Pericoronaritis is an inflammation of the gum tissues surrounding teething teeth (more often wisdom teeth). It is accompanied by severe pain in the area of the cutting tooth, limitation and pain when opening the mouth and swallowing, swelling of the gums, unpleasant odor and taste in the mouth, violation of general well-being. An improperly erupting wisdom tooth can lead to the destruction of a neighboring one, injury to the gingival and bone tissues, and the development of an abscess in the periosteum. Such teeth are often subject to removal.
Pericoronaritis is an inflammation of the tissues surrounding the wisdom tooth. Inflammation in pericoronaritis is caused by the accumulation of plaque in the opening of the gum, through which the wisdom tooth erupts. The second cause of pericoronitis is difficulty in eruption of wisdom teeth. During the eruption, the wisdom tooth can exert significant pressure on the adjacent tooth, which entails damage to the bone tissue and gums.
The main cause of pericoronitis is a decrease in the width of the dental arch in modern humans by 10-12 mm, while maintaining the size of the teeth. The change in size is due to the lack of space on the jaw for wisdom teeth, which is manifested by difficult eruption and pericoronitis.
The second cause of pericoronitis is the embryological conditions of teething: the eruption of wisdom teeth is difficult because of the thickened walls of the dental sac that surrounds the crown of the tooth and because of the thick mucous membrane of the gum. Reduced growth-forming factors also occupy an important place in the development of pericoronitis.
In the pathogenesis of pericoronitis, the fact that at the time of teething, the position of the tooth practically does not change, but part of the chewing surface is covered with a mucous membrane is important. And under this hood, food residues, plaque and microorganisms accumulate, which eventually causes a specific inflammation – pericoronaritis. Traumatization of the mucosa of the chewing surface by antagonistic teeth during chewing causes the maintenance of the inflammatory process. And, as a result, with pericoronaritis, scarring of the hood and expansion of the periodontal gap occur.
The main manifestation of pericoronitis is a pain syndrome in the area of a teething tooth. Often the pain radiates to the temple or ear area. In some cases, the process of chewing and swallowing food is difficult, and the patient has difficulty opening his mouth.
As pericoronitis develops, the inflammatory process passes to the surrounding tissues, the soreness in this case is due to the involvement of the gingival hood in the inflammatory process, less often – the incorrect position of the teething teeth. If the wisdom tooth erupts at an angle, then pericoronaritis has a more pronounced character, since the gum and bone tissue are significantly damaged, sometimes the pressure on the adjacent tooth is so great that its destruction can begin.
With pericoronaritis, the temperature in the affected area rises, body temperature rises less often, and regional lymph nodes increase. The inflammatory process in pericoronaritis is the main cause of bad breath and an unpleasant taste in the mouth and during meals.
The lack of treatment leads to the formation of a subcostal abscess, as well as to permanent suppuration. With a prolonged course of pericoronitis, soreness at rest and when opening the mouth increases, sometimes complications occur in the form of phlegmon and osteomyelitis.
Diagnosis and treatment
The diagnosis of pericoronitis is made by the dentist on the basis of clinical manifestations, patient complaints and instrumental examination. Sometimes an X-ray examination is performed to determine the growth guide. Treatment of pericoronitis is aimed at preventing complications, and the choice of treatment method depends on the characteristics of the course of the disease and on the patient’s condition. If inflammatory edema is pronounced significantly with pericoronaritis or there is a reduction of the jaws, then trigeminosympathetic blockade is indicated. During the course without complications, the pocket under the hood is washed with a weak solution of furacilin or potassium permanganate.
With pericoronaritis, the introduction of an iodoform tampon under the hood and rinsing of the oral cavity with warm disinfectant solutions is indicated. Sulfonamide preparations will be used for rinsing, 10% calcium chloride solution of 15 ml 3 times a day and painkillers are shown inside. In the absence of the effectiveness of local treatment, surgical treatment is indicated – excision of the hood under local anesthesia. During excision, the surface of the erupting tooth opens, as a result of which plaque and microorganisms do not accumulate under the hood.
Extraction of a wisdom tooth is indicated if it is in a position where eruption is impossible. This is confirmed by X-ray examination, tooth extraction is carried out after the removal of acute symptoms of pericoronitis, after extraction, the tooth well is cleaned and stitches are applied. Since the wisdom tooth does not carry a functional load, it is recommended to remove the tooth when pericoronitis is difficult to treat. Recurrent pericoronaritis is cured only after wisdom tooth extraction.
The method of treating pericoronitis with laser therapy allows you to act with an infrared beam directly through the skin. Low-intensity infrared laser radiation penetrates deep under the skin and has an anti-inflammatory and decongestant effect, as well as stimulates metabolism and blood flow to the affected area. Laser radiation, among other things, has a sufficient analgesic effect to stop the pain syndrome in pericoronitis. Laser therapy lasts 7-10 days, a contraindication is the presence of oncological processes in the oral cavity.
- Moloney J., Stassen L. F. A. Pericoronitis: treatment and a clinical dilemma // Journal of the Irish Dental Association. — 2009; 55 (4): 190-192.link
- Wehr C., Cruz G., Young S., Fakhouri W. D. An Insight into Acute Pericoronitis and the Need for an Evidence-Based Standard of Care // Dent J (Basel). — 2019; 7 (3): 88.link
- Katsarou T., Kapsalas A., Souliou C., Stefaniotis T., Kalyvas D. Pericoronitis: A clinical and epidemiological study in greek military recruits // J Clin Exp Dent. — 2019; 11 (2): e133-e137.
- Renton T., Wilson N. H. Problems with erupting wisdom teeth: signs, symptoms, and management // Br J Gen Pract. — 2016; 66 (649): e606-608.link
- Folayan M. O., Ozeigbe E. O., Onyejaeka N., Chukwumah N. M., Oyedele T. Non-third molar related pericoronitis in a sub-urban Nigeria population of children // Niger J Clin Pract. — 2014; 17 (1): 18-22.
- Nivedita S., John E. R., Acharya S., D’costa V. G. Prophylactic extraction of non-impacted third molars: is it necessary? // Minerva Stomatol. — 2019; 68 (6): 297-302.
- Shoshani-Dror D., Shilo D., Ginini J. G., Emodi O., Rachmiel A. Controversy regarding the need for prophylactic removal of impacted third molars: An overview // Quintessence Int. — 2018; 49 (8): 653-662.link