| Pericoronitis |
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Pericoronitis is an inflammatory reaction of the
operculum (this is the dense, fibrous flap that
completely or partially erupted lower jaw
wisdom tooth) covering an erupting or impacted
tooth, usually the lower wisdom tooth.
operculum (this is the dense, fibrous flap that
completely or partially erupted lower jaw
wisdom tooth) covering an erupting or impacted
tooth, usually the lower wisdom tooth.
Diagnosis is exclusively based on the symptoms and
clinical presentation. X-rays may be useful.
Pericoronitis can be classified into 3 types depending upon
the features present:
Treatments:
Topical Treatments
Acute pericoronitis is treated with gentle topical use of
antiseptic mouthwashes (such as chlorhexidine or
oxygenating agents).
Food debris, bacteria or any other irritants under the
operculum are diluted and washed out with saline.
Gentle application of 50% trichloro-acetic acid to the under-
surface of the operculum results in the immediate
cessation of pain.
Systemic Treatment
Systemic use of antibiotics such as Metronidazole, 200 -
400mg, 3x daily, for 5 days or Co-Amoxiclav, 375 - 625
mg, 3x daily for 5 days or Erythromicin, 250 - 500 mg, 3x
daily for 5 days (if allergic to Penicillins) if there are
systemic signs and symptoms.
Surgical removal of the operculum ± extraction of the
offending tooth after the acute phase has subsided is
recommended to avoid recurrence.
Alternatively, if the operculum is being traumatised by an
upper tooth, this tooth can either be ground down (and
taken out of occlusion with the caveat that the tooth may
erupt and continue tramatising the operculum) or the tooth
is removed. These options may only be a temporary stop-
gap and the lower tooth may eventually have to be
removed anyway.
clinical presentation. X-rays may be useful.
Pericoronitis can be classified into 3 types depending upon
the features present:
- Acute. Here all the features are present.
- Subacute. The classical symptoms have subsdied but
certain signs are still present along with the presence
of a sinus tract (parulis). - Chronic. Here, most of the features have subsided
but a distinct fistulous tract is present.
Treatments:
Topical Treatments
Acute pericoronitis is treated with gentle topical use of
antiseptic mouthwashes (such as chlorhexidine or
oxygenating agents).
Food debris, bacteria or any other irritants under the
operculum are diluted and washed out with saline.
Gentle application of 50% trichloro-acetic acid to the under-
surface of the operculum results in the immediate
cessation of pain.
Systemic Treatment
Systemic use of antibiotics such as Metronidazole, 200 -
400mg, 3x daily, for 5 days or Co-Amoxiclav, 375 - 625
mg, 3x daily for 5 days or Erythromicin, 250 - 500 mg, 3x
daily for 5 days (if allergic to Penicillins) if there are
systemic signs and symptoms.
Surgical removal of the operculum ± extraction of the
offending tooth after the acute phase has subsided is
recommended to avoid recurrence.
Alternatively, if the operculum is being traumatised by an
upper tooth, this tooth can either be ground down (and
taken out of occlusion with the caveat that the tooth may
erupt and continue tramatising the operculum) or the tooth
is removed. These options may only be a temporary stop-
gap and the lower tooth may eventually have to be
removed anyway.
| Photos of Pericoronits / Operculitis effecting Lower Jaw Wisdom Teeth |
- Poor oral hygiene
- Occlusal trauma to the operculum (i.e. the operculum
is bitten on by upper jaw molars) - Gingival (gum) infection
- Accumulation of bacteria and food debris beneath an
operculum - Reduced body resistance
Clinical Features:
- Redness & swelling of the operculum and gingivæ
(gums) - Ulcerated & sloughing operculum & abscess formation
- Pain (severe or radiating)
- Trismus
- Halitosis (fœtor ex ora)
- Occasionally low grade fever
- Regional lymphadenopathy (submandibular)
- Malaise
- Crypt-like area formation between the tooth and
operculum which favours food & debris lodgement &
hence, microbial proliferation - Distinct extra-oral ± intra-oral swelling near the angle
of the mandible of the affected side ± opposite to the
wisdom tooth respectively
| Surgical-Dentistry.Info |