On the management of root canals in teeth that exhibit a draining "fistulous" tract

The clinical management of teeth with necrotic pulps, with and without draining fistulous tracts, has been the subject of a wide range of personal opinions and techniques for well over a century. Fortunately, prior to the advent of the focal infection theory in the early 1900s, dental clinicians made every attempt to treat and maintain these teeth as opposed to wholesale extraction. While the treatment approaches by some may have been questionable, others claimed great success. The success claimed was empirically-based, but those that achieved this goal used methods and techniques not dissimilar to present-day practices. However, the proponents of the focal infection theory failed to consider these achievements prior to their advocacy of extracting all teeth with necrotic pulps or those that demonstrated an active infection. This paper highlights some of the prevailing concepts from opposing treatment regimens in the late 1800s in which extensive efforts were made to retain teeth.