Pericoronitis

Pericoronitis is a medical condition in which the soft tissues that surround the erupting teeth become inflamed. The inflammation occurs commonly in association with the wisdom teeth and it involves both the gums and the dental follicles. The condition can be classified with into acute and chronic, presenting different symptoms according to each type. If there is infection associated with the inflammation, this can spread to other parts of the body, leading to the appearance of life-threatening symptoms and requiring emergency treatment.

Symptoms of Pericoronitis

These are the most common symptoms that are present in patients diagnosed with pericoronitis:Acute

• Severe pain
• Inflammation
• Fever
• Pericoronal abscess (pus)
• Sudden onset
• State of general malaise
• Swollen lymph nodes (neck area)

Chronic

• Mild symptoms
• Long period of remission
• May be asymptomatic

These are the general signs and symptoms for all the patients who suffer from pericoronitis:

• Pain
• Aggravated in severe cases
• Patients describe the pain as throbbing
• Pain may radiate to the other body parts in the area, such as the ear or the throat
• Other areas to which the pain may radiate to include the floor of the mouth, the posterior submandibular region and the temporomandibular joint
• Pain may appear with movement, such as biting or talking
• The pain can be so intense, that the patient is awakened by it
• Intense pain can be elicited by applying pressure to the respective area (the pressure might also lead to purulent discharge, especially if there is a pericoronal abscess formed)
• Tenderness in the tooth that has erupted only partially
• Redness and inflammation in the area
• Bad breath appears, as the bacteria consume the proteins (putrefaction process)
• Patients complain of bad taste in the mouth, due to the purulent discharge that might occur from the affected area
• The swollen tissues might be affected by the biting process, suffering from bleeding or ulceration (visible signs of trauma from the upper teeth)
• If the inflammation spreads to the masticatory muscles, the patient might have difficulties opening the mouth (trismus)
• The patient can also experience difficulty in swallowing (dysphagia)
• The lymph nodes in the neck area (especially cervical and submandibular ones) are swollen
• The patient might also experience inflammation and redness at the level of the face
• High-running fever appears as the body tries to fight off the infection
• State of general weakness (malaise)
• Appetite loss

What Causes Pericoronitis?

These are the most common causes that lead to the appearance of pericoronitis:

• Soft tissue overlapping on the erupting teeth – accumulation of food debris and plaque – inflammatory response in the area + bacterial overgrowth
• Inadequate oral hygiene
• Not cleaning the soft tissues that overlap the erupting teeth
• Increased risk for the accumulation of debris and bacterial overgrowth
• Most common bacteria – streptococcus, anaerobic bacteria
• Often leads to formation of abscess
• Improper tooth positioning
• An upper tooth bites into the soft tissues overlapping the erupting teeth
• The upper teeth has over-erupted, biting into the soft tissues
• Complete eruption of wisdom teeth
• The teeth have erupted at a non-ideal angle
• Extra teeth (increased risk for the appearance of pericoronitis)

Treatment

These are the most common measures and treatment solutions that can be taken for pericoronitis:

• Special gels for the management of pain
• Main ingredient – lidocaine (numbing agent)
• Improved oral hygiene
• Removal of plaque through specialized methods (dentist’s office)
• Wisdom tooth extraction
• Resection of the gingival tissue
• Antibiotics might be administered in case of bacterial infection
• Oral antibiotics might also be prescribed in patients who experience systemic symptoms, suggestive of a severe infection with bacterial micro-organisms (swelling in the neck area, inflammation of the lymph nodes, state of general malaise, high-running fever)
• Recommended choices: penicillin, clindamycin, metronidazole
• Orally-administered non-steroidal anti-inflammatory drugs (pain management)
• Irrigation of the affected area – removal of pus, debris and inflammatory exudate Solutions used for the irrigation include: warm saline solutions, hydrogen peroxide, chlorhexidine and antiseptic substances
• Debridement
• Specific procedure for the removal of excess plaque and debris
• Periodontal instruments are used for a successful debridement procedure
• Drainage of the pericoronal abscess, with a small incision
• Smoothing of the opposing teeth
• Reduce the constant trauma applied to the soft tissues
• Regular usage of mouthwashes that have antiseptic and antibacterial properties
• Gargling with salty, warm water
• Emergency treatment
• Recommended in patients who have difficulties swallowing or breathing
• Intravenous treatment
• Monitoring of vital signs and of the airways

Complications

The complications that might occur in patients diagnosed with pericoronitis include:Ludwig’s angina

• Infection from the partially erupted tooth spreads to the neck or the face
• Can lead to life-threatening symptoms, with the patient having difficulties breathing to swallowing
• Requires emergency medical treatment

Follicular cyst

• Can damage the nearby teeth
• Increased risk for bone destruction

How long does Pericoronitis last?

The acute cases of pericoronitis last somewhere between ten days and two weeks. It is important to remember that the chronic cases of pericoronitis are accompanied by spontaneous symptomatic episodes, which last just as much. It is important to understand that this condition becomes chronic, if no treatment is sought for the acute episode. The removal of the wisdom teeth is often the best way to ensure that pericoronitis does not go from acute to chronic.In conclusion, pericoronitis is a serious condition and it should be treated as such. Left untreated, not only it will become chronic (affecting your overall quality of life) but it can also lead to serious complications, such as the ones mentioned above. As you have seen, pericoronitis is often linked to inadequate oral hygiene – it is in your power to improve your oral health, by taking the necessary measures at home and by visiting your dentist on a regular basis. Also, you need to consider removing your wisdom teeth, no matter how uncomfortable such an idea might make you feel. It is for the best that you prevent such health problems, then try to treat them.

Pictures : How does Pericoronitis looks like?