Fistula pre and post root canal
 

Hey everyone!
About a year ago, I went in for routine full check up and cleaning of my teeth. Additionally, I had a couple cavities filled at that time too. About a week after I noticed a bump on my lower gum, just under the first molar. I didn't think anything of it at first, I thought it was a canker sore, so I left it. It wasn't big nor bother some, and I soon forgot about it.

6months later when I went back for another cleaning, I had forgotten about my little bump and the hygienist did not notice the bump still there. Once again, I had forgotten about it and it wasn't big or bother some.

I went back for another appointment 4 months later and my dentist took some X-rays and informed me that I might have some infection underneath my tooth at the base of the roots. She didn't seem confident, but claimed that there is a small 'shadowy' area in the X-ray and my best bet was to have a root canal done.

So I went in and got the root canal, but I had some complications with it. I had more than 4 roots in this tooth and it took the dentist 2 appointments to finish. My xrays were sent off to a specialist and was given the "all good".
However, I've noticed the bump (fistula) is much bigger than it was before and often fluctuates in size. Bleeds when I brush and my gum/ jaw is obviously more puffy/ swollen

Did the root canal just make things worse?
What are my options now that I spent thousands on the procedure that didn't work.

Hi Jaacke,

If you want to cure the infection and prevent it from spreading, your only option would be to have the tooth removed. Root canal therapy cannot "cure" an infected tooth because there is no access to the microscopic canals which harbor nerve tissue. This tissue becomes necrotic (dead and infectious) after the root canal is done because there is no longer any blood supplying this tooth with nutrients. It is typical for a root canaled tooth to become abscessed from the necrotic tissue left inside these canals.

In your case, the infection had already spread beyond the tooth into the bone which was indicated by that original lump below the tooth. The xray may only show a slight infection because it is only a 2 dimensional film and can only pick up the pathology that is directly in line with the angle of the film. The fact is that for the infection to spread beyond the tooth means the original infection was larger than seen on the xray.

The bump or lump that you are referring to is called a fistula. This is the body's way of releasing the pressure from the infection. It is not a sign that the tooth is healthy, it is a sign that the infection is spreading. If the path of infection that has caused this fistual closes off from the inflammation, you can end up with a huge swelling. So this is not something to ignore any further. Your dentist may try to sell you on a re-treatment (another root canal) or a surgical root canal called an Apicoectomy. Both of these things will not "cure" the infection because neither of them does anything more than the original root canal. It is not a question of having more canals than normal, as you were told. That is irrelevant. It is the fact that it is not possible to remove all of the necrotic tissue from inside of the tooth which makes the tooth chronically infected.

Replacement options for this tooth depend on many factors and individual circumstances. The longer the infected tooth is present in the mouth, the more the bone deteriorates creating an unstable site for the placement of a dental implant.

I know you have been dealing with this tooth for quite awhile and was hopeful that you could have "saved" this tooth with the root canal. The truth is... when the term "saved or cured" is used pertaining to a root canal... it's misleading because it really means "to retain" not cure or save as in healthy or good. Very different meanings.

I know this is not what you wanted to hear but I hope this information is helpful to you.

Bryanna