Pericoronitis
Introduction
Refers to inflammation of the soft tissues covering the crown of erupting tooth and occurs more commonly in association with the mandibular third molar (wisdom) teeth. Impaction of food and plaque under the gingiva flap provides a medium for bacterial multiplication. Biting on the gum flap by an opposing tooth causes laceration of the flap, increasing the infection and swelling with a greater likelihood of traumatic biting.
Pathophysiology
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Signs and symptoms
• Severe pain near at the back of the teeth
• Swelling of gum tissue
• Pain when swallowing and chewing
• The discharge of pus
• Trismus
• Fever
Diagnostic criteria
• High temperature
• Severe malaise
• Discomfort in swallowing and chewing
• Well localized dull pain, swollen and tender gum flap
• Signs of partial tooth eruption or uneruption in the region
• Pus discharge beneath the flap may or may not be observed
• Foetor-ox oris i.e. bad smell
• Trismus
• Regional lymph nodes enlargement and tenderness
Investigation
Not needed most of time
X-ray may be indicated when there is a need to rule out other dental conditions
Treatment
Non-pharmacological
- • Excision of the operculum/flap (flapectomy) under local anesthesia
• Extraction of the third molar associated with the condition
• Grinding or extraction of the opposing tooth
Pharmacological
- • Mouth wash with hydrogen peroxide solution 3% 6 hourly for 5 days
• Amoxicillin 500mg (PO) 6 hourly for 5 days
AND
• Metronidazole 400 mg (PO) 8 hourly for 5 days
If severe (rarely) refer to section on treatment of dental abscess
Prevention
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Updated on,
4 Novemba 2020 08:21:43
References
1.STG
2. Web MD. Pericoronitis. https://www.webmd.com/oral-health/guide/pericoronitis. Accessed 04.11 2020
3. Hawaii family dental. Pericoronitis. https://hawaiifamilydental.com/news/pericoronitis/.Accessed 04.11 2020