Fistulas and Cysts in Dentistry
A fistula in the mouth is your body’s answer to a chronic infection. A fistula can develop anywhere in the body, in hard tissues (e.g. the bones) or in soft tissues (e.g. in the muscles or inner organs).
Is there a correlation between fistulas and cysts? Yes! Both may develop due to an improper root canal treatment, for example.
Ubi Pus, ibi evacuvave – where there is pus, empty it out
This is not just a rule for doctors – our body follows it as well! Let’s take the following assumption: You have a chronic infection in your body – for example in the bone around your dental root (e.g. due to a bad root canal treatment). Pus develops as the body tries to drain this “suppurative focus”; physicians call this an abscess. In doing so, the tissue confining the suppurative focus – the abscess – towards the outside is destroyed and a path of pus towards the inside of the mouth forms.
If the inflammation is not treated, the pus turns into a fistula. Since the body tries to “minimize” both the infection and the extent of the pus, it constructs a special type of granulate tissue around the pus. A fistula forms, the surrounding tissue is fine and the pus can empty out.
So a fistula is basically a kind of artificial garden hose made by our body to get pus out of a wound – and in this case into the mouth. You usually notice a bump on your gums, and when you press it, pus comes out!
A fistula on the gums is always a sign that something is wrong, and it should not be left untreated, because the infection will spread and continue to destroy bone, the dark spot on the x-ray!
Pain after a tooth extraction – a sign for a tooth fistula
If severe pain occurs two or three days after a tooth extraction, a bone infection is the cause – a so-called alveolitis. An alveolitis can have many causes. We distinguish mistakes made by the doctor from those made by the patient!
Doctor’s mistakes in case of toothache after a tooth extraction:
- Careless handling of the tissue
- Placement of strips into the extraction wound
- Bad education
Patient’s mistakes in case of toothache after a tooth extraction:
- Not following behavioral rules
- Smoking, alcohol, bad oral hygiene
The therapy consists in refreshing the wound and a tight suture of the wound. Antibiotics do not help and pain killers usually only do so for a short period of time. If you should suffer from an alveolitis, the only remedy is another visit to the dentist! It is important that the tooth socket fills with blood after the tooth extraction, because the coagulated blood “seals” the bone socket like a band-aid and thus protects it from bacteria from the oral cavity. Due to the acute nature of the occurrence, no fistula will develop. If an acute alveolitis turns into a chronic alveolitis, then a fistula may form.
What are cysts, how do they develop, and why do we get them?
There are many types of different jaw cysts. A cyst is a hollow space lined with an intricate membrane within an organ / tissue. Jaw cysts are located in the bone, i.e. in the hard tissue, which is why they are also frequently called bone cysts or hard tissue cysts. One distinguishes congenital and acquired jaw cysts.
For example, follicular, globulomaxillary, and median lower jaw cysts are congenital jaw cysts.
Contrary to those, periodontal or radicular cysts, for example, are acquired jaw cysts. The naming of cysts follows the original tissue, from which conclusions can also be drawn as to their development. Let us stay with the most common cyst, namely the radicular cysts. The cause of this type of cysts is usually teeth with badly performed root canals. Thus, teeth that were not optimally filled with root filling material can cause jaw cysts even years later. How? Decaying root canal tissue, which was not removed within the course of the root canal treatment, may cause an inflammatory stimulus in the bone. This inflammatory stimulus in turn may stimulate “embryonic tissue residue” to grow.
During our embryonic development, many different cell types are engaged in close cooperation with the forming of the body. A part of the cells later develop into bone cells, tooth cells, nerve cells, and muscle cells. A part of the cells serve as a guide, they direct the tissue cells to the proper place, so to speak, for it would be absurd if you would grow teeth in the stomach.
The embryo thrives and grows, developing more and more into the human form. The cell specialization increases and the “guiding cells” atrophy and remain in the tissues. These remains of our embryonic guides – so-called cell debris from the embryonic development – can be found distributed in all organs throughout the body. Now, if an inflammatory stimulus develops in the bone, for example due to a bad root canal treatment, then this may stimulate dormant embryonic cells to grow. The cells begin to divide and form a cyst – a so-called radicular cyst. Since the growth of the cyst itself takes place very slowly, you do not feel any pain until acute problems appear, for example a loosening of a tooth due to bone loss or a cyst infection that makes the patient aware of the problem.
Cysts can be recognized very early in X-rays – the X-rays penetrate the area of the cyst in the bone more easily, because there is less bone material than in the rest of the jaw – so a dark spot is seen. Since cysts usually increase in size by themselves, they should be surgically removed – this is called a cystectomy.
In most cases, though, not only is the cyst removed during the therapy, but the root end of the respective tooth is cut off and removed as well, which is called a root end resection. In order to do this, the gums are folded to the side, a small hole is drilled into the bone in the area of the root end and so the end of the root is uncovered that it may be shortened. This intervention is also performed when the bone around the root end is inflamed, i.e. not just in case of cyst operations.
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