Pericoronitis

Pericoronitis refers to the inflammation of the soft tissues surrounding the crown of a partially erupted tooth. This inflammation often involves the gums (gingiva) and the dental follicle, a structure involved in tooth development. The soft tissue covering the unerupted portion of the tooth is termed an 'operculum,' which can be challenging to clean with standard oral hygiene practices. The specific inflammation of this operculum is technically known as 'operculitis'.

Lower mandibular third molar impaction pericoronitis diagram

Pathophysiology

Pericoronitis arises when bacteria accumulate beneath the operculum, leading to infection and inflammation. This bacterial accumulation often occurs due to the difficulty in maintaining oral hygiene in the area, given the partial eruption of the tooth and the covering operculum. The most commonly involved tooth is the third molar, or wisdom tooth.

Clinical Presentation

Pericoronitis presents with symptoms such as pain, swelling in the gum tissue around the tooth, and occasionally, a bad taste in the mouth or bad breath. In severe cases, it can cause difficulty opening the mouth (trismus) or swallowing, and the infection can spread, causing facial swelling (cellulitis).

Diagnosis

Diagnosis of pericoronitis primarily involves a clinical examination. Dentists look for the signs of inflammation around a partially erupted tooth and may also take dental X-rays to assess the position and development of the tooth involved.

Treatment

Treatment aims to alleviate symptoms and eliminate the infection. This may involve cleaning the area, draining any abscess, and prescribing antibiotics if the infection has spread. Pain relievers and mouth rinses may also be used to manage symptoms. In recurrent or severe cases, extraction of the affected tooth may be recommended.

Prevention

Maintaining good oral hygiene is key to preventing pericoronitis. This includes regular brushing and flossing, as well as periodic dental check-ups. Dentists may also recommend the proactive extraction of wisdom teeth that are likely to cause issues, as a preventive measure.

References

• Marques, J., Montserrat-Bosch, M., Figueiredo, R., Vilchez-Pérez, M. A., Valmaseda-Castellón, E., & Gay-Escoda, C. (2013). Clinical behavior of pericoronitis in the third mandibular molar. Medicina Oral Patologia Oral y Cirugia Bucal, 18(3), e439.
• Bouloux, G. F., Steed, M. B., & Perciaccante, V. J. (2007). Complications of third molar surgery. Oral and maxillofacial surgery clinics of North America, 19(1), 117-128.

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