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Fistula

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sushantpatel_doc's picture
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A fistula is a tunnel conducting pus from one infection to the site of another. A mouth fistula is called a gum boil. More generally a fistula is due to destruction of intervening tissue between the two sites and is a major component of a periapical abscess. Inflamed pus forms an abscess causing a pressure increase in the surrounding tooth area. If the pus that accumulates at the end of the tooth have no alternate pathways for drainage over time spontaneous drainage may occur through bone next to the root end. The pathway through which the pus has burrowed is called a fistula.

Fistulas usually form near the roof of the mouth or on the gum and are difficult to detect. A fistula can also be known as a Parulis as this is the term given to the point at which the fistula reaches the surface of the mouth presented as a small pimple. This pimple usually ruptures to form an opening.

Treating a fistula requires antibiotics and extraction of the tooth that led to the fistula via root canal surgery. Also draining the abscess that led to the fistula is a treatment method although this is usually followed by root canal surgery.

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Drsumitra's picture
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Re: Fistula

A gum boil is medically known as a parulus. It is a point from which an abscessed tooth drains. It is a dental infection which may occur either due to certain gum diseases, a dead tooth or an infected root canal.

There are two kinds of gum boils. The first one is triggered by a bad root canal. In case of tooth decay, the related nerves also die eventually. These dead nerves are dangerous as any dead tissue is poisonous. So the body sends white blood cells to as a defense mechanism to get rid of these toxic dead nerves which trickle out of the tips of the roots.

The other type of gum boils are those which occur due to an infection between the gums and the tooth .This infection is referred to as gingival abscess and may require a dental surgery.

A weak immune system can also cause gum boils.

Neglected tooth decay leads to periapical tooth abscess in which the bacteria reach the end of the root.

This problem starts with a toothache, which is followed by the formation of a red and painful boil. Gradually the gum boil ripens and forms pus. It finally gets drained when a head is formed. In some cases the region below the tongue becomes tender and the lymph glands get enlarged.

As in the case of large boils found on other regions of the body, the gum boils too need immediate medical consultation. An early treatment can prevent complications as well as save the tooth by surgery or a root canal treatment.

Some of the best gum boils treatment is as follows:

Generally the gum boils are treated by drainage of the pus, disinfecting and then filling the infected tooth.
Apicectomy, which is the removal of the tip of the root, is done when disinfecting the tooth is not possible.
Extracting the tooth is another option when the damage done by the bacterial infection is irreversible.
An x-ray along with a complete examination by a dentist helps in understanding the root cause of the gum boil. After an incision has been made on the gum to drain the boil, the dentist decides what is to be done further.
Since gum boils are clear indicators of a severe infection, self treatment would result in aggravating the situation. Therefore, one should consult a dentist as soon as possible.
A generous amount of salt dissolved in warm water is a good mouth rinse. The saline water should be kept in the mouth for long periods to alleviate the pain.
Tea bags are kept in between the cheek and the gum boil for long periods or overnight. The dry tea bags help in extracting the infection, thereby curing the boil.
Hydrogen peroxide mouth wash is considered as one of the best treatment for gum boils.
Tea tree oil, grape fruit seed extract mixed with water and colloidal silver are also effective if used to rinse the mouth. They clean the mouth as well as heal the inflamed gums.
Vitamin C and garlic capsules act as natural antibiotics to cure the gum boils problem.
The goldenseal tincture helps in the ripening of the boils. After a applying it for a few times, the boil may get drained. This should be followed by a rinse with hydrogen peroxide.
A poultice is made with a wet cotton ball rolled in equal amounts of salt and baking soda. This is placed on the boil for long periods. The process should be repeated till the desired effect is reached. Once the boil matures and pus is formed, it gets drained.
Once the gum boils burst open and releases the pus, the lymph glands in the face and the neck region swell in order to deactivate the toxins. If these toxins get mixed with blood, it causes septicemia. In order to prevent poisoning of the blood, one should consult a dentist. The best gum boils treatment can be availed by timely treatment.

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Drsumitra's picture
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Re: Fistula

Chronic dental periapical infections or dentoalveolar abscesses cause the most common intraoral and extraoral fistulas. These dental periapical infections can lead to chronic osteomyelitis, cellulitis, and facial abscesses. Infection can spread to the skin if it is the path of least resistance. Fascial-plane infections, space infections, and osteomyelitis can cause cutaneous fistulas. Fascial-plane infections often begin as cellulitis and progress to fluctuant abscess formation. Compared with the other conditions, fluctuant abscess formation is more likely to result in cutaneous fistulas.

Rarely, a cutaneous lesion such as a furuncle can be misdiagnosed as a sinus tract to the skin of the face. One case report[1] demonstrates this occurrence from a periapical infection from the right central mandibular incisor, which drained to the patient's chin. Because the tooth could not be restored, it was extracted, which resolved the lesion.

Another case with cutaneous manifestations involved a 44-year-old woman with a draining lesion to the skin just lateral to the nasofacial sulcus. Oral antibiotics did not help resolve the lesion. The patient had poor dentition, and a panoramic radiograph showed 2 periapical radiolucencies of the maxillary right lateral incisor and canine. The teeth were extracted, which resolved the lesion. Sheehan et al[2] recommend a dental examination and radiographs to rule out infection of dental origin to the cutaneous face or neck.

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