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tooth health

Pericoronite by G.Bertelli

Generality

Pericoronitis is an acute inflammation of the gum that surrounds a tooth that is erupting .

The pathological process mainly affects the soft tissues of the third series of lower and upper molars (the so-called "wisdom teeth"), respectively to the right and to the left of the dental arch.

In the case of pericoronitis, the gum appears swollen, reddened and painful at the site concerned. Often, soreness extends to the entire angular area of ​​the jaw and becomes particularly intense during chewing . In the presence of acute pericoronitis, pain can also radiate to the ear and neck.

The main cause of pericoronitis is that wisdom teeth often do not find their eruptive space, remaining included or partially covered by the gum .

The pericoronal recess or the gum flap on the partially emerged tooth (defined operculum ) can trap bacteria and food fragments . Therefore, the inflammatory process at the base of pericoronitis can be supported by a pericoronal infection, which can give rise to various complications (including abscesses or cellulitis).

Treatment depends on the stage of pericoronitis and provides different options. Usually, the acute phase of the disease is managed with antibiotics and anti-inflammatories, associated with specific oral hygiene procedures (eg rinses with warm salt water, chlorhexidine-based mouthwashes, cleaning with a single-brush toothbrush, etc.). The definitive solution of pericoronitis is tooth extraction .

What's this

Pericoronitis is a particular form of gingivitis that develops at a partially erupted tooth. In most cases, the process involves the soft tissues surrounding the crown of a wisdom tooth, ie gum and dental follicle (structure that will form the supporting tissues).

" Pericoronite " comes from the union of the terms peri- (around), coron- (visible part of the tooth), -ite (inflammation), from which " inflammation of the tissues around the tooth ".

Pericoronitis can be favored by bacteria present in the oral cavity, which, penetrating inside the space between tooth and gum, determine an infectious process.

The inflammatory phenomena at the base of pericoronitis can also be induced by the pressure of the tooth during the eruption, by mechanical traumas and by the accumulation of food residues in the pericoronal recess or under the operculum.

Operculum: some notes

  • The soft tissue covering a partially erupted tooth is known as an operculum .
  • As a rule, this flap of the gum disappears when the tooth emerges completely.
  • The area of ​​the operculum can be difficult to achieve with normal oral hygiene methods.
  • Technically, the synonym " opercolite " refers to the inflammation of the single operculum.

Causes

Pericoronitis is caused by the acute inflammation of the gingiva surrounding the crown of an erupting tooth (including or not completely erupted).

The most common pericoronitis are those of wisdom teeth (third molars), especially the lower ones: if these do not find their eruptive space, remaining included or partially covered by the gum, they can cause the formation of a recess, in which the bacteria can easily nest and give infection.

Triggering and favoring factors

The factors that can predispose and maintain the phlogistic process include:

  • Infections . Pericoronitis associated with a badly erected and badly positioned wisdom tooth can be triggered and supported by an infection. The bacteria normally present in the oral cavity can penetrate into the space between the tooth and the gum, colonizing it and causing inflammation of adjacent tissues. In some cases, the active infection associated with pericoronitis may develop into pericoronal abscess (pus) or cellulite. These pathological processes can also spread to the throat or cheek.
  • Food residues . Inflammatory phenomena at the base of pericoronitis can be favored by the accumulation of food particles under the operculum or in the gingival recess.
  • Trauma and irritative factors . If the upper wisdom tooth emerges before the lower one, it can hit the flap, increasing irritation. Pericoronitis can therefore be promoted by tooth pressure during eruption and mechanical trauma (eg by biting the operculum with the opposite tooth).
  • Position of the tooth and anatomical reasons . Pericoronitis can also occur when the distance between the dental germ and the eruption area is too wide. Other times, there is no space for the wisdom tooth to be housed.

Who is most at risk

Pericoronitis is associated with the eruption of mandibular molars ( lower wisdom teeth ), so the inflammation affects mainly between the ages of 15 and 24 years.

In young children, the disease can occur during teething, immediately before the deciduous teeth eruption ( milk teeth ).

Symptoms and Complications

Pericoronitis is associated with a wide range of symptoms. Inflammation can occur in chronic and acute form.

At the site of tooth eruption, the appearance of pain in the jaw is typical, which increases with chewing. At the same time, the gum is red and swollen. Pericoronitis may worsen, causing more intense pain (often radiated to the ear). Sometimes, a feeling of unpleasant taste is reported in the mouth (due to pus leaking from the gingival recess) and / or halitosis.

Acute pericoronitis

Acute pericoronitis presents a sudden onset and short duration, but the pathology is clinically significant. This form of gingivitis is characterized, in fact, by various degrees of inflammatory involvement of the pericoronal flap and adjacent structures, as well as systemic complications.

Typically, acute pericoronitis involves wisdom teeth (third molars), especially of the lower arch.

In most cases, pericoronitis involves:

  • Unusual pain, redness and swelling of the gum;
  • Chewing difficulties;
  • Halitosis;
  • Bad taste in the mouth (caused by pus leaking from the gums);
  • Soreness or pain in the jaw.

In the presence of acute pericoronitis, one or more of the following symptoms may also occur:

  • Difficulty in opening the mouth (trismus);
  • Neck pain;
  • Enlarged submandibular lymph nodes;
  • Ear pain;
  • Presence of pus in inflammation;
  • Temperature;
  • Headache;
  • Jaw muscle spasms;
  • Swelling on the affected side of the face;

Chronic pericoronitis

Pericoronitis can also be chronic or recurrent. In this case, episodes of acute pericoronitis alternate with long remissions.

Chronic pericoronitis can cause few or some symptoms, but some signs of the pathological process are evident when the mouth is examined by the dentist.

Concurrent complications and pathologies

  • The main local complication associated with pericoronitis is the pericoronal abscess, in which the collection of pus can extend to different areas of the mouth. In more severe cases, this infection can lead to the involvement of the ear, tongue, jaw, throat, cheeks and other parts of the face or neck. A suppurative pericoronitis may involve hospitalization and immediate surgery. Occasionally, pericoronal abscess can lead to compromised airways (eg Ludwig's angina).
  • Systemic complications of pericoronitis refer to signs and symptoms that occur elsewhere than the oral cavity and include fever, malaise or swollen lymph nodes in the neck.
  • Particular attention in the management of pericoronitis must be implemented by pregnant women . If neglected, pericoronitis can also have consequences for the fetus. A pregnant woman who has been diagnosed with pericoronitis must use multidisciplinary skills (primary care physician, dentist and gynecologist) for her treatment.

Diagnosis

To make sure of the diagnosis, even in cases of mild discomfort or redness and superficial swelling of the gingiva, it is always good to consult your dentist.

He will begin to examine the oral cavity to verify the state of the growth of the included or partially erupted tooth or if there are problems, such as inflammation or swelling in the area. The purulent component can escape following compression or gingival probing.

In the presence of pericoronitis, an X-ray can also be performed to check the alignment of wisdom teeth.

Differential diagnosis

Symptoms similar to those of pericoronitis may be caused by other conditions, such as periodontitis, pulpitis from dental caries and acute myofascial pain in the temporomandibular joint disorder.

Treatment

For indications on the treatment of pericoronitis, it is always advisable to consult your dentist.

Depending on the stage of the disease and the specific clinical case, the solutions may be different:

  • If the pericoronitis is associated with mild manifestations and the pain is limited and not widespread, it is possible to manage the symptomatology with rinses of warm salt water, hydrogen peroxide or chlorhexidine (antiseptic). Furthermore, it is advisable to take care of daily oral hygiene with particular care, using a soft-bristle toothbrush. However, if the partially erupted tooth fails to emerge and food residues and bacteria continue to accumulate under the operculum, the pericoronitis is likely to return.
  • If the pericoronitis is transient and linked to the next tooth eruption, it is possible to use painkillers ; if the radiographs show that the lower tooth is not in a suitable position to completely erupt, the dentist can extract the upper tooth and prescribe antibiotics for a few days before extracting the lower one.
  • If the pericoronitis stage is particularly advanced, oral surgery could be indicated, with the aim of eliminating the gingival flap or finally extracting the wisdom tooth. The dentist will carefully clean the area to remove the damaged tissue or pus. If the area is infected, oral antibiotics will be administered.
  • If the pain and inflammation are very severe, pericoronitis is managed with intravenous antibiotics and surgery to remove the gingival flap or wisdom tooth . If the case is complex, the dentist may request that the patient be evaluated also by a maxillofacial surgeon.

Prevention

The prevention of pericoronitis is possible by practicing good oral hygiene on any tooth that is being erupted. Sticking to these simple rules can help keep the area clean, to prevent the problem from recurring and help to better manage the initial situation, while preventing the appearance of the most fearful abscess complications . However, if these maneuvers do not work and pericoronitis tends to recur periodically, it may be necessary to remove the flap of gum tissue overlying the partially erupted tooth. In some cases, it may be necessary to extract the tooth .

Pericoronitis: tips for oral hygiene

In the case of pericoronitis, the adoption of some precautions is useful to resolve in the initial phase the appearance of painful symptoms and complications.

  • Increase the brushing frequency in the affected area and clean the space between tooth and gum with particular care, possibly with the aid of a single- puff brush .
  • Several times a day, apply chlorhexidine-based mouthwashes or gels to the part, taking care to let the antiseptic agent penetrate, as far as possible, into the space between the gum and the tooth.
  • If prescribed by the dentist or primary care physician, take antibiotics and anti-inflammatories in the dosages and at the recommended times.
  • Wait for the acute phase of pericoronitis to disappear and go to the dentist for an evaluation on the possibility of proceeding with the extraction. The fact that the pain has disappeared does not mean that the problem is also solved.

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