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Pericoronitis or operculitis is inflammation and infection of the gum tissue surrounding a partially impacted or impacted tooth. It can happen if a tooth doesn’t have enough room to erupt fully through the gums.
The soft tissue covering a partially erupted tooth is called the operculum. Pockets or flaps can develop in this tissue as the tooth pushes through.
These areas are difficult to clean. As a result, food particles can become trapped here, and bacteria can multiply, leading to infection.1
Pericoronitis most often affects people in their late teens or early 20s, coinciding with the time of wisdom teeth eruption.
See a dentist immediately if you have pain or other symptoms of pericoronitis. Leaving pericoronitis untreated can lead to serious complications, such as infection leading to jawbone damage.
The main symptom of pericoronitis is pain. The pain is often throbbing and can radiate to the ear, jaw, or neck on the same side as the affected tooth.
At first, symptoms of pericoronitis may be mild or moderate. They include:2
If the infection is left untreated, it can lead to more severe symptoms, such as:
If you have moderate or severe pericoronitis symptoms, see a dentist or doctor immediately. Dentists group pericoronitis symptoms into three categories:
The primary cause of pericoronitis is poor oral hygiene. If you don't remove plaque and bacteria around newly erupting teeth properly, an infection can develop.
Pericoronitis most often occurs in people in their 20s; around 81% of those affected are between 20 and 29.3
Risk factors that increase the chance of developing pericoronitis include:4
If pericoronitis isn't treated promptly, it can lead to serious complications. These include:
Sometimes pericoronitis complications can be life-threatening, although this is rare. Untreated pericoronitis can lead to Ludwig’s angina, an infection that spreads under the jaw and tongue and causes difficulty breathing. The infection may also spread into the bloodstream, a serious condition known as sepsis.5
Once a dentist diagnoses pericoronitis, they'll recommend a treatment plan according to your specific needs. The infection and inflammation may not resolve until the tooth fully erupts on its own or a dentist removes either the gum tissue surrounding the tooth or the tooth itself.
Dentists diagnose pericoronitis through a clinical evaluation of your teeth. They check for signs of inflammation or infection. They also check for redness, swelling, pus, and gum flaps and ask you about other symptoms.
The dentist will also take X-rays to look at the offending tooth’s path of eruption. They'll also rule out other causes for the signs and symptoms, like dental decay or periodontal disease.
If your symptoms are limited to the tissue surrounding the tooth, a dentist may:
Because severe pain can limit chewing, dentists usually recommend taking nonsteroidal anti-inflammatory drugs (NSAIDs). Medications like ibuprofen, naproxen, or tylenol can reduce discomfort and swelling.
Home remedies like warm salt water rinses may also help remove plaque and food debris.
Once the infection resolves, subsequent treatment depends on the symptoms’ severity. In some cases, the dentist may suggest a “watch and wait” approach. This involves carefully monitoring the tooth for signs of infection and ensuring that it's erupting normally.
An oral surgeon may need to perform minor oral surgery if the pericoronitis is severe. They may recommend:
A dentist may use sterile solutions such as saline, chlorhexidine, or hydrogen peroxide to flush out debris from around the tooth. They may then remove damaged and infected tissue with periodontal instruments. This procedure reduces the chance of the infection returning.
This procedure removes the soft tissue, or operculum covering a partially erupted tooth. It can eliminate the deep pocket around the tooth that is difficult to keep clean.
However, dentists may only recommend operculectomy for a tooth that’s well positioned for eruption. If the tooth is impacted or doesn't have enough space to erupt as it should, extraction may be a better option.
With operculectomy, there's also the possibility of the flap growing back after it's removed.
This is necessary if the tooth is unlikely to erupt normally and is commonly done if the pericoronitis is due to a wisdom tooth. Once the oral surgeon removes the wisdom tooth, symptoms should subside within 1 to 2 weeks.
In some cases, both the wisdom teeth on the affected side need to be removed. This prevents the upper tooth from biting and damaging the inflamed lower gum tissue. Otherwise, repeated trauma can cause ulcerations and worsen the symptoms.2
Pericoronitis often resolves once the offending tooth erupts completely. However, it may persist or recur if the teeth are impacted, especially in the case of wisdom teeth. In these cases, removing the wisdom tooth usually eases symptoms.
Extracting symptomatic wisdom teeth also usually improves the health of the adjacent second molars.
You can reduce your risk of pericoronitis by:
Pericoronitis is an inflammation of the gum tissue around a wisdom tooth. It happens as the wisdom tooth erupts, creating flaps of the gums. These pockets can trap food and bacteria, leading to infection and pain.
If pericoronitis is not treated promptly, it can lead to serious complications, such as jawbone damage or difficulty breathing.
You can reduce the risk of developing pericoronitis by maintaining good oral hygiene and seeing a dentist regularly.
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