Pericoronitis

What is Pericoronitis?

Pericoronitis is a condition where the gum tissue around a tooth that is just starting to break through or has partially come through gets infected and inflamed. This condition occurs most frequently when wisdom teeth in the lower jaw are coming in, but it can happen with any emerging teeth. Pericoronitis can dramatically impact one’s everyday life. If it’s not treated in a timely manner, the infection can spread and become a serious, life-threatening issue. This is why it’s important to identify and treat pericoronitis early on, and take steps to prevent it in the future.

What Causes Pericoronitis?

When a tooth comes in, the previously clean area between the tooth and the surrounding soft pouch-like structure, called dental follicle becomes exposed to the bacteria present in the mouth. This gives bacteria an excellent environment to grow especially since the pocket around the emerging tooth is hard to clean. Some food particles can also get stuck in this area, helping bacteria grow and leading to an infection called pericoronitis.

The bacteria causing pericoronitis are diverse and aren’t the same as the ones causing gum disease. In a study, several types of bacteria including Actinomyces oris, Eikenella corrodens, Eubacterium nodatum, Fusobacterium nucleatum, Treponema denticola, and Eubacterium saburreum were found in high numbers in people with pericoronitis.

On top of this, problems can worsen when the upper and lower teeth rub against each other, specifically when the upper third molars or “wisdom teeth”, erupt or come in, they can bite down on the soft tissue overlaying the emerging lower third molars. This repeated rubbing can cause sores and make the symptoms worse.

Pericoronitis usually occurs when the lower third molars or ‘wisdom teeth’ come in. Depending on how these teeth arrive, or their position, the likelihood of getting pericoronitis varies. Studies have revealed that lower third molars that come in straight or ‘vertically’ are most likely to be associated with pericoronitis, whereas those that come in sideways or ‘horizontally’ have a lesser chance.

Poor immune system can also increase the risk of getting pericoronitis. If you have conditions like uncontrolled diabetes or immune disorders, you are more likely to develop pericoronitis. Other conditions that can lower your immune response and trigger or make pericoronitis worse include stress, upper respiratory infections, or a woman’s monthly period.

Risk Factors and Frequency for Pericoronitis

Research on the occurrence rate of pericoronitis, an infection near the wisdom teeth, is limited, and existing studies show differing results. One particular study involving military personnel found a prevalence rate of 4.92% among those aged 20 to 25. Approximately 95% of these infections were linked to the lower wisdom teeth, also referred to as mandibular third molars.

As pericoronitis often occurs around the time wisdom teeth are coming through, it’s most frequently seen in people in their twenties. Importantly, there’s no evidence to suggest that it affects one gender more than the other.

• The occurrence of pericoronitis isn’t well-studied, and available studies’ results vary.
• In a military population study, a 4.92% occurrence rate was found among 20 to 25-year-olds.
• About 95% of these infections are associated with the lower wisdom teeth.
• As this condition often happens when wisdom teeth are growing in, it’s most commonly seen in people in their twenties.
• There’s no evidence that pericoronitis is more common in either males or females.

Signs and Symptoms of Pericoronitis

Pericoronitis is a condition that usually starts with pain and swelling at the back of the mouth, near the last set of molars that are coming in. Over time, the pain could get worse and can even spread to nearby areas in the mouth. This condition can make daily activities like talking, opening the mouth, chewing, and sleeping more challenging. It can also lead to bad breath, a foul taste, pus coming from the area, and difficulty swallowing. In more serious cases, the infection might spread to deeper areas in the head and neck, which might affect breathing. It’s essential to say that pericoronitis can be either acute or chronic. Acute pericoronitis has a sudden onset and more severe symptoms, while chronic pericoronitis is characterized by milder symptoms over a longer period.

• Pain and swelling at the back of the mouth
• Pain intensifies with time and function
• Possible bad breath
• Possible foul taste
• Pus discharge
• Limited mouth opening
• Difficulty swallowing
• Potential spread of infection to deeper head and neck structures

Testing for Pericoronitis

If you have pericoronitis, a mouth examination might show several things. Pericoronitis is an infection that occurs when your wisdom teeth (third molars) do not have enough room to emerge or grow properly. The doctor will look for redness, swelling, pus, and tenderness in the back of your lower jaw, where your wisdom teeth grow. If your pericoronitis is more severe, you might have swollen lymph nodes, a fever, a lopsided face, a hard time opening your mouth, swallowing or talking, or even trouble breathing. If you’re showing any of these more serious symptoms, it’s important to see a doctor right away to prevent your airway from becoming blocked.

Pericoronitis is divided into two types, transient (temporary) and non-transient (long-lasting), depending on where the tooth is growing. If a wisdom tooth grows into a position where it can be easily cleaned and used for chewing and biting, any inflammation surrounding it (pericoronitis) will clear up once the flap of gum over the tooth (the operculum) shrinks. However, if the tooth can’t grow into a useful position, the infected operculum may remain over the tooth, causing long-lasting pericoronitis.

An X-ray is a helpful tool for diagnosing pericoronitis, as it can show the exact positions of any emerging wisdom teeth. The best kind of X-ray for this is called a panoramic radiograph, where the X-ray rotates around your head to give a full image of your teeth. Dentists might use two different systems, the Pell Gregory’s and Winter’s classifications, to explain the position of your wisdom teeth. Research has found that when wisdom teeth are growing in straight up and down, pericoronitis is more likely.

However, when looking at pericoronitis, dentists must also consider other factors. These can include how well you’re cleaning your teeth, the position of the teeth opposite the wisdom teeth on the other jaw, and the duration and seriousness of your symptoms.

Treatment Options for Pericoronitis

Dentists may vary in their treatment approaches to pericoronitis, a dental condition where a tooth (usually a wisdom tooth) is partly covered by a flap of gum that can become inflamed. This condition doesn’t have a one-size-fits-all treatment plan. The early recognition and treatment of its symptoms are crucial for successful management.

Non-Surgical Treatment Options:
1. Good oral hygiene: At the onset, if pericoronitis symptoms are mild, dentists usually recommend cleaning the affected area and maintaining good oral hygiene. This includes the use of sterilized solutions to rinse the mouth and remove the debris trapped under the gum flap (or “operculum”). Dentists may also use special dental tools for further cleaning.

2. Pain management: Since pericoronitis can cause great discomfort and impede proper eating, dentists aim to manage the pain. They may use local anesthetic injections, topical pain relievers, and oral pain relievers (NSAIDs).

3. Antibiotics: If the dentist suspects that the infection may be spreading, they may prescribe antibiotics like amoxicillin or metronidazole. For patients who are allergic to penicillin, erythromycin might be used. The dentist may even take a microbial culture to choose the best suitable antibiotic.

Surgical Treatment Options:
1. Soft tissue surgery: For some patients, the dentist might choose to remove the gum flap covering the emerging tooth (a procedure called operculectomy), to eliminate deep pockets where bacteria can gather. This is usually done using a laser, electrocautery, radiofrequency ablation, or a scalpel.

2. Bone surgery or “pericoronal ostectomy”: If a tooth is ready to emerge into the mouth but is blocked by a bone, the dentist might remove that bone to expedite tooth eruption.

3. Tooth extraction: In severe cases or when a tooth seems unlikely to emerge properly, the dentist might decide to remove the tooth. They will decide based on the patient’s dental status and the dentist’s available surgical equipment and may refer the patient to a specialist if required.

Depending on the patient’s situation, the dentist may recommend removing the opposing tooth (which might be causing trauma and worsening the pericoronitis) or the affected tooth, to prevent recurrent infections. This is especially necessary if the tooth in question is difficult to clean, like if a tooth is impacted (stuck) horizontally. However, the dentist will only consider extraction as a last resort measure, weighing the pros and cons of the decision.

Remember that these are general treatment options, and depending on each patient’s case, the dentist may suggest different treatment combinations to manage and prevent pericoronitis.

What else can Pericoronitis be?

Pericoronitis, a condition that involves inflammation and infection of the soft tissue, is usually diagnosed through a clinical check-up. However, it can sometimes be confused with other conditions that show similar symptoms. Imaging tests like X-rays or tissue studies can be particularly helpful in distinguishing pericoronitis from other potential health issues.

When examining for pericoronitis, doctors also look for signs of these other conditions:

• A foreign body stuck in the area
• Pyogenic granuloma, a type of non-cancerous skin growth
• Peripheral ossifying fibroma, another kind of non-cancerous growth that occurs in the mouth
• Tooth decay, or dental caries
• Gum disease, or periodontitis
• Periapical abscess or granuloma, which are types of infections that occur around the root of a tooth

What to expect with Pericoronitis

Dental plaque, the sticky film of bacteria that builds up on the teeth, has been linked to pericoronitis, a dental condition concerning wisdom teeth (third molars). If there is enough room for the wisdom teeth to grow properly, pericoronitis often gets better once the tooth is fully grown. However, if the wisdom teeth struggle to emerge in a favorable position, pericoronitis could persist or reoccur.

An extraction or removal of such troubled wisdom teeth can greatly improve symptoms and overall quality of life for persons suffering from pericoronitis. In addition, extracting these problematic wisdom teeth can also improve the gum health around the second molars (the teeth next to the wisdom teeth).

Possible Complications When Diagnosed with Pericoronitis

If pericoronitis isn’t treated, the infection can spread to nearby areas in the head and neck such as under the tongue, beneath the lower jaw, beside the pharynx, behind the jawbone, below the masseter muscle, and within the cheek. It’s important to identify these infections quickly because if treatment is delayed, the patient could face a severe threat of blocked airways, which can be life-threatening.

Common Areas Where Infection Can Spread:

• Under the tongue (Sublingual)
• Beneath the lower jaw (Submandibular)
• Beside the pharynx (Parapharyngeal)
• Behind the jawbone (Pterygomandibular)
• Below the masseter muscle (Sub-masseteric)
• Within the cheek (Buccal)

The Consequences of Delayed Treatment:

• Potential of life-threatening airway blockage

Preventing Pericoronitis

Pericoronitis, a dental condition, usually happens when bacteria grow too much in hard-to-reach areas that appear when your third molars, or wisdom teeth, are coming in. Maintaining good oral hygiene is essential to prevent or lessen the severity of this condition. Regular brushing, flossing, and using mouth rinse can help reduce the amount of bacteria around the surfacing area of your wisdom tooth.

It’s important to note that there may be areas that are difficult to clean during your daily oral care routine. That’s why it’s crucial to learn about this condition. By understanding the signs and symptoms of pericoronitis, you can seek dental care early if you notice anything unusual. Spotting pericoronitis early can lead to fewer symptoms, quicker recovery, and reduces the chance of developing a more severe infection.

Another way to prevent pericoronitis is by dealing with potential sources of infection ahead of time. For instance, if a dentist notices that your wisdom tooth might not come in properly – a condition that increases the risk of pericoronitis – they might recommend removing the tooth even before any problem arises. This type of preventative tooth removal is known as prophylactic third molar extraction.