Pericoronitis: Causes, Symptoms, Treatment and Prevention

Pericoronitis is inflammation of the gum tissue surrounding the crown portion of a tooth. Pericoronitis usually affects the lower third molar (wisdom tooth) where gum tissue overlaps the chewing surface of the tooth. Pericoronitis can be eith

What is Pericoronitis?

Pericoronitis is inflammation of the gum tissue surrounding the crown portion of a tooth. Pericoronitis usually affects the lower third molar (wisdom tooth) where gum tissue overlaps the chewing surface of the tooth. Pericoronitis can be either mild or severe. Chronic pericoronitis is a mild persistent inflammation of the area. Acute pericoronitis is when the symptoms increase to malaria fever, swelling in the gum, and pain, which indicates a spreading infection.
However, pericoronitis is differentiated from periodontal disease (or periodontitis) in the sense that it occurs specifically around a partially erupted tooth where the tooth has not completely move out of the gum overlying it. The cause of this condition is similar to the formation of a dental abscess in periodontitis by the entrapment of debris under the gingival tissue.

What causes pericoronitis?

The main cause for pericoronitis is an accumulation of bacteria. Usually, the tooth is only partially exposed (soft tissue impaction) and has excess gum tissue that overlaps the tooth. Bacteria and food debris get trapped in the space between the tooth and the overlapping gingiva. This overlapping gum flap is called an "operculum." Initially, inflammation of the operculum (operculates) takes place. A pericoronal infection can develop by the formation of an abscess under the operculum. If left untreated, the infection can spread to other soft tissue spaces.

What are risk factors for pericoronitis?

Most commonly, pericoronitis affects young adults in their mid-20s who are experiencing poorly erupting wisdom teeth (third molars). Pericoronitis is essentially a "wisdom tooth infection." Risk factors for pericoronitis include the presence of excess gum tissue (operculum) overlying the wisdom tooth and difficult access to the wisdom teeth for proper cleaning.

What are pericoronitis symptoms and signs?

Signs and symptoms of pericoronitis can range from mild to severe and include

• pain,
• swelling of the gums,
• tenderness,
• redness of gum tissue,
• bad breath (halitosis),
• the bad taste from pus,
• difficulty opening the jaw (trismus),
• difficulty swallowing (dysphagia),
• swollen submandibular lymph nodes,
• fever,
• loss of appetite, and
• feeling unwell.

What specialists treat pericoronitis?

Any licensed dentist is able to treat pericoronitis. In situations where surgery is required or if it is a severe and complicated case, dental specialists such an oral surgeon or a periodontist (gum surgeon) can provide treatment. In very rare cases, should the infection become more widespread, emergency services with dental care might be needed?

How do Dental Professionals Diagnose Pericoronitis?

Diagnosis of pericoronitis is based on symptoms and appearance during a clinical evaluation with a dental professional such as a dentist or oral surgeon. A dental X-ray is used to assess the area and rule out other possible causes for pain, such as tooth decay. Once all the information from the patient and facts are gathered by a dentist, the dentist will now make a further diagnosis of the condition.

What is the treatment for pericoronitis?

There are different methods for treatment of pericoronitis, there are three common methods depending on the severity of the condition:

1. Management of pain and resolving the pericoronal inflammation and/or infection
2. Minor oral surgery to remove the overlapping gingival tissue (operculectomy)
3. Removal of the wisdom tooth.

To manage the pain of severe pericoronitis, you may use over-the-counter medications  (if allowed in your country), such as acetaminophen (Tylenol) or ibuprofen (Advil). If it is localized to the tooth and there has been no spread of the infection, a dentist thoroughly cleans out the area under local anaesthesia. A dentist may prescribe an oral rinse containing chlorhexidine to keep the area clean. Otherwise, warm salt water or diluted hydrogen peroxide can be used as an oral rinse. If there is swelling or fever, a dentist may prescribe oral antibiotics such as amoxicillin or erythromycin.

Your dentist may recommend minor oral surgery to remove the operculum. This will allow better access to properly clean the area and prevent the accumulation of bacteria and food debris. In some cases, the gum tissue may grow back and create the same problem.

Removal (extraction) of the tooth is the most common treatment method since wisdom teeth sometimes are poorly positioned and do not erupt completely. This method completely removes any future occurrences of a wisdom tooth infection.
In rare cases, the symptoms become so severe that an individual needs to go the hospital emergency room to seek care due to the rapid spread of a pericoronal abscess. This is especially the case if there is swelling of the lymph nodes.

Sometimes, mild symptoms of pericoronitis can be treated at home through careful study of your oral hygiene without the use of antibiotics. Thorough and gentle brushing of the area with a small-headed toothbrush may help to break up the plaque or food that is trapped under the operculum. Oral water irrigators can be effective in clearing out the debris trapped under the operculum, as well. Rinsing with warm salt water can help to soothe the area. Additionally, diluted hydrogen peroxide can be used as a rinse or irrigating solution to help reduce the bacteria in the area.

For severe pericoronitis where swelling and fever are present, home treatments are not advised and proper care should be sought out by the appropriate dental professional.

Prevention of pericoronitis?

Prevention of pericoronitis can be achieved with accurate oral hygiene, regular dental visits (twice a year is recommended by dental association), and preemptive care. The dentist can assist in keeping these possible problem areas clean and determine the need for removal of the operculum. Another option, the dentist can also monitor the eruption of the third molars and determine the need for early extraction of these teeth. Removal of the wisdom teeth coming before eruption can prevent pericoronitis.

REFERENCES:

Hazza'a A. M., et al. "Angulation of mandibular third molars as a predictive factor for pericoronitis." The Journal of Contemporary Dental Practice 10.3 (2009): 51-58.

Nguyen, D., et al. "Common Dental Infections in the Primary Care Setting." American Family Physician 77.6 (2008): 797-802.

Medicine net, pericoronitis centre
https://www.medicinenet.com/pericoronitis/index.htm

College of Medicine, University of Ibadan, Nigeria and others
http://uch-ibadan.org.ng
https://com.ui.edu.ng/index.php/en/

Last modified: 12 Jun, 2018