Pericoronitis
Pericoronitis and Pericoronal Abscess
Pericoronitis is the inflammation of pericoronal gingiva. Pericoronal abscess is the infection of soft tissue covering the crown of a partially erupted tooth. Pericoronal abscess is most commonly seen in the mandibular or lower jaw the third molar also called as wisdom tooth. Pericoronitis leads to cellulitis and muscular spasm if left untreated. Pericoronitis occurs in the third molar area if the eruption of the tooth is not straight and when there is not enough space for the third molar to erupt. This condition triggers mostly during hormonal changes like pregnancy, stress, and improper oral hygiene.
Patients with pericoronitis experience severe pain in the affected area and malaise. Pain may radiate to the ear, floor of the mouth, and throat. The regional submandibular lymph nodes become painful. Patients experience difficulty in eating and swallowing. The signs of pericoronitis are mainly swelling and redness covering the crown of the tooth. The opposing teeth may traumatize the swelling or soft lining of the crown of the impacted tooth during mastication. This further results in severe pain due to food entrapment and other factors. Edema or inflammation will be visible in the peritonsillar and submandibular region. The swelling is extremely painful to touch. On further progression of the disease, when left untreated it leads to cellulitis which is the infection of the facial space and causes severe painful visible swelling on the face on the affected side.
This type of infection is often associated with Primary teeth eruption. The infection is associated with supra-dental tissue involving the superior portion of the follicle and the overlying mucoperiosteum, which may become inflamed. It develops into a small fluctuant abscess which is seen as swelling covering the crown of the tooth. When the fluctuance is digitally ascertained, the pedodontist or the pediatrician recommends an incision and drainage followed by a warm saline rinse at frequent intervals.
Pericoronitis when left untreated may spread to oropharyngeal area and even base of the tongue. The other infections that occur from pericoronitis are cellulitis, Peritonsillar abscess and Ludwig’s angina. In case of pericoronitis in third molar area, it can be a predisposing factor to cysts like Dentigerous cyst and other odontogenic cysts of the jaw.
The primary treatment of oral abs is mainly antibiotics based on the severity of the infection determined by the dentist. The dentist then does the incision and drainage based on the clinical findings and also operculectomy if needed. Based on the radiographic investigations, the dentist decides on the tooth causing pericoronitis whether to retain the tooth if possible or to extract. Also radiographs will help in evaluating the bone and other features leading to pericoronitis. When the symptoms are acute, the impacted third molars should be extracted. It is better to start the treatment at the onset of the disease to prevent further complications.
