Fistula on the gum of a tooth
Fistula on the gum of a tooth is a pathological formation, represented by a small path through the gum to the lesion. Most often, the fistula comes from the root of a diseased tooth. Through such a channel, serous or purulent exudate is removed. You can see the fistula in the place of the projection of the tooth, in its upper part. It looks like a sore spot. Fistulas do not form next to healthy teeth. Therefore, there is always caries near it, or a filling, crown, bridge or other restoration.
Fistulas can be detected on their own. Its appearance is preceded by swelling of the gums, pus accumulates in the tissues. When the purulent contents breaks through and begins to come out, the pain subsides somewhat. A non-healing opening is formed on the gum, from which exudate constantly oozes. This is the fistula.
A fistula on the gums can form in almost every person, regardless of age and gender. Children are no exception, since a fistula can develop even with milk teeth.
The presence of a fistula on the gums should not be ignored, since this pathology can lead to serious health problems. Pathogenic bacteria will freely penetrate into an open wound, which contributes to increased inflammation, intoxication of the body, and tooth loss. Therefore, if a formation is found on the gum, it is necessary to contact the dentist. However, it will be impossible to postpone a visit to the doctor for a long time, since the fistula will provoke pain, which will significantly worsen the quality of human life.
- Gum fistula symptoms
- Causes of the fistula on the gum
- Dangers of gum fistula
- Diagnostics of the fistula on the gum
- Gum fistula treatment
Gum fistula symptoms
The symptoms of a gum fistula are as follows:
- Toothache, which can be quite intense. Her character ranges from sharp and shooting, to aching and monotonous. The pain tends to be worse when pressure is applied to the affected tooth, for example, when chewing food.
- The tooth acquires pathological mobility, loosens.
- Inflammation forms around the gums, the skin becomes edematous and hyperemic.
- Purulent contents are secreted from the fistula.
- An increase in body temperature is possible.
- An unpleasant odor will come from the mouth, which characterizes the decay process and is not eliminated by oral hygiene.
The pain will be most intense at a time when purulent exudate only accumulates in the area of the inflamed tooth and in the gum tissue. After the pus breaks out and the fistulous canal forms, the pain subsides.
When a fistula develops due to a violation of the dental treatment technique, the fistula does not occur immediately. For some time, the process will have a latent asymptomatic course. The dentist's mistake must be corrected as soon as possible.
Causes of the fistula on the gum
As an independent pathology, a fistula on the gum is not formed.
There must be appropriate reasons for this:
Untreated caries or poor-quality treatment. Over time, caries can turn into pulpitis, and then periodontitis. The infection spreads, affects the upper part of the root, a purulent abscess occurs, and then a fistula forms.
Violation of the canal filling technique. When the doctor fills the tooth canal, he then sends the patient for a follow-up X-ray examination. This allows you to make sure that the filling was of good quality. Otherwise, an abscess may develop, and then a fistula. Moreover, in 60% of cases, the fistula is formed due to poor-quality canal filling.
Damage to the tooth root. When a doctor works with a canal using traumatic instruments, he must be as careful as possible, as there is a risk of damage. If suddenly the dentist allowed perforation of the canal and a rupture occurred, then the development of purulent inflammation is further ensured.
Teething wisdom teeth can lead to fistula formation. Few of them erupt without pain and discomfort. In the most difficult cases, the process is delayed for a long time, the gum becomes inflamed and swollen. The tooth injures her from the inside as it grows. In this place, pus begins to accumulate, which finds its way out through the fistulous canal.
Prolonged eruption of milk teeth in children. In this case, the mechanism of formation of a fistula on the gum is similar to that which occurs when a wisdom tooth erupts.
Cystic formations in the gum cavity can cause a fistula. Fistulas form against the background of cyst inflammation.
The presence of a granuloma of the tooth, in which pus accumulates in the soft tissues around. If this focus of infection is not sanitized in time, then a fistula will form.
There are also risk factors that can give rise to diseases that contribute to the formation of fistulas, among them:
- Severe fatigue;
- Sudden hypothermia of the body, or overheating;
- Immunity disorders;
- Diseases of an infectious nature of both the body in general and the oral cavity in particular.
Dangers of gum fistula
If a fistula is found on the gum, it is necessary to seek help from a dentist as soon as possible. After all, the consequences of this pathology can be very serious.
If the existing inflammation is ignored for a long time, tooth loss is possible. This is due not only to its increased mobility, but also to damage to healthy tissues located nearby. The more extensive the process, the higher the likelihood that the tooth will have to be surgically removed.
In addition, the inflammation can involve the periosteum, which contains the vessels responsible for nourishing other healthy teeth. The infected periosteum undergoes degenerative processes, which in the future will lead to the loss of not one, but several teeth at once. In this case, a massive surgical intervention is required, which will be aimed at removing the entire diseased part of the periosteum.
If there is a lot of pus, then it can affect the soft tissues of the face. When this happens, they also have to be removed during the operation.
Such serious consequences must necessarily force a person to seek the advice of a dentist if a fistula is found on the gum.
Diagnostics of the fistula on the gum
A visual examination of the patient will be enough for the doctor to make a diagnosis. An X-ray examination may be required to clarify the condition of a diseased tooth and to pinpoint the focus of inflammation.
With its help, it will be possible to determine the depth of the fistula, the degree of growth of the granuloma or cyst, the extent of the lesion of the periosteum, etc.
The doctor must make a differential diagnosis with diseases such as gum cyst, adipose tissue, purulent tissue inflammation. Self-diagnosis of fistula is unacceptable.
Gum fistula treatment
After the examination, the doctor will prescribe treatment for the patient. It can be of two types: medication and operational.
A combined scheme is usually used:
- Opening the tooth to gain access to the root canals.
- Pumping out purulent masses, removing dead tissue.
- Antiseptic treatment of the inflammation focus.
- The introduction of the therapeutic composition into the dental cavity for a certain time. After that, the patient is sent home, setting a date for his next appointment.
- During a second visit to the doctor, he will remove a temporary filling from the tooth and assess the condition of the tooth cavity.
- If necessary, the doctor will re-treat the tooth with the drug. The appointment of physiotherapeutic procedures is not excluded.
- After the inflammation has been reliably controlled, the dentist will install a permanent filling.
- If the fistula has formed due to damage to the canals, then in some cases the doctor may not remove the filling from the tooth. The site of inflammation can be accessed through the gum.
In the presence of a crown or a post, tooth filling is a very difficult process, therefore, most often the doctor recommends surgical removal of the tooth apex.
To complete the fistula treatment process, a rehabilitation course will be required. The affected area is irradiated with ultrasound or treated with a laser. Fistula can be treated with biometric current.
If necessary, the doctor will prescribe oral antibiotics to the patient if local treatment is not enough. The course of antibiotic therapy is 7 to 10 days. The drugs of choice are broad-spectrum antibiotics, for example, Augmentin, Tsiprolet, Ofloxacin, Sumamed.
The imposition of professional dental gels and pastes on its surface will contribute to the speedy tightening of the fistula.
With regard to symptomatic treatment, it is possible to prescribe antihistamines to reduce swelling of the gums, taking painkillers.
At home, the doctor may recommend that the patient rinse his mouth with antiseptic solutions: Chlorhexidine, Miramistin, Furacilin. The use of medicinal herbs, such as chamomile, is not excluded.
As for the surgical treatment, it is indicated in three cases:
- Large areas of soft tissue are involved in the inflammation process.
- The tooth is covered with a crown or has pins.
- The tooth periosteum has undergone degenerative processes.
Affected tissue is removed mechanically by scraping. Subsequently, the tooth canal is treated with a laser. The surface of the tooth is filled. These are the main manipulations performed by the doctor in the patient's oral cavity. Then he lets him go home, giving appropriate recommendations. Systemic antibiotics and antiseptic treatment of the affected area are mandatory.
Fistulas on the gums cannot go away on their own, so there is no need to waste time and postpone a visit to the dentist. Extinction of pain is possible, but not relief of the inflammatory process. Therefore, the sooner professional treatment is started, the faster it will be possible to achieve complete recovery.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.