Treatment of dental fistulas

Gum fistula

Gum fistula is a medical condition that develops as a result of infection of the tooth structures or surrounding tissues. Below are the main reasons for the formation of gingival fistulas:

• Advanced caries Untreated caries can penetrate the inside of the tooth, infecting the pulp (the central part of the tooth containing nerves and blood vessels). When the pulp becomes infected and dies, the infection can spread along the root of the tooth, forming an abscess that can lead to a fistula.
• Injuries to the teeth Cracks or fractures of the tooth can allow bacteria to access the pulp, leading to infection and fistula formation.
• Advanced periodontal disease Bacteria that cause periodontal disease destroy the bone and connective tissues that support the teeth. When the infection reaches the root of the tooth, an abscess may form, and then a fistula.
• Improper endodontic treatment — sometimes root canal treatment does not completely remove the infection, which leads to its recurrence and fistula formation.

In conclusion, the main cause of the formation of gingival fistulas is neglected or improper treatment of infections of the teeth and gums.

Symptoms of gingival fistula

Gum fistula can cause a variety of symptoms, including:

• Tooth or gum pain — sharp or dull, intensifying when eating or drinking, especially when consuming hot or cold foods and drinks.
• A lift or lump on the gum — usually filled with pus, which can periodically burst and release pus, bringing temporary relief.
• Unpleasant smell from the mouth — caused by purulent discharge.
• Sensitivity of the tooth to pressure or when eating.
• Swelling and redness of the gums around the fistula.
• Fever — in case of a serious bacterial infection.
• Unpleasant taste in the mouth.

It should be borne in mind that some fistulas may be less obvious and not cause pronounced symptoms, especially in the early stages.

Oral-sinus fistula

An oral-sinus fistula (oral-sinus connection) is a rare but serious condition that involves an abnormal connection between the oral cavity and the paranasal sinus, most often the maxillary sinus that is closest to the upper teeth. The main reasons for the formation of an oral-sinus fistula are:

• Tooth extraction — the most common cause. The upper molars are often very close to the maxillary sinuses, and the roots can reach into the sinus. Removal of the tooth can cause a break in the thin bone and tissue barrier, leading to the formation of a fistula.
• Advanced periodontal disease Chronic inflammation causes bone loss, which in extreme cases can lead to fistula.
• Injuries or surgeries in the sinus area or upper teeth — any interference that breaks the barrier between the sinus and the oral cavity can trigger a fistula.
• Retained teeth or wisdom teeth — if they are close to the sinuses, they may be the cause of the fistula.
• Neoplasms or cysts — lead to tissue loss and fistula formation.

Oral-sinus fistula requires immediate treatment, as it can cause recurrent sinus infections and healing problems after extraction.

Symptoms of oral-sinus fistula

Typical symptoms are:

• Problems with speaking and eating - air or food can get into the sinuses, causing unpleasant sensations and changing the voice to “nasal”.
• Unpleasant taste or smell from the mouth — caused by a sinus infection penetrating into the mouth.
• Pain or discomfort in the sinus area.
• Bubbles of air or fluid in the mouth — are formed when air or fluid from the sinus leaks through the fistula.
• Frequent sinus infections.
• Problems with healing after tooth extraction.
• Recurrent sinusitis.

How is a tooth fistula treated?

Treatment depends on the cause and aims to remove the source of the infection and provide an outlet for pus to prevent further development of the infection. Treatment methods include:

• Antibiotic therapy — used when the infection spreads beyond the fistula area.
• Drainage — emptying of the fistula from pus, performed by the dentist through compression or incision.
• Root canal treatment — removal of infected pulp, cleaning and filling of root canals.
• Tooth extraction in case of serious damage or infection.
• surgery — used in rare cases, e.g. with advanced periodontal disease.

After treatment, it is important to prevent recurrence by maintaining oral hygiene, avoiding tobacco and regular visits to the dentist.

How long does a tooth fistula heal?

The healing time depends on many factors, including the patient's health, the severity of the infection, and the treatment used. After canal treatment, the fistula usually begins to heal within a few days. If surgery is necessary, the healing time can be extended to several months.

What is the danger of an untreated tooth fistula?

Untreated fistula can lead to:

• The spread of infection to other teeth, jaw bones and further parts of the body.
• Abscess of the jaw — a serious complication threatening tooth loss and even life.
• Osteomyelitis — infection of the bone, leading to its destruction.
• Systemic infection (sepsis) in extreme cases.
• Damage to tissues and bones around the tooth.
• Chronic pain and discomfort.

Anyone who notices symptoms of a fistula should immediately consult a dentist.

Will the tooth fistula disappear by itself?

The fistula can temporarily “disappear” when the pus has an outlet, which causes pain and swelling to subside. However, the infection remains and without treatment usually recurs, often in a more severe form. Therefore, professional help should always be sought to effectively cure the cause and prevent complications.