Dental fistula still there after root canal
 

I developed a fistula in early December. I went to the dentist and it was my #7 tooth, the filling had fallen out and the root was infected. I was put on a zpack and then a week later, another zpack. She opened up my tooth and lanced the fistula in order to drain. I went back to have the root canal finished and the fistula was filling again. She put me on clyndimyacin for ten days and when I went back, the fistula had drained and she was able to finish the root canal. I finished my antibiotics this past Thursday and I woke this am to find that the fistula had filled back up. I touched it and it burst again. It has been filling up and busting all day. Should I be worried? She is a very good dentist yet this is the first time something like this has ever happened to me. I just don't understand why the fistula keeps filling back up. Reading some posts, I'm getting a little worried about something else causing this. I think it's also important to note that when I first went in with the fistula, she did xray the tooth next to #7 as well, that had a crown the month prior, just to be sure it was not that tooth.

Thank you!

Sorry, that is my number 6 tooth, that had the infection and the root canal performed.

Hi bubble,

A fistula is the result of a long standing infection. In your case, the tooth is infected and most likely a cyst has formed at the end of the root. The area is overwhelmed with bacteria so in an attempt to release the pressure, the bacteria burrows a hole through the bone and gum resulting in a visible fistula. This is not a shallow infection. The infection is not the fistula itself. The infection is deep in the bone.

Once a tooth is infected there is no procedure to "cure" the infection. The tooth has thousands of tiny canals that are not accessible. These canals are not cleaned out during a root canal or apicoectomy which means they will continue to harbor infected nerve material.... leaving the tooth chronically infected. Sooner or later, the infection spreads from the tooth into the bone... resulting in a fistula and/or large swelling. Antibiotics cannot cure the infection either. The most the meds will do is temporarily subside some of the symptoms. But eventually the bacteria becomes resistant to the antibiotics which can make it difficult to eradicate the infection once the tooth is removed..

The infection in the bone causes the bone to deteriorate and there is no rebuilding of bone that is lost to this type of infection. So the sooner the tooth is removed, the more favorable the outcome. The cyst would be removed when the tooth is removed.

I wish I could give you better news but the only way to rid yourself of the infection is to remove the tooth and clean out the infection. It is BEST to have an oral surgeon remove this tooth and not a general dentist because the surgery needs to be thorough and unfortunately many GD's are not thorough enough with their oral surgery.

Please talk with your dentist about this and replacement options asap and get in to see the oral surgeon. I know this is scary, but you will be okay :)
Let us know how you are doing...

Bryanna

Thank you. That's what I have feared, as I have done some research on fistula's and it is scary. I just hope that if the tooth is removed, they will be able to treat the infection. I know I shouldn't dwell on it, but if the antibiotics don't treat the infection after the tooth is removed...then what happens?

Thank you and I will be talking to the dentist on Tuesday and looking for an oral surgeon as well.

Hi bubble,

The source of the infection is the tooth. During the extraction of the tooth, the oral surgeon will also remove the cyst and all necrotic tissue and bone associated with the infection. Most likely you will then be put on an antibiotic to help kill off any residual bacteria. The key here is to get it done asap.

Please try not to be scared.... you will be okay.
Please think twice if your dentist tries to sell you on waiting, re treatment, or an apicoectomy. None of those options are wise or worth the effort.

Check back with us.. ok :)

Bryanna

Will do! Thank you so much!!!

Well, the dentist said she would be concerned if I didn't have the fistula, that the bacteria would have nowhere to go and would be sitting up there, possibly causing a systemic response. She prescribed me Flagyl as she said it should settle down with that. She looked at the xrays again and they looked fine.

However; the bump hasn't refilled back up since Monday night(fingers crossed) and I don't plan on taking the Flagyl. I have been having massive stomach pain and black stool that I just came back from the Dr's for and she said it could have been due to the clindamycin, that I took my last does of last Thursday. She said to let my dentist know that I cannot take anymore antibiotics at this time.

Should the bump (fistula) come back, I will have to get another opinion with an oral surgeon. I do not like the idea of taking all of these antibiotics....

Bubble,

Your dentist said what?????????????????
A fistula is systemic. It is the body's response to infection. It is the body's way of letting off the pressure from the infection. The original fistula may close over but a new one will form in the same or different spot.

Please get another opinion.

Any chance you post the x-rays of this tooth?

Your physical complaint of black stool is a bit concerning. Clindamycin can cause intestinal problems even after you have been off of it for awhile. By any chance are taking an iron supplement??

Bryanna

Yes, and now, the fistula started filling back up today.

It is concerning me and now I have to wait until Monday again to contact someone else.

Unfortunately, no, I don't have the xrays.

No, I take no iron supplements. I went to the Dr. and they found there was no blood in the stool, which is good but I'm concerned whether or not it was the clindamycin causing these issues or if it could possibly be related to my infection in my mouth.

And because I am having these stomach issues, I don't want to take any more antibiotics, certainly not something stronger than clindamycin. And certainly not clindamycin again......

Bubble,

This tooth is very ill and I am upset that your dentist misinformed you... to say the least. Please see an oral surgeon this week.

In the meantime, rinse 3-4 times a day with warm salt water. Make sure to squish the water up into that area deliberately so as to keep the fistula soft.

This is an active infection and you may need further antibiotics even when the tooth is removed. Something other than clindamycin will be prescribed. In the meantime, some diet tips... start taking a probiotic and avoid sugar and soft drinks as much as possible. Drink lots of filter water throughout the day.

A great probiotic called Culturelle will help restore the lactobacillus bacteria which is one of the most important bacterias that antibiotics destroy in the intestines. Stay on this for several months even if you have to take another antibiotic. Just take the probiotic 2 hours before or after the antibiotic. Avoiding sugar is imperative because sugar in any form suppresses the immune system making it work harder to fight infection. The water drinking helps remove toxins from the infection that travel through the renal system (bladder and kidneys).

I am so sorry your dentist gave you false hope. I hear this all the time.... :/

Bryanna