Extra-oral Sinus Tract

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DENTAL INFECTIONS follow the path of least resistance. They usually cause the soft tissue to swell or form an intra-oral fistula. However, the infection can break through the skin, making it look like a bad pimple. These external buccal fistulas are not commonly seen. Therefore, some of these cases are treated by dermatologists first since patients do not realize that it is actually a dental etiology.

A 45-year-old African American female was referred to me by a dermatologist for root canal treatment of the upper left side. The patient said that since January 2013 she had noticed a pimple that formed on her left cheek. She tried to treat it at home but it did not heal. Eventually she went to a dermatologist who excised and seared off the tip so that the pus would stop draining. She used topical antibiotics and also took oral antibiotics. However, she said that the pimple got worse (Figure 1). She went to go see another dermatologist who referred her to me saying that the tooth was the culprit. A periapical x-ray (Figure 2) was taken and it was clearly noted that there was a periapical radiolucency of the palatal and distobuccal roots. Root canal treatment was done (Figure 3) and one month later a follow-up (Figure 4) was done to see the healing process. As you can see, the “pimple” has gotten smaller.

Because many of these patients come from dermatologists who try to treat the skin, the area tends to heal with slight scarring. Even if the patient goes to a dentist first, these external sinus tracts tend to heal with a slight concavity. It is important that dentists and dermatologists recognize this and first treat the source of the infection, which is coming from the tooth..

July - September 2013

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