Fistula on tooth

Definition

In medicine, a fistula represents a non-physiological connection between two body cavities or between an internal organ and the body surface. This connection is then referred to as an inner or outer fistula. It serves to drain a fluid. A fistula on a tooth belongs to the second category; it usually connects a pus-filled cavity with the oral cavity through a so-called fistula duct. The pus-filled cavity, a so-called abscess, which is caused by a chronic inflammation at the root tip of a tooth, can then empty itself through the resulting duct.

Causes

A lack of oral hygiene leads to caries. The caries causes bacteria to move from the oral cavity into the tooth cavity and thus reach the tip of the root. Bacteria can easily multiply there and form a focus of inflammation, especially if the immune system is weakened.

This inflammation can spread further and further inside the tooth and attack the bone for a long time. The body sends more and more so-called inflammatory cells to the damaged area, pus develops. This pus can no longer flow off naturally.

It seeks its own way out through the jawbone. This leads to the formation of a fistula tract. A tooth fracture, orthodontic treatment or periodontosis can also trigger this process.

According to current studies, smoking is a factor that promotes inflammation and thus represents an increased risk. After a root canal treatment a tooth fistula cannot heal. The reason for this is the persistence of the previous inflammation, because there are still bacteria in the damaged area.

The inflammation may return. Sometimes the fistula even develops afterwards. A perforation (piercing) of the tooth root by the dentist during root canal treatment can be the cause.

The dentist uses his instruments to pierce the root of the tooth with his instruments, sometimes unconsciously (strongly curved root canals are often a particular difficulty), so that a hole is created in the bone. At this opening an inflammation can develop again, which can be accompanied by pus and fistula formation. If an apicoectomy has been performed, sometimes symptoms may persist and a fistula may form.

This is always based on the problem that the previous treatment did not result in sufficient sterility. This can be caused by an incorrect preparation of the root, overlooking a root canal, using an unsuitable irrigation fluid or a leaky closure of the tooth. The apicoectomy can only be as good as the root filling it is based on. If necessary, it may have to be renewed if the pain persists in order to be successful.