Fistulous tract

Fistulous tract (Lat. fistula) is a pathologic channel in the gum or bone through which inflammatory products (exudate) are discharged from the focus at the root of the tooth to the outside. It is a kind of drainage passage created by the body to reduce the pressure inside the inflammatory focus.

Etiology and pathophysiology

A fistula is formed when purulent inflammation at the root tip (abscess) destroys the cortical plate of the jaw and bursts under the mucosa. A characteristic hole (the mouth of the fistulous passage) appears on the gingiva, often with the discharge of pus. The appearance of the fistula is usually accompanied by a decrease in acute pain, as the pressure in the focus falls. Fistulous passage from the pathological focus around the root of the tooth can open not only on the gum, but also in the maxillary sinus, in the nasal cavity, on the skin of the face or neck.

Clinical significance

The presence of a fistula is a sure sign of pulp death and chronic bone destruction (apical periodontitis). A fistula cannot heal on its own unless the cause, an infection inside the tooth, is removed. Treatment requires thorough root canal treatment or, in advanced cases, tooth extraction.