Summary Four cases of dermal fistulas of dental origin have been presented to bring this entity more clearly to the attention of pediatricians. This subject is poorly documented in pediatric writings and may be relatively unfamiliar to many pediatricians. A dermal fistula in the submandibular region in children presents a different diagnostic problem, and the differential diagnosis is reviewed. Inability to eradicate the fistula completely is not uncommon and, in some cases, is due to lack of recognition of its origin in diseased dentition. It has been emphasized that permanent cure of a fistula originating from a periapical dental abscess can be obtained only by removal of the infected dentition.