THE LIGAMENT AND INTO THE BONE. THERE IS NO CONSERVATIVE OR OTHER DENTAL TREATMENT THAT CAN ALTER THIS INFECTION.

<< My dentist then performed exploratory gum surgery and discovered a hole in one of the roots that he said was causing the infection. He amputated most of the root leaving just a little nub for stability.>>

EXPLORATORY GUM SURGERY...... NOT EXACTLY. THE PROBLEM IN THE GUM TISSUE WAS SECONDARY AND AS A RESULT OF THE INFECTION INSIDE OF THE TOOTH. THE ROOT THAT HE AMPUTATED WAS BADLY DETERIORATED FROM THE INFECTION. THIS DOES NOT MEAN THE OTHER ROOTS WERE HEALTHY, THEY WERE JUST INTACT MORE SO THAN THIS ONE AT THAT TIME. THERE IS NOTHING STABLE ABOUT THIS TOOTH.

<< This solution worked well and the tooth was pain free after healing. He believed that my body was reacting to a foreign body and that this would be the most conservative treatment. >>

THE ROOT AMP TEMPORARILY REDUCED THE INFLAMMATION IN THAT AREA. BUT BECAUSE THE TOOTH IS SO INFECTED, THE PROBLEM IS STILL PRESENT AND THE BACTERIA IS STILL SPREADING. YOUR BODY WAS REACTING TO THE INFECTION...... AND WILL CONTINUE TO REACT TO IT. THAT FOREIGN BODY STUFF HE TOLD YOU.......... BS.

<<Fast forward 9 months when I developed pain in the gum above the tooth. Upon examination, my dentist says I have another infection as evidenced by a hole in the gum (pictured) which is emitting puss when prodded. He says another fistula would have already formed except the puss is draining.>>

AS I SAID THE INFECTION IS STILL BREWING. IT IS NOT ANOTHER INFECTION, IT IS THE SAME ONE AND ALL EVIDENCE SHOWS IT'S SEVERE.

<< I've attached a picture of the hole and an X-Ray of same where you can see the amputated root. Based on the puss, he has concluded that the original procedure failed and that my body is still treating the tooth as a foreign object. He also said there is a 6mm pocket around the gum. >>

AGAIN THIS FOREIGN STUFF...... THE TOOTH HAS BEEN CHRONICALLY INFECTED SINCE THE ONSET OF THE INITIAL INFECTION PRIOR TO THE ROOT CANAL PROCEDURE. SINCE ROOT CANALS CANNOT CURE AN INFECTED TOOTH, THE RC PROCEDURE DID NOT "FAIL". THE PROCEDURE IT IS FLAWED TO BEGIN WITH AS THE ANATOMY OF TOOTH DOES NOT ALLOW ACCESS TO THE HUNDREDS OF TINY CANALS THAT HARBOR INFECTED NERVE TISSUE. YOUR TOOTH IS NOT A FOREIGN OBJECT AND YOUR BODY IS REACTING TO THE INFECTION.

<<He has offered two options: 1) We can repeat the original gum surgery and remove the rest of the root. >>

NO YOU REALLY CAN'T. YOU NEED ROOT STRUCTURE TO ANCHOR A TOOTH IN THE BONE. THE TOOTH DOES NOT JUST SIT ON THE GUM IT NEEDS ROOTS. REPEATING ANY PROCEDURE WILL NOT CURE THE INFECTION INSIDE OF THIS TOOTH NOR WILL IT CURE THE INFECTION IN THE JAW BONE.

<<2) We can extract the tooth and replace it with an implant. >>
THE ONLY WAY TO ATTEMPT TO CURE THIS INFECTION IS TO REMOVE THE SOURCE OF THE INFECTION WHICH IS THE TOOTH.

REGARDING A DENTAL IMPLANT.... ANYTIME A ROOT CANALED TOOTH IS REPLACED BY AN IMPLANT THE RISK OF INFECTION AND FAILURE OF THAT IMPLANT IS HIGH DUE TO THE LONG STANDING INFECTION IN THE BONE. WHEN THIS TOOTH IS REMOVED THE BONE NEEDS TO BE THOROUGHLY DEBRIDED OF ALL VISIBLE INFECTION AND NECROTIC BONE. BONE GRAFTING SHOULD ONLY BE PLACED AT THAT TIME IF THE CLEANED BONE IS HEALTHY ENOUGH TO RECEIVE IT. OTHERWISE THE INFECTION WILL SPREAD TO THE GRAFT AND IT WILL FAIL. AN IMMEDIATE IMPLANT SHOULD NOT BE PLACED IN THIS AREA AT THE SAME TIME AS THE EXTRACTION ..... AGAIN DUE TO INFECTION AND FAILURE.

THIS TOOTH IS ALSO IS CLOSE PROXIMITY TO YOUR SINUS. SO THERE MAY BE A SINUS PERFORATION AND/OR THE INFECTION MAY HAVE INVADED THE SINUS CAVITY. THIS TOOTH SHOULD ONLY BE REMOVED BY AN ORAL SURGEON... NOT A GENERAL DENTIST.

<<He is strongly recommending the extraction, so my question to you is whether that is reasonable.>>

THIS IS THE FIRST AND ONLY THING THAT I AGREE WITH YOUR DENTIST ON. IT IS NOT ONLY REASONABLE TO REMOVE THIS TOOTH.... IT IS IMPERATIVE THAT YOU REMOVE IT.

<<PS A secondary question would be - what caused the infection in the first place. Why don't all root canaled teeth develop infection if bacteria is prevalent in the tooth structure?>>

THE INFECTION WAS CAUSED BY EITHER DECAY THAT WENT INTO THE NERVE OF THE TOOTH, OR TRAUMA FROM DRILLING INTO THE TOOTH DURING A RESTORATION OR CROWN PREP.

ALL ROOT CANALED TEETH ARE INFECTED. AS SOON AS THE NERVES BECOME DISEASED, FOR WHATEVER REASON (DECAY OR OTHER) THE TOOTH BECOMES CHRONICALLY INFECTED AS THERE ARE NO MEANS OF REMOVING ALL OF THE INFECTED NECROTIC NERVE TISSUE FROM THE HUNDREDS OF TINY CANALS INSIDE OF THE TOOTH.

THE BACTERIA PROLIFERATES FROM THESE TINY CANALS, INTO THE OTHER AREAS OF THE TOOTH, THROUGH THE TOOTH INTO THE PERIODONTAL LIGAMENT, INTO THE JAW BONE AND FURTHER. RESULTING IN BONE LOSS, ETC.

DURING THIS PROCESS, THE IMMUNE SYSTEM TRIES TO DEAL WITH THE INFLAMMATION AND INFECTION AND THE BACTERIA TRIES TO FIND A WAY T RELEASE ITSELF. SOMETIMES THE BACTERIA PUSHES THROUGH THE GUM AND BONE OUT THROUGH THE TISSUE...OTHER TIMES IT PROLIFERATES INTO THE SINUS MEMBRANES AND BEYOND... SOMETIMES IT GOES THROUGH THE BLOOD STREAM AND SETS UP IN AN ORGAN OR A JOINT.

NOT ALL INFECTED TEETH HAVE ORAL SYMPTOMS. ESPECIALLY IF THE INFECTION HAS TRAVELED ELSEWHERE IN THE BODY.

PLEASE SEE AN ORAL SURGEON FOR THE REMOVAL OF THIS TOOTH AND NOT YOUR GENERAL DENTIST.

Keep us posted...... good luck!
Bryanna

Bryanna...Quick note...please don't worry about upsetting/disturbing me. Goodness. Yes, I'm in much pain. Today, again is not good. But, it does no good for me or anyone not to hear the truth. It is hard at times to fully take in what you are saying about rc's ... and of course it's confusing when dentists don't confirm this information. But, I think we each have to do our best to research what we can about our medicines, procedures, etc. and make our own decisions.

When I hear things in medicine that are controversial, things that doctors say are nonsense, I always remember the story of the physician that was ostracized and I think even penalized, because he suggested that women were dying in childbirth because doctors delivering babies weren't washing their hands and were spreading germs. Simple common sense...yet doctors of the time thought that this was "nonsense."

Yes, I do believe I'm in a difficult situation. My health is worsening and it seems to have started with the dentist who had such trouble with putting on a crown....after an onlay fell off. Now I'm wondering if more than one thing went wrong.

On top of the multiple health problems and great pain, I'm concerned about my teeth and likely future repairs and my limited options for the replacement of any teeth removed.

I will probably see for another consultation an oral surgeon who does implants. He is well respected by everyone in my area. He confirmed that I have Trigeminal nerve damage. He is the one dental professional here who semi agreed that rc's are really not good for people. No one else agrees and/or will discuss it. I'm also switching dentists to one that works with this oral surgeon. I always keep my ears open for unusually good dentists...I will travel anywhere in my state.

I ordered the book you suggested used...unfortunately they are sending it book rate....I think it is going to be literally strapped to the back of a snail and sent my way. They said it should arrive by the end of Sept. :rolleyes: