A fistula is a canal that develops between two points to drain an infection from an abscess, and a sinus tract is a drainage canal that originates at a point of infection but has only one ending. Although these terms are used interchangeably in relation to dentistry, a dental fistula is more likely to be a sinus tract infection than an actual fistula, according to Medscape. A fistula or tract can take various forms, and the cause and location of the tract helps determine the best treatment method.
A dental or oral fistula is commonly associated with an abscess, which can be caused by trauma or injury to the mouth, a build-up of food bacteria, or be the result of surgery, extraction of the molars, or a congenital defect. Whether the abscess is gum- or tooth-related, it usually results in an infection that can spread to the bone or the tooth pulp. As the pressure and pain of the abscess builds, the infection pushes its way to the surface of the gum to drain. Occasionally, a failed root canal treatment might cause a pus corridor to form near the location of the root tip or apex.
The typical indication of a dental fistula or sinus tract is a bump that develops on the gum tissue or gingiva, where it's called a gum boil, or in proximity to an abscessed tooth. The bump might alternatively appear and disappear, and is a sign that infection exists and your body is using the fistula to drain it. Since draining releases the pressure of the abscess, the fistula itself is often not painful, although many patients report an unpleasant taste.
Many patients avoid seeking medical attention for a dental fistula, simply because they don't experience pain, according to a case report published by the International Journal of Clinical Pediatric Dentistry. Since an infection is the root cause, the fistula is unlikely to heal and disappear on its own. Without care, the infection can travel to your jawbone and affect other parts of the body. Here are a few treatment options your doctor may prescribe:
- Rinse with a warm salt water solution to kill bacteria.
- Schedule an urgent dental examination to determine the severity of the infection.
- Take antibiotic medication prescribed by your doctor or dentist, to help contain the infection.
- Maintain your oral hygiene regimen to ensure the healthiest environment possible.
Your dental professional's first line of defense will be to clean the area around the fistula, and allow accumulated pus to run out. Most dentists recommend antimicrobial therapy to help your body fight the infection. For bacterial infections that begin inside a tooth, the dentist will make a small hole in the tooth enamel to enable the infection to drain. In the case of a badly infected and damaged tooth, your dentist may elect to extract the tooth. This process may be followed by a root canal treatment or an apicoectomy to remove the tip, and a discussion of your options for replacement of the tooth.
The prognosis for a dental fistula is typically very positive, provided you follow recommended treatment to eliminate the infection. Often, within a few months you won't even notice where the canal existed. Prevent future infections by stepping up your daily brushing and flossing routine, supplemented by regular dental exams and cleanings.