Pericoronitis

• Inflammation of soft tissue around the crown of erupting tooth or impacted tooth.
• When eruption is complete there is an opening through the membrane, the rest of the crown is covered by a flap of soft tissue known as operculum
• Can occur un any tooth at any age but commonly occurs in lower 3rd molar at the age of 18–24 years

Causes

• Impaction: food collection, stagnation inside the flap or operculum, provides favorable media for bacterial growth and inflammation.
• Injury: if upper tooth is continuously traumatizing lower gum flap.
• Vincent’s infection: can start from pericoronal pocket or spread to pericoronal pocket from other sites of gingiva
• Decreased resistance to infection e.g. common cold, Diabetes Mellitus, Anemia , TB
• Eruptive irritation:
• Bouts of pain or attack of pain occurs in between every 2–3 yrs
• After that for a few months or years: silent period: no pain
• But in eruptive phase pain appears

Clinical Features

• Soreness and tenderness followed by pain and swelling
• Due to inflammation there is spasm of muscles of mastication
• Trismus: difficulty in opening mouth
• Dyshagia
• Regional lymphadenopathy
• Abscess formation in extra or intraoral region (pericoronal abscess)
• Systemic: fever, malaise, halitosis due to inflammation

Management

• Manage acute condition and definitive treatment

Acute condition

• Clean all area with H2O2 or Normal Saline (irrigation)
• Antiseptic solution: Chlorhexidine etc
• Hot salt water mouth wash 2–3 times daily
• Analgesics and anti inflammatory
• Antibiotics started ASAP
• Penicillin-amoxicillin (80% effective)
• Metronidazole (25%)
• Or both together
• Soft food
• Oral hygiene

Definitive management

• Analyze available space for tooth to erupt
• Look for whether angulation is favorable
• Advice for intra oral periapical X ray and OPG (oralpanoramogram) to see the position of the teeth if inline with occlusion, if not inline: extraction is advised
• Tooth extraction
• Operculectomy
• Removal of upper teeth if pain