chronic fistula for 3 yrs
 

I have been fighting with a chronic fistula for over 3 yrs now. It began on the outside of tooth #3. Which had had 2 root canals on it. They finally decided to pull the tooth because of the chronic infection. It would swell up the whole side of my face. They would put me on an antibiotic and it would go away for a while and then come back. So we just pulled it. After tooth was pulled we decided to do an implant. So 3 or 4 months after extraction the oral surgeon did a bone graft. waited for 3 months and put the implant in. Even during this time the fistula would fill up and i would pop it and so on. After the implant went in I did another round of antibiotic (amox). After a couple of weeks my face swelled up again. The oral surgeon said the implant failed and would need to come out. He also discovered the #4 tooth had a a large crack in it. So he removed both the implant and bone graft. Then removed the #4 tooth. Again waiting to heal several months. In the mean time the fistula continues. I waited for 4 months and went back to oral surgeon. He again placed the implant in. This time did not need to do the bone graft. I explained to him that it will indeed infect and swell up but he did not put me on an antibiotic. 1 week later face is swollen and infection returns. He puts me on an antibiotic (amox) and said to just give it some time.
About a month later fistula fills up again and I decide to get a second opinion. The new oral surgeon did an xray and said that the implant was failing again and I should have it removed. He put me on Clyndamicyn. And now today (1 month later) fistula is filling up again and is aching.
So with all that being said...What the heck is causing this fistula? There are no teeth back there anymore. Do I have the implant removed again? HELP!!!:eek::eek:

Welcome KrissyU. :Tip-Hat:

Hi KrissyU,

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

You have a typical and severe case of what can occur when a tooth is root canaled. The rc procedure is done to retain a tooth that will unfortunately remain unhealthy simply because there is no access to the hundreds of tiny canals inside the tooth that will continue to harbor infected nerve tissue. Therefore, it is irrelevant how many times the tooth is root canaled, it will remain infected. The bacteria eventually proliferates beyond the tooth, into the periodontal ligament, into the jaw bone, into the adjacent teeth and beyond.

The fistula is the opening to a tract of infection that has burrowed a hole from the tooth, through the bone, out the gum tissue. Removing just the tooth or teeth is not enough to cure the fistula. The entire area, including any bone and tissue that is involved with the formation of the fistula, also needs to be removed or the fistula will keep occurring as the bacteria continues to make its way through the tract. In upper teeth the tract of infection can travel to the sinus or beyond.

As long as there are untreated areas of infection, antibiotics will be ineffective.

Regarding the placement of a dental implant. It is always risky to replace a root canaled tooth with a dental implant because there is often residual bacteria residing in the jaw bone from that chronically infected tooth, especially if the dentist who removed the tooth did not debride the infected bone thoroughly at the time of that surgery. This bacteria may not be clinically visible until it has grown quite large. Sometimes the bacteria is well hidden in the nooks and crannies of the bone and unless it is very profound, it is not even picked up on dental radio graphs.

Dental implants should never be placed in bone that is questionable. It is imperative for you to have that implant and any remnants of the bone graft removed. That area should be surgically debrided very thoroughly and specimens of the tissue and bone removed from that area should be sent to a pathologist to determine the species of bacteria so the proper antibiotic can be prescribed for you. You should also have a discussion with the oral surgeon about IV antibiotic therapy as oral antibiotics may not be sufficient. A

Have you had any sinus, ear or throat issues? Unexplained fever or fatigue? Headaches? Have you had a dental or sinus CT scan?

Bryanna

Bryanna, as I await my question to be approved by admin and posted, I am continuing to read your helpf advice. Since this is related to my situation, when one has a fistula for years does bone and tisue ALWAYS need to be removed to clear the infection.

Hi civic,

I will re post your question and answer in bold type.

<<when one has a fistula for years does bone and tisue ALWAYS need to be removed to clear the infection>>

YES, A THOROUGH ATTEMPT NEEDS TO BE MADE TO REMOVE THE DISEASED TISSUE AND BONE AT THE TIME THE TOOTH IS REMOVED. ANY DISEASED REMNANTS LEFT BEHIND WILL NOT ONLY PREVENT THE SITE FROM HEALING BUT THE BACTERIA FROM THE INFECTION WILL CONTINUE TO BREW. WITH THAT SAID, THERE IS NO GUARANTEE THAT THE AREA CAN BE COMPLETELY DEBRIDED OF DISEASE BECAUSE THE BACTERIA HIDES MAKING IT DIFFICULT OR IMPOSSIBLE TO SEE CLINICALLY OR RADIO-GRAPHICALLY. THE LENGTH OF TIME FROM THE ORIGINAL INFECTION, WHICH OCCURRED SOMETIME BEFORE YOU HAD THE ORIGINAL ROOT CANAL, TO THE TIME OF THE EXTRACTION IS AN INDICATOR OF THE SEVERITY OF THE INFECTION. NEITHER ROOT CANAL CURED THE INFECTION AND IN YOUR CASE THAT IS CLEARLY EVIDENT BY THE RECURRENT FISTULA.

Placing a dental implant in an area that had a root canaled tooth is very risky to begin with because there is no guarantee that the bone is healthy (without disease) to receive a bone graft or an implant. Anytime a fistula has formed, especially one that has been chronic, indicates that the bone is compromised and perhaps too fragile to integrate with a dental implant. The infection and failure rate of implants placed in compromised bone is very high.

Bryanna

Bryanna... Sorry for the slow reply I have been out of town. When the Oral Surgeon removed the first implant he says he thoroughly cleaned and debrided it. He did take a biopsy of the bone and sent to pathology. It came back clean according to Surgeon. I asked if it should be tested for type of bacteria. He said it did not. That wouldn't do any good.. The only xray is the one that goes around your head. Yes I have sinus infection often. Feel like crap all of the time. Getting an appt. to go back and get this 2nd impant removed. Dont know what to do next.:eek: But am sick and tired of being sick and tired!

Thank you Kitt:D

Krissy,

The panoramic xray is diagnostic to see the upper and lower jaws in their entirety as well as some other anatomy. However this type of xray does not show the areas up close like periapical and bitewings xrays do. It is advantageous to have a full mouth series of xrays... which include about 16 periapicals and 4 bitewings as well as the panoramic film.

Bryanna