Contents
A fistula on the gums in adults or children is a companion of a purulent inflammatory process in the area of uXNUMXbuXNUMXbthe diseased tooth. This is a protective reaction of the body, a symptom that requires attention and immediate treatment, otherwise serious consequences that pose a threat to health and even life will not be long in coming.
What is a fistula
This is a passage lined with epithelium, and connecting the focus of the formed inflammation at the root of the tooth and the oral cavity itself. Its task is to ensure the outflow of pus from the focus of inflammation. The development of the fistula takes place gradually and consistently.
If a focus of purulent inflammation has formed, then over time its volume increases, therefore, pressure on neighboring tissues, including bone, increases. Pus is looking for a way out and will move in the direction of least resistance, making its way. From the thickness of the jaw, pus strives under the periosteum, and this is how a small abscess is formed. Patients may notice a lump on the gum with a whitish apex.
Further events can go according to two scenarios.
If for some reason, pus cannot find a way out for itself and break through the periosteum and mucous membrane, then periostitis develops, better known as “flux”. Appropriate symptoms appear: severe pain, pronounced edema, which violates the symmetry of the face, general well-being may worsen, and the temperature may rise.
If pus finds a way out, then patients notice a fistula. When pressing on this area, the pus comes out – and at this moment all symptoms disappear. Over time, when the purulent inflammation subsides, the fistula can be delayed, however, if the main cause of its formation is not treated, then it can form again during an exacerbation.
Causes of a fistula on the gums in adults
The main and most common cause is purulent inflammation that has formed at the top of the tooth root, that is, apical periodontitis. In turn, periodontitis is a complication of caries, which was not cured in time. Nevertheless, there are a number of other reasons that can lead to the formation of purulent inflammation:
- poor quality root canal treatment about the pulpit, when they were not completely sealed, not carefully processed and the infection remained in them, or one of the channels was missed, so even previous treatment does not exclude the formation of inflammation in the future.
- serious trauma in the past, for example, a root fracture or perforation, as a complication of root canal filling – such injuries open the way for infection and predispose to the formation of an inflammatory process.
Symptoms of a fistula on the gums in adults
Symptoms of a fistula on the gums in adults are reduced to the formation of a “tubercle”, “pimple” as patients call it, an unpleasant odor and taste in the mouth are characteristic. Pain may be absent, as the pus has found a way out and does not compress the dense network of nerve vessels. However, some patients note the appearance of mild soreness when biting.
It is more important to talk about the symptoms that precede the fistula on the gums in adults. Given that statistically more often, the cause is apical periodontitis, the following symptoms appear:
- severe toothache, which is aggravated by biting;
- enlargement and soreness of the submandibular lymph nodes;
- swelling and pain in the projection of the root of the causative tooth;
- the appearance of an unpleasant taste and smell from the mouth.
Such symptoms may appear even if the tooth has previously been treated, there is an extensive filling or even a crown. But as soon as a fistula has formed, the clinical picture becomes erased: the pain disappears, only mild pain persists when biting, and then not always.
Treatment of a fistula on the gums in adults
When drawing up treatment tactics, many nuances are taken into account: whether the tooth was previously treated, what is the condition of the root canals, how damaged the tooth is, and much more, as well as the reasons for the formation of a fistula on the gums in adults.
Periodontal treatment. The main goal of treatment is to stop the focus of inflammation behind the root apex, remove infected tissues in the root canal, disinfect and high-quality canal filling, and, of course, restore the anatomical shape and integrity of the tooth. Such treatment can take more than one day, and even a month.
If you have previously had endodontic treatment. Complications during root canal filling, unfortunately, are not uncommon: sometimes the filling material cannot be brought to the root apex due to the complex anatomy of the canals, their partial obstruction, etc. This is precisely the cause of complications – the development of infection.
It is not uncommon for a doctor to fail to notice one of the canals or its branches during endodontic treatment, or not to remove the infection completely due to their difficult patency.
In this case, the treatment consists in opening the canals, their subsequent processing and high-quality filling, first with temporary, and then with permanent material. Such a procedure is complex, lengthy and subsequent treatment is delayed for months.
When a tooth is perforated during treatment. A perforation is a hole that was made by a dentist during treatment. Such holes, if appropriate measures have not been taken, are one of the reasons for the development of purulent inflammation. Perforation can occur during root canal treatment, or when a pin is inserted when it does not fit the shape of the canal. Radiography will allow to identify inflammation, but more often this problem is indicated by the appearance of corresponding symptoms.
Treatment in this case is very difficult, but it all depends on the timeliness of treatment. If the perforation is noticed in a timely manner, then the filling materials can close the perforation without problems, but this situation requires constant monitoring by the doctor.
Diagnostics
The symptoms of a fistula on the gums in adults are specific, but all diagnostic measures are aimed at identifying the main cause of its formation. This will help visual and instrumental methods of examination.
It all starts with a survey and clarification of complaints. According to some characteristics of pain, a dentist can make a preliminary diagnosis, but additional examination methods are needed to confirm it.
After that, the dentist proceeds to instrumental methods of examination: each tooth is probed, percussion (tapping), temperature tests are also performed.
The condition of the gums deserves special attention. The data obtained make it possible to carry out a differential diagnosis, that is, to distinguish one disease from another if their symptoms are similar.
It is possible to make a final diagnosis and confirm it only after X-ray or CT scan. These research methods visualize a picture hidden from the eyes, allow you to assess the size of the inflammatory lesion and even see the fistulous tract if a radiopaque material is introduced into it before the image (for example, gutta-percha).
Having determined the cause of the formation of the fistula, some individual characteristics and a treatment plan is drawn up.
Modern treatments
Dentistry is a dynamically developing branch of medicine; modern equipment and the latest filling materials are constantly being introduced into practice, which allow saving teeth even in the most difficult situations.
The success of the treatment of fistula on the gums in adults depends on the quality and accuracy of diagnosis. Significant assistance in this is provided by CT, radiography, and visiography. These methods of examination give a complete picture of what is happening.
The use of a dental microscope also reduces the chance of complications during endodontic treatment, including perforation.
Prevention of fistula on the gums in adults at home
Prevention comes down to regular and thorough brushing of teeth: in the morning after breakfast and before bedtime using standard and additional hygiene products and items, namely brushes, pastes, flosses and irrigators.
Unfortunately, not a single brush and paste will provide 100% removal of plaque, therefore, at least 2 times a year, preventive examinations in the dentist’s chair and professional oral hygiene are necessary. Its main purpose is to remove tartar and plaque, because these are the main causes of caries, as well as inflammatory gum disease.
Timely treatment of caries, when it has not yet turned into complications, is the most effective prevention of fistula on the gums. In addition, it is necessary to choose an experienced dentist who will provide high-quality endodontic treatment.
Popular questions and answers
Fistula on the gums in adults, unfortunately, is not the rarest complaint, and despite the fact that this is just a symptom, the consequences can be very serious. In order not to accelerate their onset, you need to follow certain rules. As soon as he talks about it dentist, implantologist and orthopedist, candidate of medical sciences, associate professor of the Department of Dentistry of the Central State Medical Academy Dina Solodkaya.
The longer a tooth with such inflammation is in the oral cavity, the less bone tissue remains around it. After the removal of such a tooth, the bone volume may not be enough to install the implant and a bone augmentation operation will be required.
Other possible complications include the formation of an abscess and phlegmon, and this is already an acute surgical pathology. Treatment of large abscesses and phlegmon is carried out within the walls of the maxillofacial hospital and these conditions not only pose a threat to health, but also to the life of the patient.
Therefore, it is so important to seek professional dental care in a timely manner and carry it out in full, strictly following all the recommendations of the doctor.
Nevertheless, when a toothache appears and there is a fistulous tract, you need to get an appointment with the dentist in the near future – to diagnose and determine whether conservative treatment is possible (without removing the causative tooth).
To improve the outflow of pus, it is recommended to rinse the mouth with a solution of soda and salt. Rinse your mouth several times a day. Otherwise, alternative methods of treatment may be ineffective and even harmful.