What is Pericoronitis

Pericoronitis is an acute infection which causes swelling or inflammation of gums and surrounding soft tissues of a partially erupted tooth. Pericoronitis usually occurs in lower wisdom tooth area. Wisdom teeth usually erupt in late teens. When there is not enough space for wisdom tooth to erupt, then tooth becomes impacted.  Wisdom tooth may be partially or completely impacted. A flap of gum tissue is created in partially erupted wisdom tooth where food impaction can occur. Soft tissue flap covering partially impacted tooth is known as operculum. Entrapment of food below operculum or injury by the opposing tooth on operculum can lead to Pericoronitis.  When the flap becomes inflamed and swollen, then it is known as Pericoronitis. Pericoronitis can also occur in relation to completely impacted wisdom tooth or partially impacted wisdom tooth.

Signs and Symptoms of Pericoronitis

• Gum tissues in relation to partially impacted tooth become swollen and inflamed.
• Gum tissue will appear red and pus will discharge from gums in relation to tooth. Pus can result in increase in bulk of flap and can interfere with jaw closure.
• Lesion will be extremely tender and painful and pain may also radiate to ear, throat and floor of mouth.
• Bad taste and bad odor is present from oral cavity.   
• Patient will have difficulty in swallowing and will have difficulty in closing the jaws. Pain will aggravate on biting from opposite tooth as it will cause trauma to the flap present around the affected tooth.  
• Swelling of cheeks may also occur in Pericoronitis.
• Swelling of lymph nodes (Submandibular lymph nodes) and jaw muscles spasm may also occur in Pericoronitis.
• Fever, increase in number of white blood cells (Leucocytes) and malaise indicate sever infection.

Diagnosis of Pericoronitis

Pain, swelling and redness in relation to partially erupted tooth will diagnose Pericoronitis.

Treatment of Pericoronitis

Treatment of Pericoronitis depends on many factors. Treatment depends on:

• Severity of swelling which is present
• Whether  the involved tooth is to be extracted  or not and
• Whether systemic complications are present or not.

Debridement of area is done by cleaning the area. Flap is raised and pus and debris is removed by rinsing with water after giving topical anesthesia to the patient. If severe acute symptoms are present, then antibiotics are also prescribed to the patient to reduce the infection.

Patient is instructed to do hourly rinses with solution of tea spoonful of salt in glass of warm water. Patient should take more of fluids and should maintain good oral hygiene to avoid any food accumulates in wisdom tooth area. Patient should brush and floss properly to avoid any food deposits. Food deposits will aggravate the pain. Pericoronitis infection can regress in duration of 5-7 days. If tooth doesn’t erupt completely, then food accumulates will keep depositing below the gums and can cause Pericoronitis to recur.

Operculectomy that is surgical removal of flap over partial erupted tooth can also be done in case of Pericoronitis.      

Dentist may or may not remove the involved tooth. Dentist will do examination and will make out that whether tooth can completely come or not.  If the tooth can erupt completely without any complication, then dentist may not do tooth extraction. 

If tooth is to be retained and is not to be pulled out, then surgical procedures using periodontal knife or electro-surgery may also be required. After giving anesthesia to the patient, to remove the tissue, wedge shaped cut is made on gums. Periodontal pack is given after tissue removal.

Pericoronitis Home Remedy

• In initial stage of Pericoronitis, patient can do rinses with solution of tea spoonful of salt in glass of warm water. Rinse with this solution 2-3 times a day.
• Patient should brush his teeth after meals to remove the left over food particles in mouth. Food particles present over involved tooth site will aggravate the pain. 

Prevention of Pericoronitis

To prevent chances of Pericoronitis, patient should maintain good oral hygiene by brushing and flossing regularly. This is done to avoid deposits under gums. If Pericoronitis reoccurs, then flap of gum tissue is removed by the dentist. Flap of gum tissue may grow back again and in that case, extraction of wisdom tooth is required. 

When to Consult an Oral Surgeon

If symptoms of Pericoronitis are present, then patient should visit his oral surgeon. If patient’s wisdom teeth are erupting, then he should visit his dentist twice a year for examination.

Complications of Pericoronitis

• It may become localized in form of pericoronal abscess.
• Cyst formation can occur in case of partially erupted vital tooth.
• Pericoronitis can cause difficulty in swallowing if it spreads to back soft tissue.
• Peritonsillar abscess formation, cellulitis, Ludwig’s angina are infrequent but can occur as a complication of Pericoronitis.