Pericoronitis Causes, Symptoms & Treatment

What is Pericoronitis?

Pericoronitis (or operculitis) is a type of gum infection. It most often affects people with wisdom teeth (third molars) that haven’t come in properly.

When a wisdom tooth is impacted and can’t erupt fully, a flap of gum tissue sits over it. This flap can become a trap for bacteria and food particles, eventually becoming infected.¹

Pericoronitis can affect any erupting tooth, but most cases are due to impacted wisdom teeth. It’s most common in people in their late teens or early 20s because this is when the wisdom teeth generally erupt into the mouth. 

See a dentist immediately if you have pain or other symptoms of pericoronitis. Leaving pericoronitis untreated can lead to serious complications, such as the infection spreading to your jawbone.

Symptoms of Pericoronitis

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, the symptoms of pericoronitis may be mild or moderate. They include:²

• Red, swollen gum tissue near the affected tooth
• Pus around the affected tooth
• Difficulty biting or chewing
• Bad breath or a bad taste in the mouth

If the infection is left untreated, it can lead to more severe symptoms, such as:

• Severe pain
• Difficulty opening the mouth
• Swelling of the affected side of the face
• Swollen lymph nodes
• Fever
• Breathing difficulties 
• Difficulty swallowing 

See a dentist or doctor immediately if you have moderate or severe pericoronitis symptoms. 

What Causes Pericoronitis?

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.

Unfortunately, the area can be difficult to keep clean if there isn’t enough space for those teeth to emerge completely.

Pericoronitis most often occurs in people in their 20s; around 81% of those affected are between the ages of 20 and 29.³

Risk factors that increase the chance of developing pericoronitis include:⁴

• Being pregnant
• Smoking
• Being stressed or fatigued
• Having a respiratory tract infection or other infection
• Taking immunosuppressive drugs, such as steroids

Diagnosing and Treating Pericoronitis

Once a dentist diagnoses pericoronitis, they’ll recommend a treatment plan according to your specific needs.

It may be possible to wait until the wisdom tooth fully erupts. But in most cases, the dentist or an oral surgeon will need to remove the gum flap, the tooth, or both.

Diagnosis 

Dentists diagnose pericoronitis by visually examining your teeth. They’ll check for signs of inflammation or infection, such as redness, swelling, or pus. They’ll also ask you about any other symptoms you may be having.

The dentist will also take X-rays to view your impacted tooth better. They’ll want to be able to rule out other causes for your symptoms, like tooth decay or periodontal disease.

Treatment Options 

If your symptoms are limited to the tissue surrounding the tooth, a dentist may:

• Thoroughly clean the area
• Remove any food debris
• Drain any pus
• Prescribe antibiotics if there are signs the infection is spreading

To reduce the pain, your dentist may recommend taking over-the-counter pain relievers like ibuprofen, naproxen, or acetaminophen (Tylenol). Home remedies like warm salt water rinses can also help remove plaque and food debris.

Once the infection resolves, the next steps will depend on your specific situation. Sometimes, there may be room for your tooth to erupt fully, and the dentist may suggest a “watch and wait” approach.

Minor Surgery

An oral surgeon may need to perform minor oral surgery if the pericoronitis is severe. They may recommend:

1. Cleaning out the infected tissue 

A dentist may use a sterile solution to flush out debris around the tooth. They may then remove damaged and infected tissue with special instruments like curettes. This reduces the chance of the infection returning.

2. Performing an operculectomy 

This means completely removing the gum flap covering the tooth. This will make the area much easier to keep clean since there will no longer be a pocket where food and bacteria can get trapped.

However, dentists may only recommend this procedure if your tooth is well-positioned to erupt properly. Extracting the tooth may be a better option if the tooth is impacted (can’t fully erupt). Otherwise, the excess gum tissue may grow back even after it’s fully removed once.  

3. Extracting the offending tooth 

If your pericoronitis involves an impacted wisdom tooth, the most likely next step is to extract the tooth. If left in place, the tooth is unlikely to erupt properly.

In some cases, both the wisdom teeth on the affected side need to be removed. This prevents the upper molars from biting and damaging the inflamed lower gum tissue, which could worsen your symptoms.²

Can Pericoronitis Be Prevented?

You can reduce your risk of pericoronitis by:

• Proper oral hygiene — Regular brushing and flossing, especially around newly erupting teeth, helps remove plaque and bacteria
• Seeing a dentist regularly — Check-ups can identify any problems early, and professional teeth cleanings can help remove tartar buildup
• Taking pre-emptive action — Contact a dentist promptly if you develop any symptoms of pericoronitis
• Avoiding smoking — Smoking increases the risk of pericoronitis and gum disease in general
• Managing stress levels — Stress can weaken the immune system, making you more susceptible to infection
• Maintaining a healthy diet — A balanced diet rich in nutrients helps support your immune system and overall health

Outlook 

Pericoronitis often resolves once the offending tooth either erupts completely or is removed. Removing impacted wisdom teeth may also improve the health of the adjacent teeth.

Following minor surgery, your symptoms (including pain) should subside within 1 to 2 weeks.

Risks and Complications of Pericoronitis

If pericoronitis isn’t treated promptly, it can lead to serious complications. These include:

• Infection of the surrounding bone (osteomyelitis)
• Infections in other areas of the head and neck
• Airway obstruction
• Mandibular nerve injuries
• Trismus (difficulty opening the mouth)

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

Summary

Pericoronitis is inflammation of the gum tissue around a partially erupted tooth, usually a wisdom tooth. The tooth may be covered with a flap of gum tissue that can easily trap bacteria and food particles and become infected.

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 regularly seeing a dentist.