Causes of a fistula on the gums
Fistulas in the area of the gum or tooth can be caused by various factors. In the majority of cases, inflammatory processes that are present directly at the tip of the tooth root cause the formation of a fistula tract. Only by the formation of this fistula tract can the outflow of the purulent secretion be guaranteed.
The inflammatory processes responsible for the development of a fistula at the gum can have various causes. In many cases, advanced carious defects can be detected in the affected patients. As soon as these carious defects reach the depth of the tooth, bacteria can spread within the tooth pulp.
Starting from a so-called pulpitis (inflammation of the tooth pulp), the bacteria then pass through the root canal to the tip of the root. There, if suitable treatment is not carried out, inflammatory processes develop and a purulent secretion is secreted. Furthermore, the bacterial pathogens can reach the root tip from a deep gum pocket.
Some of the patients affected have had a dental trauma before the fistula appeared on the gums. In addition, foreign bodies that penetrate deeply along the edge of the gums can cause irritation. Due to the permanent irritation, inflammatory processes may develop and a fistula may form on the gums.
Since only a targeted therapy, tailored to the cause, can ensure long-term treatment success, comprehensive diagnostics should be carried out. If a fistula occurs after a root canal treatment, the cause is the persistence of a deep-seated inflammation. Since there may still be bacteria in the tissue, the inflammation cannot heal.
Furthermore, a fistula can form if the root is accidentally perforated during root canal treatment. The difficulty is that each root canal can be curved or bent differently. If the root is inadvertently pierced by the dentist, a hole is created towards the bone.
In this case, bacterial colonization and accumulation of pus quickly occurs and the fistula can make its way to the gums of the oral cavity. Apicoectomy is usually the last step to save a tooth after a root canal treatment has failed. However, apicoectomy is also only an attempt to save the tooth and there is no guarantee that the tooth will be free of symptoms after the treatment.
A possible complication is the formation of a fistula. The fistula is a sign that not all bacteria below the root tip have been removed and that secretion continues to form. Therapeutically, an attempt can be made to save the tooth by resecting the root tip again and removing the fistula tract, but the probability that the tooth will be free of symptoms is low. If this is unsuccessful, the tooth must be extracted if it continues to radiate symptoms.
