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 (periodontal infection), a foreign body, an abscessed tooth, a split tooth, a failing root canal or a retained deciduous (baby) tooth with the permanent tooth erupting beneath it.
Four Types of Gum Boils
I. There are Four 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 treatment is sometimes called a root canal abscess treatment. The root canal relieves the pressure as well as the discomfort. An extraction also relieves the pressure and discomfort. If it is caused by and abscessed baby tooth which leads to an early extraction, a space maintainer may be required to hold the space open for the erupting permanent tooth. If the permanent tooth will be erupting soon, the space maintainer is not necessary. If there is no erupting permanent tooth beneath, and the elected treatment is an extraction, then additional treatment of a root canal and crown or a fixed bridge are recommended.
II. The second type of abscess is called a periodontal abscess, sometimes called a gum abscess or a soft tissue abscess. A pressure increase due to a foreign object within the gum tissue surrounding the tooth, or a pocket between the bone and gums, can cause this type of abscess. The foreign object may be just that, or it may be a tooth fragment, a splinter of bone, or even a retained suture. The pocket may also be formed as a result of poor oral hygiene resulting in bone resorption. This would require improved oral hygiene and possible periodontal therapy.
III. 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. This also is a soft tissue abscess.
IV. The fourth type is called a periapical abscess (around the root tip of a tooth) and is usually caused by neglected decay which has reached the pulp of the tooth and infection 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. The treatment for this condition is either extraction or root canal. This fourth type , which has advanced to the drainage or fistulous tract stage, is sometimes called a ruptured dental abscess. It also involves the soft tissue after it penetrates the bone.
Any of the above above four type abscesses which involve the pulp of the tooth will be considered a bacterially infected tooth.
Gum Boil Symptoms
Symptoms for the abscess are numerous including tooth ache, ear ache, tenderness and 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 observing the symptoms, clinical exam, and x-rays. The treatment usually involves extraction or root canal as both will clean up any infection from the root tip. Obviously, in most cases, the root canal is the treatment of choice as the tooth will not need replacement in the future with a bridge or an 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. A gum boil caused by a retained baby tooth with the permanent tooth erupting just beneath it, is readily resolved by simple extraction only as the permanent tooth will erupt into its position.
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, such as mobility of the tooth and possible loss.
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 strictly adhered to. Use dental floss at least once per day. Avoidance of too much sugar and regular checks and professional cleaning by your dentist or dental hygienist are strongly advised.
Should you have drainage of pus, a toothache, or swelling and tenderness 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.