Can You Get A Pimple In Your Mouth?

Abscessed (infected) teeth frequently cause symptoms that prompt patients to seek treatment. Abscesses are caused by tooth decay (caries), trauma, gum disease, and failed root canals. Infections around the end of the roots are also called periapical abscesses. Untreated, these infections can be extremely painful and pose a risk of spreading to the brain (intracranial sinuses) and the neck. Both conditions, although rare, can lead to death. Additionally, mouth infections can cause chronic full-body inflammation that can lead to common illnesses like Alzheimer's disease and heart attacks.

Pimples In the Mouth

In my daily practice, I often find infected teeth that the patient is entirely unaware of. Most often, I find asymptomatic infections on radiographs (x-rays). Sometimes, I can see what appears to be a pimple on the gums adjacent to the tooth, usually at the level of the root tip. The pimple is usually on the cheek side (buccal). However, they are occasionally found on the tongue side (known as the palatal on the upper and lingual on the lower). Technically a pimple around a tooth is known as a dentoalveolar fistula. 

What is a Fistula?

A fistula is defined as an improper connection between different body compartments. For example, in the case of a tooth, the connection is between the jaw (alveolus) and the mouth. Dentoalveolar fistulae arise after teeth become infected. The infection can cause bone loss around the root. The infection can then break through the gums discharging pus into the mouth.

Why Does it Not Hurt?

 If the patient ignores the initial pain, the formation of a fistula often relieves the painful symptoms. Often, in infected teeth, the nerve is dead, so it can't sense pain. The abscess, however, can build up pressure in the alveolar bone around the tip of the root, causing intense pain. Once a fistula forms, the pressure dissipates, and the pain disappears.

What to Do About a Fistula

There are several options to treat a fistula. The goal is to clear the infection, and antibiotics are almost always part of the treatment. Sometimes removing the tooth is the only option. Dentists call the procedure an extraction.

Root Canal

The treatment can range from root canal to extraction, depending on the situation. If the tooth is intact enough and the infection is not too large, root canals remove the dead nerve tissue within the tooth. The body can subsequently heal the infection. 

Root Canal Retreat

The root canal can sometimes be redone if the tooth has a failing root canal from previous treatment. Not surprisingly, the procedure is known as a root canal retreat. 

Apicoectomy With Retrograde Fill

Sometimes a failing root canal can respond to a surgical procedure where the root tip is removed, and a small filling is placed in the root tip. This procedure is done when, for various reasons, a root canal retreat is not indicated, as in a tooth that has already had a retreat and the infection is still present. This surgical procedure requires a small incision in the gums above the tooth near the tip of the root.

Periodontal Surgery

Sometimes a fistula can result from gum disease, otherwise known as periodontitis. Periodontitis that is bad enough can cause an acute flare-up and subsequently a fistula. More severe cases of gum disease often require pocket reduction surgery. Pocket reduction surgery involves conventional instruments like scalpels or more modern ones like lasers. Still, either technique eliminates the infection, and the fistula heals.

How to Avoid a Fistula

Regular dental care is one of the most important things you can do. Once you have had a root canal, it can fail at any time, and there are no preventative measures against reinfection. Previously root canalled teeth should be checked regularly by your dentist to make sure they are not infected. The standard is a cleaning and check-up every six months. Obviously, brushing and flossing should be a part of your daily routine-floss once per day and brush at least twice. In addition, I strongly recommend a whole-food diet devoid of processed carbohydrates like the paleo diet. You can find more information on the specifics here. Lastly, check your own mouth regularly. Call your dentist immediately if you see anything unusual (like a pimple), because there are no viable DIY cures.