Pericoronitis

What is Pericoronitis?

Pericoronitis is an inflammatory condition of the operculum or gum flap around a partially erupted/impacted tooth.
It is common around the lower last molars or wisdom teeth. Upper canine may also be affected.

Classification of Pericoronitis

Pericoronitis can be classified into:

  1. Subacute
  2. Acute
  3. Chronic
  4. Acute-on-chronic

Causes of Pericoronitis

  1. Mixed microbial infection
  2. Food impaction and plaque accumulation under gum flap
  3. Trauma to gum flap from opposing tooth
  4. Ulcerative gingivitis
  5. Reduced resistance
  6. Anaerobes in plaque

Symptoms and clinical features of Pericoronitis

  1. Soreness and tenderness around partially erupted tooth
  2. Pain
  3. Swelling
  4. Enlargement of regional lymph nodes
  5. Fever
  6. Abscess formation

Investigations

  • Radiographs
    • To establish the position of the affected tooth and its relationship to the second molar
    • This may show impacted third molar

Treatment for Pericoronitis

Non-drug treatment

  • When mouth opening is possible: careful irrigation under the gum flap to clear debris, using warm saline mouthwash
  • To be done frequently until stagnation area is removed
  • Operculectomy
  • Disimpaction of the third molar by surgical extraction
  • Occlusal reduction of opposing tooth
  • Extraction of opposing tooth to forestall supraeruption and sequelae

Drug treatment

  • Appropriate antibiotics
  • Analgesics
  • Supportive therapy

Possible complications of Pericoronitis

  • Cellulitis
  • Ludwig’s angina
  • Osteomyelitis
  • Submasseteric abscess
  • Temporomandibular joint ankylosis