Pericoronitis Causes, Symptoms & Treatment

What is Pericoronitis?

Pericoronitis is also known as operculitis. This condition is characterized by the inflammation of the soft tissue with a partially erupted tooth crown.

Pericoronitis is associated with swelling and infection of the gum tissue around the wisdom teeth. These are the third and final set of molars that erupt when people are in their late teens or 20’s.

wisdom teeth crowding

This condition is seen most often in relation to the mandibular third molars. It develops when the molar becomes partially impacted due to bacteria accumulation. Typically, the tooth is only partially exposed (partial eruption), and excess gum tissue overlaps the tooth.

Pericoronitis is a type of gingivitis. It develops around teeth as they are erupting out of the gums.

Pericoronitis happens when the wisdom teeth do not have enough room to erupt through the gingival (gums). As a result, they may only partially come through the gums. This can lead to inflammation and infection of the soft tissue surrounding the wisdom tooth. Pericoronitis most commonly occurs around the lower wisdom teeth.

What Causes Pericoronitis?

Pericoronitis is caused by a tooth that has failed to come in or has only partially erupted. This partially-erupted wisdom tooth often leaves a flap of gum tissue. Food particles and other debris collect there, making an ideal breeding ground for bacteria to flourish.

Here are some common causes of pericoronitis:

  • Practicing poor oral hygiene
  • Not brushing and flossing regularly
  • Not seeing your general dentist for checkups
  • Stress
  • Pregnancy 
  • Upper respiratory tract infections 

Symptoms of Pericoronitis

The symptoms associated with pericoronitis vary based on the severity of the infection.

Milder pericoronitis cases are referred to as acute pericoronitis, symptoms include:

  • Painful, swollen gum tissue near the erupted tooth 
  • Difficulty biting down in the area without hitting the swollen tissue
  • A bad taste in your mouth 
  • Bad breath or halitosis 
  • Loss of appetite 

The symptoms associated with more severe cases of pericoronitis: 

  • Swelling of the face
  • Swollen lymph nodes 
  • Jaw spasms 
  • Trismus, more commonly referred to as “lockjaw”
  • Numbness or tingling of the face 

Pericoronitis Risk Factors (Who is at Risk?)

If you identify with any of the following, you have a higher risk of developing pericoronitis:

  • Have poor oral hygiene
  • Have extra gum tissue
  • Are pregnant
  • Are under a lot of stress
  • Are between the ages of 20 and 29
  • Have improperly erupted wisdom teeth (third molars)

Potential Complications of Pericoronitis

The more severe symptoms of pericoronitis are associated with an infection spreading to the throat and neck. In severe cases, this can affect a person’s breathing and swallowing functions. It can even be life-threatening. An acute pericoronal abscess may develop that can stay localized or spread. 

Untreated pericoronitis can cause Ludwig’s angina. This is an infection that spreads under the tongue and jaw. It is also associated with other deep infections in the neck, throat, and head.

There is also the risk that pericoronitis can spread into the bloodstream. This life-threatening condition is known as sepsis. If you develop any symptoms of sepsis, seek emergency medical care immediately.

How Long Does Pericoronitis Last?

Symptoms associated with chronic pericoronitis generally only last for a day or two. However, they keep coming back month after month. The symptoms last three to four days for acute cases.

How is Pericoronitis Diagnosed?

Pericoronitis is diagnosed during an oral health evaluation. If you suspect you have pericoronitis, set up an appointment with your dentist or periodontist. They will exam your wisdom teeth (third molars) and look for signs of the condition. They will also check to see if your gums are swollen, red, inflamed, tender, or draining pus.

How is Pericoronitis Treated?

After diagnosis, treatment is necessary to resolve pericoronitis.

The treatment options available for pericoronitis include professional and home remedies.

If your case requires professional attention, your dentist will begin by flushing away accumulated food particles and debris from the affected area. Next, they will prescribe a course of oral antibiotics, usually penicillin, to help clear up the infection. 

Your dentist may also recommend an antibacterial mouth rinse that contains chlorhexidine. This rinse will help fight and clear the infection. You can also dilute some hydrogen peroxide or use warm salt water as an oral rinse.

Another home remedy for pericoronitis is an oral irrigator. This device allows you to properly and thoroughly clean your hard-to-reach wisdom teeth. Irrigators clear out particles and bacteria beneath the operculum to speed up healing and prevent pericoronitis.

You can take over-the-counter pain medication like acetaminophen, ibuprofen, or pain relievers that your dentist prescribes. 

The next step in treatment depends on your wisdom tooth’s status. This is because pericoronitis often develops near a tooth still in the process of eruption. If this is the case, your dentist will monitor the area to make sure it stays clean and infection-free until your wisdom tooth has fully grown in.

In the case of severe symptoms, you may need to see a maxillofacial surgeon. They will perform minor oral surgery to remove the operculum, or flap of gum tissue.

If it looks like your wisdom tooth won’t come in normally, your dentist will likely recommend extracting the tooth.

Can Pericoronitis Go Away On Its Own?

Pericoronitis will not go away on its own. It is essential to treat the condition immediately and properly before any chronic symptoms and conditions arise. Contact your dentist as soon as you start noticing any symptoms of pericoronitis. 

The course of treatment can vary greatly between cases, from rinsing with mouthwash to tooth extraction. This is why it’s crucial for you to schedule an appointment with your dentist.

What is the Prognosis for Pericoronitis?

The prognosis for pericoronitis is very good after treatment is complete. The condition typically resolves in about one to three weeks (depending on the patient). Pericoronitis can return if the original infection that caused the condition is not treated.

Reminder: do not neglect treatment, as pericoronitis will not resolve without it.

Resources

Pericoronitis. (2017, May 17). https://www.dental.columbia.edu/patient-care/dental-library/pericoronitis.

Dhonge, R. P., Zade, R., Gopinath, V., & Amirisetty, R. (n.d.). An Insight into Pericoronitis. http://www.ijohmr.com/upload/An%20Insight%20Into%20Pericoronitis.pdf/.

Kay, L.W. “Investigations into the Nature of Pericoronitis-II.” British Journal of Oral Surgery, Churchill Livingstone, 29 June 2005, www.sciencedirect.com/science/article/abs/pii/S0007117X66800112.

McNutt, Matthew, et al. “Impact of Symptomatic Pericoronitis on Health-Related Quality of Life.” Journal of Oral and Maxillofacial Surgery, W.B. Saunders, 18 Nov. 2008, www.sciencedirect.com/science/article/abs/pii/S0278239108011944.

Nitzan, D.W., et al. “Pericoronitis: A Reappraisal of Its Clinical and Microbiologic Aspects.” Journal of Oral and Maxillofacial Surgery, W.B. Saunders, 11 May 2010, www.sciencedirect.com/science/article/abs/pii/S027823918580029X.

Wade, W. G., et al. “Predominant Cultivable Flora in Pericoronitis.” Wiley Online Library, John Wiley & Sons, Ltd, 18 Dec. 2007, onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-302X.1991.tb00499.x.

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