What Causes a Gum Boil (Fistula)?
Gum boils go by many names, gum boil or fistula, but medically it is known as a parulus. It is the exit point through the gums and sometimes the bone through which an abscessed tooth drains.
I have heard patients call it a pimple, and once it drains, pus may emanate from the fistulous tract. It is an obvious dental infection caused by either a gum infection, a foreign body, an abscessed tooth, a split tooth, or a failing root canal.
Types of Gum Boils
There are three types of gum boils. The first is a periapical abscess, meaning around the apex or tip of the root of a tooth, often called an abscessed tooth. The infection is around the tooth root and results in pressure build up. This causes pain in the bone as well as the tooth, if not relieved by extraction or root canal. The root canal relieves the pressure as well as the discomfort.
The second type of abscess is called a periodontal abscess, sometimes called a gum abscess. A pressure increase due to a foreign object within the gum tissue surrounding the tooth, or a pocket between the tooth and gums, can cause this type of abscess. The first is within the tooth and the second is outside the tooth.
The third type of gumboil is pericoronal (around the crown of a tooth). It is usually associated with a wisdom tooth which is erupting and the gum tissue becomes infected or inflamed.
The periapical abscess (around the root tip of a tooth) is usually caused by neglected decay which has reached the pulp of the tooth and infections travels to the root tip, a cracked tooth allowing harmful bacteria to infiltrate the pulp or nerve canal which also results in infection, or a nerve dying with the same result. Whatever the cause, there is a resultant tooth ache which, if left untreated, will lead to a gum boil and pus, and therefore the fistulous tract.
Gum Boil Symptoms
Symptoms for the abscess are numerous including tooth ache, ear ache, swelling of the lymph nodes or glands, swelling of the mouth, sensitivity to hot or cold, fever, foul breath, and several others.
Treatment and Diagnosis
The problem is diagnosed by a combination of reading the symptoms and x-ray. The treatment usually involves extraction or root canal as both will clean up any infection from the root tip. Obviously the root canal is the treatment of choice as the tooth will not need replacement in the future with a bridge or implant. The treated tooth will need to have a full crown placed in order to maintain strength. That would also be necessary if an implant were used after an extraction.
So it behooves the patient to have regular check-ups to avoid this procedure if possible. If it is a gum abscess then whatever the cause is must be eliminated. If it is a pericoronal abscess, then the offending tooth, which is usually a wisdom tooth, should be removed. Or, an operculectomy can resolve the problem. That treatment involves the removal of the tissue which allows ample room for the tooth.
On occasion, gum disease can result in your gums moving away from your teeth and bone, allowing food particles and debris to collect which allows bacteria to proliferate and form a periodontal abscess. If not resolved, bone will also dissolve leading to even more advanced problems.
A Warning on Self-Treatment
Self treatment of gum boils by home remedies can lead to even more severe infections in the mouth and elsewhere in the body, so treatment by your dentist is a must. He can then provide the proper treatment to rid you of the infection. Please, spare yourself from home remedies. If an abscess is left untreated, the infection can spread to other body parts or organs and actually cause death.
Of course, prevention is the best guard against gum boils or fistula’s. Proper brushing with fluoridated toothpaste twice a day should be adhered to. Use dental floss at least once per day. Avoidance of too much sugar and regular checks and professional cleaning by your dentist are strongly advised.
Should you have drainage of pus, a toothache, or swelling in the head and neck region, see you dentist as soon as possible. If the infection spreads, the situation could become dangerous.
Life Member American Dental Association, Emeritus Fellow of Academy of General Dentistry, Americana Association of Implant Dentists.