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Updated on September 27, 2022

Pericoronitis Causes, Symptoms & Treatment

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What is Pericoronitis?

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.

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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, 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
  • Tooth sensitivity
  • An unpleasant taste in the mouth
  • Bad breath

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

  • Difficulty opening the mouth
  • Swelling of the affected side of the face
  • Swollen lymph nodes (lymphadenopathy)
  • Fever
  • Breathing difficulties (dyspnea) 
  • Difficulty swallowing (dysphagia) 

If you have moderate or severe pericoronitis symptoms, see a dentist or doctor immediately. Dentists group pericoronitis symptoms into three categories:

  1. Acute pericoronitis — severe symptoms with the inability to open the mouth
  2. Sub-acute pericoronitis— symptoms are of lower intensity and there are no restrictions opening the mouth 
  3. Chronic pericoronitis— short-lasting, low-grade pain without other 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.

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

  • Being pregnant
  • Smoking
  • Being stressed or fatigued
  • Having an upper respiratory infection or other viral infection
  • Taking immunosuppressive drugs, such as steroids

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.5

How to Treat Pericoronitis

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.

Diagnosis 

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.

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's signs the infection is spreading

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.

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 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.

2. Performing an operculectomy 

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.

3. Extracting the offending tooth 

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

Outlook 

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. 

Prevention

You can reduce your risk of pericoronitis by:

  • Maintaining meticulous 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, while professional teeth cleanings can help remove tartar buildup.
  • Taking pre-emptive action — contact a dentist promptly if you develop any dental symptoms.
  • Avoiding smoking — smoking increases the risk of pericoronitis and other gum diseases.
  • 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.6

Summary

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.

6 Sources Cited
Last updated on September 27, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Pericoronitis.” Columbia College of Dental Medicine
  2. Kwon, G., et al.Pericoronitis.” StatPearls. 2022.
  3. Moloney, J., et al.Pericoronitis: treatment and a clinical dilemma.” Irish Dental Association. 2009.
  4. Katsarou, T., et al.Pericoronitis: A clinical and epidemiological study in greek military recruits.” Oral Medicine and Pathology. 2019.
  5. Kavarodi A. M. “Necrotizing fasciitis in association with Ludwig's angina - A case report.”  The Saudi Dental Journal. 2011.
  6. LanzaGalvão, E., et al.Association between mandibular third molar position and the occurrence of pericoronitis: A systematic review and meta-analysis.” Archives of Oral Biology. 2019.
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