What is Pericoronitis?

Arnaud Pontin (Image: Gay Globe)

Pericoronitis is a condition characterized by inflammation and infection of the soft tissues surrounding the crown of a partially erupted tooth, most commonly the third molars, also known as wisdom teeth. This condition typically arises when the wisdom teeth do not fully emerge through the gums, leaving a flap of gum tissue covering a portion of the tooth. Bacteria and food particles can become trapped beneath this flap, leading to irritation, inflammation, and eventually infection.

The word « pericoronitis » is derived from Greek roots: « peri » meaning « around, » « coron » meaning « crown, » and « -itis » indicating inflammation. Therefore, pericoronitis literally translates to « inflammation around the crown. »

Understanding the Anatomy: To comprehend pericoronitis fully, it’s essential to grasp the anatomy of the wisdom teeth and surrounding structures. Wisdom teeth, or third molars, are the last set of molars to emerge in the oral cavity, typically erupting between the ages of 17 and 25. However, due to limited space in the jaw or misalignment, they may only partially erupt or remain impacted beneath the gum line.

When a wisdom tooth partially erupts, a small portion of the tooth emerges while the rest remains covered by the gum tissue. This flap of gum tissue creates a pocket where bacteria, plaque, and food particles can accumulate, promoting bacterial growth and inflammation.

Symptoms of Pericoronitis: Pericoronitis can manifest with various symptoms, which may include:

1. Pain and discomfort around the affected tooth and surrounding gum tissue.
2. Swelling and redness in the gum tissue near the partially erupted tooth.
3. Difficulty opening the mouth due to pain and swelling.
4. Foul taste or odor emanating from the affected area due to bacterial infection.
5. Formation of pus or discharge around the tooth.
6. Swollen lymph nodes in the neck.
7. Fever and general malaise in severe cases.

These symptoms can range from mild to severe, depending on the extent of inflammation and infection. In some instances, pericoronitis may lead to complications such as cellulitis (spread of infection to adjacent tissues), abscess formation, or even systemic infection if left untreated.

Causes of Pericoronitis: Several factors contribute to the development of pericoronitis, including:

1. Partial eruption of wisdom teeth: When wisdom teeth only partially emerge through the gums, they create an ideal environment for bacteria and debris accumulation.
2. Poor oral hygiene: Inadequate brushing and flossing can lead to the buildup of plaque and food particles around the partially erupted tooth, increasing the risk of infection.
3. Trauma or injury: Trauma to the gum tissue covering the wisdom tooth, such as accidental biting or friction from adjacent teeth, can trigger inflammation and predispose to pericoronitis.
4. Impaction: Impacted wisdom teeth, which fail to erupt fully due to obstruction by bone or adjacent teeth, are more prone to pericoronitis.
5. Immunocompromised conditions: Individuals with weakened immune systems may be more susceptible to infections, including pericoronitis.

Treatment Options: The management of pericoronitis aims to alleviate symptoms, control infection, and prevent recurrence. Treatment modalities may include:

1. Antibiotics: In cases of acute pericoronitis with signs of infection, antibiotics may be prescribed to combat bacterial growth and reduce inflammation. Commonly prescribed antibiotics include amoxicillin, metronidazole, or clindamycin.
2. Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen may be recommended to relieve pain and discomfort associated with pericoronitis.
3. Warm saltwater rinses: Gargling with warm saltwater can help reduce inflammation, alleviate pain, and promote healing by flushing out debris and bacteria from the affected area.
4. Oral hygiene measures: Practicing good oral hygiene, including gentle brushing and flossing around the affected tooth, can help remove plaque and debris, reducing the risk of infection.
5. Irrigation and cleaning: Dentists may irrigate the affected area with antimicrobial solutions or perform professional cleaning to remove debris and bacteria trapped beneath the gum flap.
6. Surgical intervention: In cases of recurrent or severe pericoronitis, surgical removal of the wisdom tooth (extraction) may be recommended to prevent future episodes and alleviate symptoms.
7. Drainage of abscess: If an abscess forms as a complication of pericoronitis, it may need to be drained surgically to relieve pressure and facilitate healing.

Prevention Strategies: Preventing pericoronitis involves maintaining good oral hygiene practices and addressing potential risk factors. Some preventive measures include:

1. Regular dental check-ups: Routine dental visits allow for early detection and management of dental issues, including wisdom tooth impaction and pericoronitis.
2. Proper oral hygiene: Brushing teeth twice daily with fluoride toothpaste and flossing regularly help remove plaque and debris, reducing the risk of pericoronitis.
3. Wisdom tooth evaluation: Dental X-rays and clinical examination can assess the position and alignment of wisdom teeth, allowing for timely intervention if impaction is detected.
4. Timely removal of problematic wisdom teeth: Dentists may recommend extracting impacted or partially erupted wisdom teeth to prevent pericoronitis and other associated complications.