Causes and methods of treatment of a fistula formed on the gum

A fistula on the gum is a pathological cavity in the soft tissues, formed as a result of a long-term, sluggish purulent inflammatory process in the area of the roots of the teeth. In medical practice, the problem occurs quite often, usually due to non-compliance with preventive measures and advanced dental diseases of an infectious nature. The capabilities of modern medicine make it possible to effectively eliminate the disease in various ways. Let us consider in detail the causes, features, symptoms, diagnosis, as well as methods of treatment of this pathology.

What is a dental fistula and what does it look like?

A dental fistula is a canal formed in the gum as a result of processes of decay and necrosis. Through this channel, pus comes out from the source of inflammation. Such a perforation channel is called a fistula - from the Latin “fistula”, which means tube.

As a rule, the lesion is located in the deep layers of soft tissue (periodontium) and is adjacent to the root of the tooth.

Externally, the fistula looks like a small formation with a rounded hole, the diameter of which is from 3 to 8-9 mm, depending on the severity of the disease and the duration of the inflammatory process directly at the site.

The tissues surrounding the canal can also be inflamed, and in especially severe cases they are susceptible to necrosis (death).

Symptoms of the disease

Fistula does not develop in a short time - it is a disease that occurs as a result of long-term exposure to pathogenic microorganisms on soft tissue. As a result, periodontal damage and necrosis gradually occurs, a perforating channel is formed, through which pus from the abscess comes out.

Symptoms of the inflammatory process can be noticeable much earlier than the formation of a fistula, however, if no measures are taken, a fistula tract gradually forms.

A number of signs indicate this disease:

The most obvious manifestation is the periodic discharge of pus and blood from the opening of the fistula on the gum.
In the area of the tooth located close to the canal, severe pain appears. The pain can become acute or aching in nature, and be of varying degrees of intensity.

A characteristic unpleasant odor emanates from the oral cavity, which does not disappear after brushing the teeth, rinsing or using special products to freshen breath.
The presence of a purulent abscess often provokes an increase in body temperature, above subfebrile. A sluggish inflammatory process is accompanied by a slight increase in body temperature - up to 37-38 degrees.
The roots of the affected tooth become mobile, the surrounding tissues become red and swollen.

The formation of fistulas on the gums cannot be ignored , as it is accompanied by constant discomfort, pain and other unpleasant symptoms. Timely diagnosis, accurate identification and elimination of the causes of the disease, as well as highly effective therapy can restore the affected tissues and restore health to the patient.

Causes of the disease

Fistulas on the gums do not develop on their own; they are formed as a result of complications of other dental problems and diseases of the oral cavity. Dentists identify several main reasons that provoke the development of a perforation channel or fistula:

Chronic periodontitis can, under unfavorable conditions, lead to complications in the form of the formation of pathological fistulas. Patients suffering from granulomatous periodontitis are especially prone to the appearance of fistulas on the gums.
Chronic periodontitis and periodontal disease increase the risk of developing fistulas as a result of the formation of purulent cysts and abscesses in the tissues adjacent to the tooth root.
Advanced forms of caries in the third and fourth stages often provoke the development of pulpitis and the formation of purulent cysts in the periodontium. Lack of treatment for an abscess leads to gradual tissue decomposition, resulting in the formation of fistulas on the gums.

Medical errors in the treatment of caries and the consequences of surgical intervention can also lead to the formation of fistula tracts.
A fistula on the gum is formed as a result of chronic or acute osteomyelitis - purulent inflammation of bone tissue.

Additional factors contributing to the development of fistulas are: decreased immunity, hypothermia, systematic violation of the rules of hygienic care of teeth and oral cavity.

Diagnostic methods

If symptoms characterizing the development of fistulas on the gums appear, you must immediately contact your dentist for further diagnosis and treatment. Modern methods make it possible to accurately identify the disease in one go, identify its causes and develop a plan of therapeutic measures.

Diagnosis of the problem occurs in several stages:

The first stage of diagnosis to identify a fistula on the gum is a visual examination by a doctor of the oral cavity .
Dental tomography is an examination of the dentition using special equipment based on X-rays. This is a modern scientific achievement that opens up the possibility of more accurate diagnosis of fistulas on the gums, their localization, features of cysts and abscesses. Not in all cases, doctors resort to tomography in diagnosis, but in complicated forms of the disease and polycystic disease, this method is the most informative.

In some cases, a biopsy is indicated . The purulent cyst is punctured, and the doctor takes a small amount of cystic fluid to analyze, exclude or confirm the malignant nature of the formation.

To diagnose other diseases that are indirectly related to the development of fistula tracts, additional examination may be necessary.

Therapeutic methods

To determine how to treat a gum fistula, the dentist determines the patient’s condition at the diagnostic stage and selects appropriate therapeutic methods on an individual basis. Treatment can be endodontic, surgical and conservative . However, in dental practice, as a rule, these three types of therapeutic measures are combined.

In most cases, without opening the purulent sac, it is not possible to solve the problem of gum fistula, and without medication support and rehabilitation procedures, it will not be possible to eliminate the causative agent of the infection and restore the affected area. Let's look at the features of these types of treatment.

Endodontic measures

After diagnosis and administration of an anesthetic drug, the dentist eliminates the cause of the perforation channel - an abscess. To do this, complete cleansing of dental tissues affected by caries, removal of necrotic pulp and the contents of a purulent cyst.

In some cases, to cure a fistula on the gum, tooth extraction is indicated . After all the manipulations, the doctor treats the root canals with antiseptic solutions and leaves them for further treatment.

Conservative methods

After cleaning the root canals, the patient is advised to take antibiotics to eliminate the infection, as well as the use of local antiseptic and anti-inflammatory agents, and rinsing the mouth.

Having eliminated the inflammation and saved the tooth, the dentist installs a filling and prescribes rehabilitation procedures - laser and ultrasound treatment of fistula tracts, ozone therapy, vitamins for recovery, ointments and gels for healing.

Surgical intervention

In case of serious periodontal damage, inflammatory process affecting bone tissue or polycystic disease, surgical intervention is indicated. After diagnostic procedures and preliminary preparatory measures, tissue resection, cyst cleaning, removal of formed granulation, treatment with antiseptic agents and suturing are performed.

During the rehabilitation period, treatment in a hospital department of maxillofacial surgery, antibiotics and local treatment of the postoperative wound are indicated. After the stitches are removed and the course of antibiotics is completed, the doctor decides on further conservative treatment of the patient .

Folk remedies

In dental practice, when treating any disease, folk remedies can only be used in addition to drug therapy. Moreover, traditional medicine is not effective in eliminating dental fistula. Traditional medicine can enhance the effectiveness of medications and procedures, help eliminate symptoms and speed up recovery during the rehabilitation period.

In folk medicine, the antiseptic properties of chamomile flower infusions are often used. Prepare an antibacterial infusion for mouth rinsing. Calendula and oak bark have similar properties. For rapid healing and regeneration of affected tissues, aloe vera juice is used.

use additional folk remedies to improve your condition and eliminate symptoms only in consultation with your doctor . In folk medicine, there are often recommendations that contradict science and can only aggravate the situation. Traditional methods cannot replace effective endodontic therapy and surgery.

Under no circumstances should you try to open an abscess yourself - if you do it incorrectly, healthy tissues will become infected. Pathogenic microorganisms, having penetrated the blood, can provoke sepsis, which puts a person’s life in danger.

Prognosis for recovery

A fistula on the gum is not a fatal disease. Provided timely diagnosis and selection of an effective complex of drug and endodontic therapy, the prognosis is favorable - recovery and complete recovery occurs quickly , its duration depends on the individual characteristics of the body and the patient’s health status.

In advanced cases, rehabilitation may take longer. The possibility of losing the affected tooth cannot be ruled out. Despite this, timely and properly selected therapy ensures complete recovery in almost all cases.

The only situation when doctors cannot guarantee a favorable outcome is the degeneration of a purulent cyst into a malignant tumor. But even in this situation, timely measures taken - surgical intervention and conservative treatment - provide a high chance of recovery.

The mortality rate from malignant tumors of this type today is no more than 10%.

Prevention

Dental fistula is a disease that can be easily prevented by following preventive rules and providing proper oral care. To do this you need:

Regularly take care of maintaining proper oral hygiene. Brush your teeth twice a day with a properly selected toothpaste and brush, periodically remove tartar deposits, and use dental floss.
Get preventative dental checkups every 6 months. This will allow pathologies to be identified at an early stage.

Treat caries and other oral problems in a timely manner.
Take care of a nutritious, balanced diet and exclude harmful foods and drinks.
Lead a healthy lifestyle, stop smoking.

The condition of the teeth and oral cavity affects the functioning of other organs and systems. If there is a focus of infection in the mouth and pathogenic microorganisms spread, other dangerous diseases may develop. Therefore, you should not postpone the treatment of dental diseases - this is important for the health of the whole body, especially the digestive system. Treatment started in the initial stages of the development of any dental disease almost always gives positive results and takes less time.

Source: https://tvoidantist.ru/lechenie/desen/svishh-na-desne.html

Fistula on the gum: causes and treatment

It is almost impossible to independently determine the nature of pain or inflammation in the oral cavity without appropriate preparation.

It is necessary to take such a formation as a fistula with particular seriousness. Only a dentist can identify the cause of the disease, its nature and possible methods of treatment. If the patient postpones visiting the doctor for a long time, he may even lose one of his teeth.

What is it and what are the symptoms of the disorder?

Fistula is an inflammatory disease. It looks like a hole or pouch in the gum. In fact, this is a channel inside the gum that connects its surface and the suppuration in the area of the tooth root.

It drains the resulting fluid and purulent masses from the source of inflammation. In the vast majority of cases, it can be detected by simple visual inspection with the naked eye.

A fistula forms on the gum due to the proliferation of connective tissues (granulation). As a result, the healing process of the inflamed root or nerve of the tooth becomes more difficult. This causes infection, rapid proliferation of pathogenic bacteria and suppuration.

With a prolonged course of the disease, the growing granulation disrupts the mucous and bone tissue of the gums. Pus begins to flow onto its surface, and a fistula forms.

In addition to the obvious, this dental disease has other symptoms:

toothache , it can be severe or aching. Usually worsens with pressure (eg, chewing);
mobility , loosening of the problematic tooth;
visible inflammation and redness of the gums around the affected tooth;
discharge of purulent masses ;
increase in the patient's body temperature.

The most accurate diagnosis can be made using X-ray equipment. But in most cases, you can limit yourself to a routine examination.

Classification of the disease

The photo shows an external fistula on the gum

A fistula on the gum can be external or internal:

the formation of the external form on his own. This is usually the reason for visiting the dentist.
internal ones by visual inspection. To detect it, radiography is necessary. The internal course of the disease is inflammation, the formation of a focus of infection at the root of the tooth before the fistula reaches the gum surface. The patient cannot detect the internal form of the disease on his own.

Where is the reason?

But in any case, the appearance of fistulas is preceded by some inflammation and the formation of a purulent area at the root of the tooth. Subsequently, suppuration breaks through to the surface of the gums through the resulting fistula.

Even if the tooth looks completely healthy or has recently been treated, the appearance of a fistula clearly indicates some kind of inflammatory process inside the gums.

The causes of fistula formation are usually:

advanced forms of caries or pulpitis, their untimely or inappropriate treatment;
poor-quality filling of dental canals;
perforated tooth root;
inflamed cyst;
difficult, prolonged eruption of wisdom teeth;
granuloma.

Necessary clarifications:

If the treatment of caries was not performed well enough, the disease can progress and lead to inflammation of the dental nerves and take the form of pulpitis. Without proper treatment, it develops into periodontitis. With pulpitis, infection occurs, inflammation of the nervous tissue of the tooth itself. If treatment is not carried out, this can lead to complete death of the dental nerve and the spread of inflammatory processes deeper - to the tooth root. As a result, periodontitis appears - inflammation, the formation of pus at the top of the tooth. Subsequently, a canal is formed - a tube through which pus from the source of infection flows to the surface of the gum, forming a fistula.
Statistics show that the percentage of poorly filled canals during dental treatment reaches 65-70%. The main mistake is insufficient filling depth. This leaves an empty area at the root tip. Such cavities are a favorite place for bacteria to multiply and cause infection. Over time, the affected area grows beyond the boundaries of the tooth root and a cavity forms at its apex with the formation of pus, and then a fistula.
If you clean the dental canal carelessly, it may be accidentally damaged. As a result, a non-physiological hole is formed. Without timely filling, it can cause inflammation, the formation of purulent masses and the appearance of a fistula.
Very often, until a certain moment, a cyst at the apex of a tooth root does not manifest itself in any way, and therefore is not diagnosed and not treated. But if some unfavorable conditions occur, for example, a decrease in the body’s immune defense, the cystic formation can become inflamed. When enough pus forms, it begins to look for a way out. This is how a fistula forms on the gum.
It’s rare that wisdom teeth erupt without some discomfort. In difficult cases, the process drags on for a long time, the gums in its area become inflamed and swollen. As a result, it is injured by the growing tooth on the inside and the one located opposite on the outside. In this place, pus accumulates, and then a fistula appears.
The cause of a fistula can be a granuloma - an accumulation of fluid and pus in the soft tissues of the gums around the tooth. If timely treatment is not carried out, the inflammatory process can lead to the formation of a fistula.

How does a fistula form on the gum and the basics of its treatment:

Surgical treatment is the main solution

The photo shows an internal bone fistula from a cyst into the periodontium

At the moment when the tooth fistula appears on the surface of the gum and the pus comes out, the patient feels sudden relief. Pain sensations are significantly reduced, and the person thinks that there has been an improvement.

This is why most often a visit to the dentist is postponed and the disease becomes more complicated. What can be done if a fistula appears in the mouth?

The advanced form is very difficult to treat with therapeutic methods. Without timely treatment, the inflammatory process and suppuration affect the periosteum. In this case, it is no longer possible to hesitate; emergency measures are necessary to remove the pus as quickly as possible and to save the adjacent teeth.

The affected tissue is removed by curettage, after which the canal is treated with a laser. The treatment does not end there and the patient continues it independently in accordance with the doctor’s recommendations.

Treatment at home

Only a dentist can choose the optimal method of treating a fistula. And he can certainly determine whether drug treatment is sufficient only after an examination using X-rays.

Whatever treatment is chosen, it must begin with removing the cause of the problem. To do this, the dentist opens the diseased tooth and thoroughly cleans the inflamed canals. Then the resulting cavity is thoroughly washed and disinfected.

Medicine is placed in it in the form of a paste and a temporary filling is placed. Subsequently, the tooth canals are filled and a permanent filling is placed.

When performing dental procedures, an additional course of treatment with antibiotics is required to stop the inflammatory process. It is prescribed for 7 or 10 days depending on the severity of the case. The most commonly used are: Augmentin, Tsiprolet, Ofloxacin.

Furacilin, Chlorhexidine and Miramistin can be used for this. Treatment must be supplemented with antihistamines (Tavegil, Erius).

Folk recipes

The use of decoctions and ointments from medicinal herbs cannot eliminate the cause of the fistula or lead to its complete cure. But they are excellent anti-inflammatory agents. They can be used before visiting the dentist to relieve inflammation and swelling or after for the purpose of speedy healing.

How to cure a fistula in the mouth without the use of chemicals and surgery:

For rinsing, use a decoction or tincture of chamomile and calendula . These herbs can be used individually or together. In addition to them, eucalyptus, sage, fir, and yarrow have an anti-inflammatory effect.
from eucalyptus . The leaves of the plant are crushed and mixed with sunflower oil. The mixture is infused for 24 hours, then chopped onions are added. All ingredients are taken in approximately equal proportions. Then a little of the resulting ointment is wrapped in a sterile bandage or napkin and applied to the fistula. The product draws out purulent masses and helps heal the wound.
Bee propolis has a disinfecting effect . To speed up healing after medical intervention, it is recommended to dissolve it or keep it under the tongue to cleanse the oral cavity of bacteria.

Complete relief from fistula is impossible without eliminating the root cause of its occurrence. A visit to the dentist is inevitable. Delaying it can only complicate, aggravate the situation and lead to tooth loss.

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Source: http://dentazone.ru/bolezni-desen/drugie/svishh.html

Fistula on the gum: what it looks like, why it’s dangerous, treatment in adults

A fistula on the gum is a sign of an inflammatory dental disease, which is an opening between the source of inflammation and the oral cavity itself.

Ignoring the inflammatory area of the gums can lead to serious consequences and deterioration in overall health.

What to do if a fistula canal is detected on the gum, and what methods of treating dental disease exist?

Fistula on the gum: what is it, what does it look like?

The fistulous opening on the gum is a convex neoplasm of an inflammatory nature, rising above the surface of the periodontium. From the fistula tract it is possible to discharge pus mixed with blood, accompanied by severe pain. As a rule, the location of the lesion is in the alveolar region of the gums near the pathological tooth.

Symptoms of the disease

A fistula in the oral cavity in adults and children has the following symptoms:

hyperemia and cyanosis of the affected mucous membrane of the gums;
sensation of a foreign body in the mouth;
halitosis observed when breathing and talking with an interlocutor;
pain during chewing and hygiene procedures;
discharge of pus and blood from the affected area;
pathological mobility of teeth.

In addition to the above symptoms of the disease, against the background of a local inflammatory process, general health worsens , body temperature rises weakness and apathy appear .

Why is a fistula on the gum dangerous?

A fistula on the gum mucosa is dangerous due to the occurrence of diseases of internal organs, infection of the blood and lymph, irreversible changes in the tissues of the oral cavity and face, and partial or complete loss of teeth.

To avoid undesirable consequences, if a suspicious tumor is detected in the oral cavity, you should immediately contact your doctor to make a diagnosis and prescribe treatment for a fistula on the gum.

Reasons for the formation of a fistula tract

The reasons for the formation of a fistula on the gum mucosa can be:

caries and its complications (pulpitis, periodontitis);
improperly sealed tooth canals, resulting in an inflammatory process at the root apex;
pericoronitis (inflammation of the eighth tooth);
improper eruption of temporary and permanent teeth;
granuloma of the tooth.

In addition to the main reasons leading to the appearance of gum fistula, there are a number of factors that provoke the inflammatory process in the periodontium:

frequent stressful situations;
overwork;
colds;
decline of the immune system;
intoxication of the body due to infectious diseases.

Caries and pulpitis

Lack of treatment for the carious process is fraught with penetration of infection deep into the root canal. Infection of the nerve and blood vessels located in the tooth pulp leads to a serious inflammatory process called pulpitis .

Ignoring nightly throbbing pain and other signs of pulp inflammation is dangerous due to necrosis of the periodontium and bone tissue, as well as the formation of a dental cyst. In such a situation, a fistula is formed as a result of the formation of a huge amount of exudate and swelling of soft tissues.

Periodontitis

Periodontitis is a complication of untreated or poorly treated pulpitis. There are cases when periodontal inflammation occurs after the introduction of infection through pathological periodontal pockets (with gingivitis and periodontitis).

In acute and chronic periodontitis, a fistula is a consequence of ignoring the disease. Pus comes out through the resulting hole, and the throbbing pain subsides. Having broken through, purulent exudate forms again and again until the disease is treated. Lack of treatment for periodontitis and fistula leads to tooth loss.

Perforated root

When the preparation of dental canals is poor and the integrity of the root walls is violated, root perforation is formed. Through the resulting hole, bacterial microflora can penetrate into the tooth cavity, resulting in the formation of a fistula on the gum with a large inflammatory area. The danger of perforation lies in infection of the soft tissues and periosteum of the oral cavity.

Granuloma and cyst

Dental granuloma is an inflammatory lesion of the root apex and periosteum of the jaw. The cyst and granuloma grow over several weeks. In the first days of the disease there are no complaints.

After a certain time, the patient complains of a change in tooth color. When exposed to favorable factors (hypothermia, stress, infections), a fistula with purulent discharge appears on the gum.

At the same time, the body temperature rises, the sublingual lymph nodes enlarge, and throbbing pain bothers you.

Fistula on the gum after treatment or tooth extraction

Treatment of a tooth by filling is indicated for caries, pulpitis, periodontitis, as well as during the preparation of a tooth for the placement of orthopedic structures.

According to statistics, in more than 50% of cases of therapeutic treatment in dentistry, canal filling is carried out poorly.

As a result, an unfilled canal or its perforation leads to an inflammatory focus of an infectious nature.

As for tooth extraction, if the rules of asepsis and antisepsis are not followed during the operation, infection may be introduced into the resulting hole. In this case, the inflammatory exudate exits through the gingival fistula.

How to treat a fistula on the gum

Treatment of the inflammatory area on the gum is carried out by a dentist after identifying signs of the disease and obtaining an image of the teeth. On an x-ray you can see what the fistula looks like, its location and the area of damage to the periosteum.

Removing a fistula on the gum includes several stages:

Removing the cause of the inflammatory process.
Antibacterial and anti-inflammatory therapy.
Surgical intervention.
Antiseptic treatment of affected areas.

Therapeutic therapy is carried out by experienced doctors in a dental clinic. The cost of treating a fistula depends on the degree of damage to the soft tissues and periosteum, as well as the patient’s preferences. As a rule, procedures to eliminate fistula formation cost about 4–6 thousand rubles.

Conservative treatment in adults. Antibiotics

After diagnostic measures and elimination of the cause of the inflammatory process, appropriate treatment is prescribed. In order to destroy pathogens and reduce the inflammatory process, antibiotics are used that affect the activity of pathogenic microflora:

"Arlet";
"Metronidazole";
"Sumamed."

In addition to the internal use of antibacterial agents, affected areas are also treated with antimicrobial gels and ointments:

"Dentamet";
"Metrogil denta";
"Asepta".

For baths and rinsing the mouth, the following are recommended: miramistin and an aqueous solution of chlorhexidine.

Surgical treatment of fistulas

Surgery is indicated for:

destruction of jaw bone tissue;
presence of orthopedic structures and pins;
spread of infection to adjacent tissues of the oral cavity.

Under local anesthesia, the dental surgeon pierces the fistula and removes the anesthetized tissue using curettage. The next step is treatment of the root canals with a special laser and filling of the tooth. After removal of the fistula and affected tissue, the patient is given recommendations for treating the inflammatory gum area at home.

Treatment during pregnancy

The task of treating a gum fistula in a pregnant woman is not only to eliminate the defect in the oral cavity, but also to preserve the life and health of the fetus. Therefore, therapy should be carried out jointly with a dentist and obstetrician-gynecologist. When prescribing medications, all risks of complications and the health status of the unborn baby are taken into account.

If the use of certain drugs during pregnancy is unacceptable, treatment is postponed to the period after childbirth, and symptoms are relieved with local drugs.

Treatment of a fistula on the gum at home

How is a fistula on the gum treated at home? This method of therapy is practiced in cases where you have to postpone a visit to the dentist for some time. Home treatment is also used as an additional therapy to a course of antibiotics. In order to eliminate the acute symptoms of the inflammatory process, medicinal plants and oils are used.

How to rinse a fistula

To eliminate signs of inflammation and destroy pathogenic microflora, it is recommended to rinse your mouth with the following means:

infusion of chamomile;
infusion of calendula and oak bark;
"Rotokan";
Mouth rinses: “Parodontax”, “Lacalut aktiv”, “President defense”.

If the fistula has ruptured and purulent exudate has accumulated in the oral cavity, an aqueous solution of chlorhexidine 0.05% is used for rinsing. When the exudate does not come out on its own, how to draw out the pus? To do this, you can prepare a soda-salt solution and rinse with it 3-4 times a day until the desired result is obtained.

Folk recipes

You can cure fistula at home with folk remedies by using:

onions, eucalyptus and sunflower oil (the mixture is applied to the fistula 2-3 times a day);
aloe, Kalanchoe, propolis (the mass is applied through gauze to the affected area for 10–15 minutes);
crushed raw potatoes, salt (the mixture is used as an application for 10-15 minutes 2-3 times a day.)

In addition to local therapy, it is recommended to drink infusions of echinacea and pomegranate peel, as well as fruit and berry fruit drinks. Such drinks will help restore the immune system, thereby preventing further growth of the infection.

eucalyptus tincture

It should be remembered that the use of exclusively traditional methods of treatment will not help to cope with the problem, but will only aggravate its course. To prevent complications, dental care from a doctor is necessary.

Complications. Forecast

With a timely visit to the dentist, proper treatment and compliance with all recommendations of the attending physician, the prognosis for treatment of a fistula on the gum is favorable. If you ignore the disease or treat it yourself without the supervision of a dentist, the following may occur:

granulomas;
osteomyelitis;
phlegmon;
atrophy of the periosteum;
disorders of the gastrointestinal tract;
sepsis.

Can a fistula go away on its own? Unfortunately, the answer is no. Based on the etiology and pathogenesis of dental disease, getting rid of a fistula is possible only through medication and surgery.

P. I. Ivasenko - Emergency conditions in outpatient dental practice, M.: Medical book, 2009.
Yakovleva V.I. – Diagnosis, treatment and prevention of dental diseases, Minsk 1994.
Ivanov V.S., Urbanovich L.I., Berezhnoy V.P. — Inflammation of the dental pulp, M., Medicine, 1990.
Borovsky E.V. - Clinical endodontics, M.: JSC Dentistry, 2003.
Afanasyev V.V. — Surgical dentistry: textbook, M.: Geotar—Media, 2011
T. G. Robustova, V. V. Afanasyev [and others] - Surgical dentistry / 4th ed., M.: Medicine, 2010.

Source: https://DesnaZub.ru/zabolevaniya/svishh-na-desne

Fistula on the gum: causes, treatment

A detailed overview of all the causes of a fistula on the gum, as well as first aid methods for this pathology

A fistula on the gum can form regardless of age and gender.

The pathology has characteristic symptoms, but to find out the cause of its occurrence, just an examination will not be enough - an X-ray examination will be required.

This is due to the fact that the fistula is the result of internal suppuration in the gum tissue. Why it develops, how to treat it and whether its occurrence can be prevented - this will be discussed later in the article.

What is the disease

In dentistry, a fistula or fistula is a kind of passage or duct (channel) passing from the place of accumulation of pus inside the gum to its surface.

In most cases, it is located in the projection of the diseased tooth. By the time it matures, a hole appears on its surface, which allows the contents of the abscess to escape out.

The pathology can become chronic and fraught with serious complications.

Why does a fistula form?

The main reasons for the formation of a fistula on the gum:

diseases of the oral cavity, especially in an advanced stage,
errors during therapeutic or preventive measures (for example, damage to soft and hard tissues, perforation, infection penetration into the tooth cavity, and so on),
penetration of bacteria under the crown, filling and other structures if they do not fit tightly,
insufficient oral hygiene,
difficulty erupting wisdom teeth,
tooth trauma - a fistula appears near a healthy unit of the dentition, for example, in a fall due to nerve damage or root fracture,
malignant tumors - can manifest themselves as multiple fistulas and copious leakage of pus.

It is important to know! People who have problems with the immune system or have chronic diseases of an infectious nature (both in the mouth and in the body) are at greater risk than others.

The risk group includes patients whose activities are associated with frequent and/or prolonged hypothermia and fatigue.

The formation of a fistula can be provoked by an addiction to cigarettes or sweets, or a diet poor in vitamins and healthy elements.

Diseases of the gums and teeth that cause fistulas

There are a number of oral diseases, untimely treatment of which provokes the formation of a fistula.

1. Caries and pulpitis

Untreated caries and the subsequent inflammatory process in the pulp - pulpitis - gradually leads to the death of nerve fibers.

However, the source of infection not only does not disappear, but also continues to spread to neighboring tissues. Accumulating, purulent exudate seeks a “way out”, which manifests itself in the formation of a fistula on the surface of the gum.

The pathology can occur without severe pain or pain occurs due to mechanical impact on the tooth.

2. Periodontitis

Periodontal tissues located around the apex of the tooth root, when inflamed, also provoke the formation of a fistula. Most often, a chronic form of periodontitis leads to the appearance of a fistula. Inflammatory exudate accumulates in the bone and then breaks through the hole in the gum. Since a fistula with periodontitis forms under the periosteum, outwardly it looks like a white pimple or bump.

3. Periostitis

Periostitis is an inflammatory process affecting the periosteum. It proceeds, accompanied by a deterioration in the general condition, pain of various types and swelling of the gums in the area of development of the pathology.

Often leads to the formation of a fistula, through which the body gets rid of the accumulation of pus and exudate.

By the way, it is gumboil (and this is the non-medical name for this pathology) that is the main cause of the formation of purulent inflammation, lumps on the gums and, accordingly, a fistula.

4. Periodontitis

Suspicion of this disease falls if, at the time of the appearance of the fistula, the tooth is absolutely healthy, has not previously been subjected to medical procedures, and no structures have been installed on it.

With periodontitis, a periodontal pocket forms over time at the junction of the gums and tooth enamel, into which bacteria penetrate. Under favorable conditions, they actively multiply, causing inflammation.

If the pocket is deep, the outflow of exudate is difficult, so a fistula may form.

5. Tooth cyst

A cyst is a formation separated from other tissues in the form of a sac at the top of the tooth, filled with inflammatory fluid and/or pus. Its overflow stimulates the formation of a fistulous tract in the gum and the outflow of contents into the oral cavity. Pain from a cyst most often occurs during chewing or pressing on the affected unit of the dentition.

What additional symptoms does the problem manifest?

What does a fistula on the gums look like in an adult? This is a small round-shaped formation, reddish or whitish in color, resembling a pimple or “bump” with or without a hole in the center (in the ripening phase). Associated symptoms will be as follows:

the mucous membrane in the area of the affected tooth turns red, swells,
touching the inflammatory area leads to pain. Sometimes the pain is diffuse, and the patient cannot accurately determine where it is concentrated,
due to the constant secretion of pus, a putrid odor appears from the oral cavity,
taste sensations change, food becomes unpleasant (for the same reason that pus gets into the oral cavity and gastrointestinal tract),
the tooth may become mobile.

On a note! The formation of a fistula on the gum may be accompanied by general weakness and malaise. Associated symptoms will be lethargy, maintaining the temperature within 37˚-38˚C. Swelling and increase in the volume of the cheek, as a rule, are not observed, however, the lymph nodes located on the affected side may become enlarged.

Is a fistula on the gum dangerous?

Why is a fistula on the gum dangerous? The formation of a fistula in the gingival tissue, on the one hand, performs a protective function, facilitating the removal of purulent contents out. On the other hand, the lack of treatment provokes the spread of inflammation to nearby areas, including the periosteum and bone tissue.

This leads to tooth mobility, degenerative changes in the gums and jaw, infection in the blood, sinuses, inner ear, and brain.

Complications include not only the removal of the causative unit of the dentition (and sometimes adjacent teeth), but also such serious pathologies as sepsis, sinusitis, the formation of cysts in the jaw, brain abscess, infective endocarditis, abscesses of soft tissues of the face and neck.

On a note! If you consult a doctor in a timely manner, treatment of the fistula occurs quickly and without negative consequences.

If the patient delays a visit to the dentist, toxic products of tissue breakdown enter the blood and lymph, which can lead to the development of strokes, heart attacks, and infectious damage to internal organs.

In advanced cases, a granuloma forms at the site of inflammation, spreading to the periosteum and jaw.

Differential diagnosis: what pathologies need to be excluded

Before treating a gum fistula, you need to rule out some other diseases with similar symptoms. For example, swelling, redness of the mucous membrane, the appearance of a “bump” can be observed with the formation of a wen, inflammatory processes in soft tissues not related to the teeth.

For this purpose, in addition to visual inspection, radiographic examination is used. The image will help to find out whether the periosteum is affected, what the size of the cyst is (if there is one), features of the filling of the apex of the root of the dental unit and other points.

Features of treatment of fistula on the gum

The direction of treatment for a fistula on the gum depends on the cause of the phenomenon:

if the fistula is caused by caries, pulpitis, periodontitis, the dental canals are subjected to opening, removal of affected areas, application of a medicinal composition and filling,
if the root apex of a dental unit is poorly sealed, access to it can be achieved by unsealing the canals or through an incision in the gum,
if the cause of the formation of a fistula is in a cyst, the dentist removes the formation surgically,
wisdom teeth, the appearance of which is accompanied by inflammation and fistula, must also be removed,
in case of periodontitis, the doctor can install drainage to ensure the outflow of accumulated exudate, and then take measures to eliminate the cause of the pathology (removing tartar, correcting the bite, replacing the crown, and so on).

During the treatment process, the specialist carefully cleanses hard and soft tissues from pathogenic accumulations through mechanical and pharmacological effects. Antiseptic, antibacterial compounds and disinfecting pastes are used. At the same time, it is recommended to take antibiotics, anti-inflammatory drugs, antihistamines, and rinse the mouth with antiseptic solutions.

“I somehow had a lump on my gum, I thought it was a fistula. When I went to the doctor, it turned out that it was a wen. It’s good that I didn’t have to cut it, otherwise I was worried, didn’t sleep for several nights, and was generally afraid to go...”

Elena, 34 years old, from a post on the woman.ru forum

How to get rid of a fistula surgically

Surgical removal of a fistula on the gum is carried out if the pathology is not amenable to therapeutic intervention or has become threatening. The operation is indicated in the following situations:

the presence of a crown, a pin, the impossibility of opening or removing them under normal conditions,
degeneration of the periosteum and bone tissue of the jaw,
involvement of a large volume of soft tissue in the inflammatory process.

The surgical method of treatment consists of opening the abscess through an incision in the gum. After cleaning and antiseptic treatment of the affected area, the edges of the wound are connected with sutures.

If necessary, a drainage is placed to allow the remaining pus to drain.

Antibacterial drugs and symptomatic therapy (painkillers, anti-inflammatory, antihistamines and other drugs) must be prescribed.

Home treatment: traditional methods

What to do if there is a fistula on the gum, but there is no way to quickly see a doctor? At first, you can use home remedies. Traditional medicine offers many recipes to reduce inflammation, relieve swelling of the gums, and reduce pain.

Most often, when a fistula forms, mouth rinses with herbal decoctions and water infusions are used.

Plants such as chamomile, sage, yarrow, and oak have anti-inflammatory, soothing, decongestant and antiseptic effects.

It is highly not recommended to use alcohol tinctures for rinsing; they can provoke additional irritation of inflamed tissues.

An aqueous solution of soda and salt perfectly relieves swelling. To prepare it, you need to take a teaspoon of each component and dissolve them in 0.2 liters of pre-boiled and cooled water.

It is important to know! It will not be possible to cure a fistula on the gum using only folk recipes.

Reducing pain, swelling and redness of the mucous membrane, stopping the discharge of pus and even healing of the fistula opening is just an illusion of healing and recovery.

The remaining infection will sooner or later make itself felt again. The chronic form of the pathology is a frequent consequence of self-treatment, leading to serious complications.

Preventive actions

You can prevent the formation of a fistula if you follow a number of preventive measures:

visit the dentist regularly for timely detection of diseases,
do not delay visiting the doctor if any unusual sensations or changes appear in the oral cavity,
improve the quality of oral hygiene,
adhere to a healthy diet, enrich your diet with vitamins and minerals,
increase immunity, lead an active and healthy lifestyle.

To get rid of a fistula on the gum, you should not self-medicate. Timely and professional help from a specialist will relieve complications and allow you to save your tooth.

Source: https://mnogozubov.ru/svishh-na-desne/