A dental fistula in children—also known as a parulis or gum boil—is a pathological drainage pathway that forms as a result of a chronic dental infection, usually originating from pulp necrosis due to deep caries or trauma.
馃搶 Recommended Article :
Dental Article 馃斀 Facial Cellulitis vs. Angioedema in Dental Emergencies: Key Differences, Severity, and Management ... Facial cellulitis and angioedema are two potentially life-threatening conditions frequently encountered in dental emergencies. Although both present with facial swelling, they differ significantly in etiology, clinical presentation, and treatment approach.Although often painless, a fistula indicates the presence of an active infectious process that requires immediate dental intervention. Understanding its etiology, clinical presentation, and management is essential for effective pediatric care.
Advertisement
✅ Etiology of Dental Fistula in Pediatric Patients
The most frequent causes include:
1. Deep Dental Caries
The primary cause is untreated dental caries that lead to irreversible pulpitis and ultimately pulp necrosis. This allows bacterial proliferation and abscess development, culminating in fistula formation.
2. Dental Trauma
Trauma—particularly in anterior teeth—may cause pulpal ischemia and necrosis, increasing the risk of chronic periapical infection.
3. Developmental Anomalies
Anomalies such as dens invaginatus or enamel defects increase susceptibility to pulp exposure and infection.
4. Failed Dental Treatments
Incomplete pulpotomies, pulpectomies, or restorations can predispose the tooth to persistent infection.
馃搶 Recommended Article :
Dental Article 馃斀 What Are the Symptoms of a Dental Infection? ... Dental infections typically arise from untreated dental caries, periodontal disease, or trauma that allows bacteria to invade the pulp or surrounding tissues.✅ Clinical Characteristics
A pediatric dental fistula typically presents as:
▪️ A small, raised white or yellowish lesion on the gingiva or mucosa
▪️ Intermittent pus drainage
▪️ Minimal pain (because pressure is released)
▪️ A necrotic primary or permanent tooth
▪️ Radiographic evidence of periapical radiolucency
The fistula itself is not the disease, but a symptom of the underlying infection.
馃搶 Recommended Article :
Dental Article 馃斀 Dental Abscesses in Primary Teeth: Evidence-Based Management in 2025 ... This article reviews evidence-based approaches (2025) for diagnosis, management, and prevention, highlighting the importance of early intervention to preserve oral and general health.✅ Diagnosis
Diagnosis is primarily clinical, supported by:
➤ Radiographic Evaluation
▪️ Periapical radiograph or CBCT to identify periapical pathology
▪️ Tracing the fistulous tract with a gutta-percha cone
➤ Pulp Vitality Testing
Useful for permanent teeth; typically unreliable in primary teeth.
➤ Caries and Trauma Assessment
Determining the original source of infection is essential for treatment.
馃搶 Recommended Article :
Dental Article 馃斀 Preventing Dental Emergencies in Primary Dentition: Caries, Abscesses and Early Intervention ... This article examines preventive strategies to reduce dental emergencies in primary dentition, focusing on early childhood caries, dental abscesses, and the role of early intervention in maintaining oral health.✅ Evidence-Based Treatment of Dental Fistula in Children
The goal is not to treat the fistula itself, but to eliminate the source of infection.
1. Pulp Therapy or Root Canal Treatment
▪️ Primary teeth: pulpectomy using resorbable materials
▪️ Permanent teeth: conventional root canal therapy
This eliminates bacterial load and restores periapical health.
2. Extraction of Non-Restorable Teeth
Indicated when:
▪️ The tooth has severe destruction
▪️ There is pathological mobility
▪️ Infection persists despite treatment
3. Systemic Antibiotics
Antibiotics are not first-line treatment but may be used when:
▪️ Facial cellulitis is present
▪️ The child has systemic symptoms (fever, malaise)
▪️ The infection is rapidly progressing
➤ Common pediatric antibiotic doses:
▪️ Amoxicillin: 40–50 mg/kg/day divided every 8–12 h
▪️ Amoxicillin + Clavulanate: 40–45 mg/kg/day (based on amoxicillin component) every 12 h
▪️ Clindamycin (penicillin allergy): 10–20 mg/kg/day divided every 6–8 h
These are evidence-based pediatric doses, but clinicians must consider weight, severity, and guidelines.
馃搶 Recommended Article :
Dental Article 馃斀 Managing Pediatric Odontogenic Infections: Diagnosis, Symptoms, and Treatment Guidelines ... Odontogenic infections in children are frequent emergencies in pediatric dentistry. They arise from bacterial invasion of dental pulp and surrounding tissues, commonly due to untreated caries or trauma.✅ Prevention Strategies
▪️ Early and routine dental visits
▪️ Fluoride therapy for caries prevention
▪️ Restoration of early carious lesions
▪️ Traumatic injury prevention counseling
▪️ Sealants for high-risk occlusal surfaces
馃搳 Comparative Table: Management Approaches for Pediatric Dental Fistula
| Aspect | Advantages | Limitations |
|---|---|---|
| Pulp Therapy (Pulpectomy) | Preserves tooth structure; high success in primary teeth | Requires child cooperation; not suitable for severely damaged teeth |
| Extraction | Eliminates infection quickly; simple procedure | May affect occlusion and arch space; requires space maintenance |
馃挰 Discussion
A pediatric dental fistula is the result of a long-standing infectious process, most commonly linked to untreated caries, emphasizing the importance of early intervention and preventive dentistry. While fistulas may appear benign due to absence of pain, they reflect chronic periapical pathology that may compromise both primary and permanent dentition. Evidence indicates that definitive dental treatment, not antibiotics, is the most effective approach. When treated appropriately, prognosis is excellent and recurrence is rare.
馃搶 Recommended Article :
Dental Article 馃斀 Key Differences Between Pediatric and Adult Odontogenic Infections: Updated Clinical Guidelines ... This article outlines the major anatomical, clinical, and therapeutic distinctions between pediatric and adult odontogenic infections, highlighting the need for age-specific diagnosis and treatment approaches.✍️ Conclusion
A dental fistula in children is a visible sign of an underlying infection requiring prompt diagnosis and treatment. Elimination of the infectious source —whether through pulp therapy or extraction—is essential for complete healing. Preventive strategies remain key to avoiding severe complications and maintaining long-term pediatric oral health.
馃攷 Recommendations
▪️ Evaluate any gingival lesion suspicious of a fistula with radiographs.
▪️ Treat the source of infection—not just the fistula.
▪️ Avoid unnecessary antibiotic use.
▪️ Emphasize prevention through caregiver education.
▪️ Monitor treated teeth until complete radiographic healing is confirmed.
馃摎 References
✔ American Academy of Pediatric Dentistry. (2024). Guideline on antibiotic therapy for pediatric dental patients. AAPD Reference Manual. https://www.aapd.org
✔ Fuks, A. B., Papagiannoulis, L., & Duggal, M. S. (2021). Pulp therapy for primary teeth. International Journal of Paediatric Dentistry, 31(1), 5–15. https://doi.org/10.1111/ipd.12701
✔ Siqueira, J. F., & R么莽as, I. N. (2023). The microbiology of apical periodontitis. Dental Clinics of North America, 67(1), 1–16. https://doi.org/10.1016/j.cden.2022.08.001
✔ Robertson, A., & Andreasen, J. O. (2019). Traumatic dental injuries in children. Pediatric Dentistry, 41(3), 210–218.
馃搶 More Recommended Items
► Surgical excision of mucocele with local anesthesia in an 8-month-old baby
► Odontogenic facial cellulitis in a pediatric patient - Diagnosis, treatment and multidisciplinary management
► Odontogenic infection in facial spaces - Pharmacological and surgical management in pediatric patients