Pericoronitis

The symptoms of acute pericoronitis may include:

• Severe pain around the back teeth
• Redness and swelling of the gums
• Difficulty swallowing
• Trismus or lockjaw (restricted mouth opening)
• Facial swelling
• Pus or drainage
• Fever
• Swollen lymph nodes in the neck

The symptoms of chronic pericoronitis may include:

• Mild pain (often, temporary) near the back teeth
• Halitosis (bad breath)
• Dysgeusia (bad taste in the mouth)

The primary cause of pericoronitis is partial tooth impaction, i.e., when a part of the tooth remains trapped within the gums. This creates a pocket where bacteria, food particles, and plaque can accumulate, leading to infection and inflammation.

The diagnosis is given by a dentist using the following methods:

• Oral examination: The dentist reviews the medical history, symptoms, and presentation, examines the wisdom teeth, and checks for excess gum tissue.
• Dental X-ray: The dentist may perform a dental X-ray to rule out other conditions, such as tooth decay, and examine the health of tooth roots.

The severity of the pericoronitis-associated inflammation influences the course of treatment recommended for each patient. Options include:

• Dental cleaning: The affected area is irrigated to wash out bacteria, food particles, or other debris. The use of antibiotics or an antibacterial mouthwash may also be recommended.
• Antibiotics: Oral antibiotics may be prescribed to clear the pericoronitis-associated infection.
• Medicated mouthwash: A prescription mouthwash that contains chlorhexidine, a topical antiseptic, is recommended to kill harmful bacteria causing pericoronitis.
• Operculectomy: In many cases, removal of the gum flap (operculum), which is a short oral surgery procedure, is recommended; sedation during this procedure is often unnecessary. Typically, with local anaesthesia, this procedure is completed within an hour.
• Wisdom tooth removal: If the wisdom teeth continue to cause problems or recurrent pericoronitis, removing them may be necessary. This procedure is often performed by an oral surgeon or periodontist with or without sedation.

If patients develop pericoronitis-associated symptoms, such as bleeding gums, tooth pain, and related fever, they are advised to schedule a dentist appointment right away. If pericoronitis is not treated promptly, it may exert a domino effect, i.e., lead to the deterioration of oral and overall health.

Pericoronitis is not always preventable, but the risk can be reduced by:

• Maintaining good oral hygiene, especially around partially erupted wisdom teeth
• Regular dental check-ups for early detection of gum or wisdom tooth problems
• Professional cleaning to remove plaque and debris around erupting wisdom teeth

For management of pericoronitis, consult a:

• General dentist: The first point of contact for diagnosis and initial management
• Oral and maxillofacial surgeon: For wisdom tooth removal
• Periodontist: In cases of advanced gum involvement