Brief overview
- Description: Connection between a cavity filled with pus, e.g. caused by an inflamed tooth root, and the oral cavity.
- Symptoms: Initially, mild swelling and redness of the gums develops, as well as a feeling of pressure on the tooth; over time, the pain increases until the pus empties into the oral cavity via the dental fistula.
- Causes: The cause of dental fistulas is usually inflammation of the tooth, tooth root or tooth root tip.
- Prognosis: If treated in time, the chances of recovery are good. If left untreated, dental fistula can lead to tooth loss and damage to the jawbone in the long run.
- Treatment: As early as possible; treatment with antibiotics; removal of the inflamed root tip, extraction of the affected tooth if necessary; opening of the fistula by a minor surgical procedure.
- Diagnosis: Discussion with the doctor (anamnesis), physical examination (e.g. inspection of the teeth and oral cavity, cold test on the affected tooth, X-ray).
What is a dental fistula?
Dental fistulas are unnatural, tube-like passages or connections between a cavity filled with pus and the mucous membranes in the oral cavity (for example, gums). Fistulas serve to allow fluids such as pus, which has collected in the cavities of the tissue due to the inflammation, to flow through or out. The principle is comparable to a drainage channel.
Fistulas on the tooth or gum usually occur due to infection with bacteria at the root or tip of the tooth. In most cases, the tooth is pre-damaged by caries, which causes bacteria and other pathogens to penetrate the tooth root and multiply.
This causes inflammation in the tissue. In the further course, a pocket with pus forms. With increased pressure, the dental fistula opens and the purulent secretion subsequently drains from the source of infection (base of the fistula) via the fistula canal into the oral cavity.
How do dental fistulas, dental abscesses and aphthae differ from each other?
Dental fistulas, abscesses and aphthae differ from each other in cause and structure. Aphthae are painful but usually harmless lesions of the oral mucosa. They develop as a result of a strong reaction of the immune system, which causes tissue to die. Triggers are, for example, diseases, injuries or stress. Aphthae usually heal on their own within a few weeks.
Fistulas and abscesses are usually triggered by bacteria that invade the tissues of the oral cavity, multiply there and cause inflammation. Whereas the resulting pus in a fistula often empties itself under excessive pressure, the focus of inflammation in an abscess is encapsulated by the surrounding tissue. An abscess must always be opened surgically.
While abscesses and aphthae generally form in the entire oral cavity, for example on the palate or tongue, dental fistulas usually develop only on the gums above individual teeth.
How do you recognize a fistula in the mouth?
A dental fistula usually develops on just one tooth in the lower or upper jaw. The symptoms are very weak at the beginning. Often, those affected initially feel only a swelling of the gums and a feeling of pressure or tension on the tooth. As the disease progresses, a small, blister-like elevation forms above the tooth on the oral mucosa and fills with pus. The inflamed area is unnaturally reddened and sometimes sensitive to touch.
If too much pus accumulates and the pressure in the dental fistula becomes too great, it eventually bursts and the pus empties through the fistula tract into the oral cavity. In most cases, the pain decreases briefly in this way. However, the fistula itself does not disappear and fills with pus again after a short time.
Since the symptoms usually subside again as the fistula bursts, sufferers often do not see a dentist for several weeks or even months. Some sufferers have a dental fistula for years before they see the dentist.
To speed up healing and avoid secondary damage, you should see a dentist as soon as possible if symptoms persist.
Why do you get a dental fistula?
The most common cause of a dental fistula in the oral cavity is a bacterial inflammation of the tooth root, or more precisely the tooth root tip. Usually, the bacteria (mainly streptococci and staphylococci) get to the tooth root when the tooth is already pre-damaged by caries, for example. If the inflammation remains untreated for a long time, a dental fistula eventually forms above the inflamed tooth.
Smoking, poor diet (for example, a lot of sugar) and poor dental hygiene also increase the risk of dental fistulas and at the same time slow down healing. Other risk factors are: Inflammation of the oral mucosa, dental inflammation, a weakened immune system, and injuries in the mouth and throat.
Who is affected?
Dental fistulas, which result from infections of the teeth, tooth roots and periodontium, primarily affect people between the ages of 20 and 40. However, dental fistulas occur at any age, including children and adolescents.
In addition, people with pre-existing conditions (such as diabetes mellitus, bronchial asthma) or immunocompromised people (for example, after a stem cell transplant or chemotherapy), as well as heavy smokers and alcoholics, are more frequently affected by infections in the oral cavity.
How dangerous are fistulas in the mouth?
If patients do not seek medical treatment, the inflammation may progress. In the process, the open wound repeatedly becomes infected with bacteria. The inflammation spreads and may also damage the jawbone.
In rare cases, a fistula becomes blocked, encapsulates itself and becomes an abscess. There is then a risk that the bacteria from the collection of pus in the abscess will spread through the bloodstream and cause blood poisoning (sepsis). This is especially true for abscesses that are not treated or not treated in time.
Sepsis is life-threatening for those affected, as in severe cases it leads to the failure of vital organs such as the heart or kidneys. Patients must receive medical treatment as quickly as possible in a hospital, usually in an intensive care unit.
Dental fistulas sometimes recur despite treatment. In this case, renewed treatment by a dentist is necessary.
How do you treat a dental fistula?
The dentist usually treats a dental fistula with antibiotics to contain the spread of bacteria. The affected person takes these as a tablet every day. The doctor determines the dosage and application depending on how far the inflammation has progressed.
In order to specifically combat the inflammation and avoid antibiotic resistance, it is sometimes necessary to have the pathogen determined in a laboratory (antibiogram).
If the cause of the dental fistula is an inflamed tooth root, the doctor removes the affected part of the root tip (root tip resection). In some cases, it is necessary to remove the tooth completely to stop the inflammation.
This causes the pus to drain into the oral cavity, and if necessary the doctor suctions off any remaining pus in the wound with a small suction cup. Even after this procedure, the doctor usually prescribes antibiotics to speed up healing and reduce the risk of renewed inflammation.
If the inflammation is localized, the cause of the inflammation has been eliminated, and there are no other risk factors (e.g., immunodeficiency), the doctor sometimes does not use antibiotics.
Often, these measures are sufficient for a dental fistula to heal. In some cases, however, dental fistulas return despite treatment (for example, on a root-treated tooth or after a tooth has been extracted). Then another visit to the dentist is necessary.
Under no circumstances should you lance or squeeze a dental fistula yourself. This may cause the inflammation to worsen and delay healing.
The effect of these home remedies has not been sufficiently proven scientifically. Before using them, please ask your dentist for advice.
After treatment of dental fistula, it is necessary for those affected to have the healing process checked regularly by the dentist until the symptoms have subsided. In this way, affected persons reduce the risk of complications and prevent renewed inflammation.
How does the doctor make the diagnosis?
In the event of toothache and symptoms in the mouth area, the dentist is the first point of contact. The dentist first conducts a detailed consultation with the patient (anamnesis). The doctor will ask, for example, how long the symptoms have been present and whether the patient is experiencing pain or other symptoms (such as fever).
He then examines the teeth and mouth. To do this, he examines the teeth and mouth for visual conspicuities such as swelling, unnatural redness, discoloration or injuries.
The dentist then takes X-rays of the jaw. These show how far the inflammation has progressed and whether the jawbone has already been affected.
If there are complications, such as inflammation of the jawbone, the dentist will refer the patient to an oral or maxillofacial surgeon. If necessary, the latter will perform further examinations such as an ultrasound examination (sonography), computed tomography (CT) or magnetic resonance imaging (MRI) to assess the spread of the inflammation and possible damage to the jawbone.
How to prevent dental fistula?
To prevent dental fistula, dentists recommend that an incipient inflammation of the tooth or tooth root be treated as soon as possible. It is best for those affected to contact a dentist as soon as they experience the first symptoms, such as a feeling of pressure, swelling and/or slight pain.
- Ensure thorough, daily oral and dental hygiene.
- Clean hard-to-reach areas and interdental spaces with dental floss.
- Have your teeth checked by the dentist at least once, ideally twice a year.
- Have your teeth professionally cleaned by the dentist at least once a year.
- Strengthen your immune system: eat a balanced diet, exercise regularly, avoid stress and maintain your social contacts.
