Pericoronitis is inflammation or swelling of the gums around a specific tooth. To be specific, it is a swelling around the erupting third molar tooth which is also known as wisdom tooth. Pericoronitis is of two types as acute and chronic. If it’s acute, there will be a stinging pain in the area of the erupting tooth, accompanied with fever and redness also affecting the neck. The chronic condition is merely a relapse of the acute form but with mild symptoms.

It is entirely treatable by just removing the causative factor like removing the operculum (flap of gum covering the partially erupted wisdom tooth) or sometimes extracting the third molar.

If pericoronitis is left undiagnosed and untreated, then it can lead to an abscess or even potentially lethal neck space infections. So, it is important to identify and treat it in time.

Moving further in this article, you will get to know the causes of this irritable gum condition, its signs, symptoms, probable diagnosis, treatment, and prevention.

What is Pericoronitis?

Sometimes the third molar erupts in strange positions and angles creating pressure on the overlying gum. As a result, there is an inflammation of the gums, and this condition is called pericoronitis. We are subjected to a lot of discomforts due to an erupting wisdom tooth.

The discomfort is due to inflamed gingiva which is subjected to biting forces from the opposing third or second molar of the upper jaw. The flap of gum covering this erupting third molar is called an operculum.

This operculum primarily gets affected and infected by bacteria. Bacteria accumulate around this tooth because operculum forms a pocket causing food lodgment in this area.

Pericoronitis is not necessarily a periodontal problem; rather it can be called a developmental problem. It can be chronic or acute based on its extent and duration of persistence.

It is a relapsing condition and hence, the momentary relief from ice packs and other home remedies shouldn’t be relied upon for long-term relief.

If left untreated, pericoronitis can lead to the formation of the pericoronal abscess or even space infections like Cellulitis and Ludwig’s Angina. These are potentially life-threatening conditions. (1)

Classification of Pericoronitis

The definition of pericoronitis states that it is an inflammation of the soft tissues surrounding the crown of a tooth. This includes a broad spectrum of severity, making no discrimination to the extent of the inflammation into adjacent tissues.

A pericoronal infection caused by bacteria and fungus sometimes leads to a pus-filled space called pericoronal abscess, cellulitis, and Ludwig’s Angina.

Pericoronitis is classified as acute and chronic depending on the severity and duration of infection. (2)

Acute

  • Acute pericoronitis (sudden onset and short-lived, but significant) is stated as “varying degrees of inflammation involving the pericoronal flap and adjacent structures, and sometimes leading to systemic complications.”
  • Systemic complications can be explained as signs and symptoms occurring outside of the mouth, such as fever, malaise or sometimes swollen lymph nodes in the neck.

Chronic

  • Pericoronitis may also be chronic or recurrent in nature when there are repeated episodes of pericoronitis occurring periodically. Chronic pericoronitis may cause very few symptoms, but some signs are usually visible when the dentist examines the mouth. It is a long-standing case of pericoronitis.

Signs and Symptoms

Initial symptoms include –

  • Redness around the erupting third molar
  • Swelling around the erupting teeth
  • Difficulty on mouth opening
  • Swelling in the neck of the affected side
  • Bad taste in the mouth
  • Exudation or pus coming out from a flap of gum covering the tooth
  • Food lodgment in the affected area
  • Bad breath

If left unattended, pericoronitis can cause severe symptoms like gum bleeding and swelling in the submandibular gland (below the lower jaw). There can also be a severe pain on chewing food.

Sometimes in sporadic cases, the infection spreads to spaces of the neck and causes a severe condition called Ludwig’s Angina. This is a fatal condition and can even compress the trachea causing difficulty to breathe.

Causes of  pericoronitis

There are three most common reasons for pericoronitis.

  • There is a flap that covers the erupting third molar called Operculum. When the opposing tooth continually bites over the operculum, it causes swelling. This is the primary cause of Pericoronitis.
  • Secondary to that, there is a constant accumulation of food under the operculum. This leads to the manifestation of colonies of bacteria and fungus (candida) in this area. This further leads to swelling in the operculum as well as in the surrounding gum.
  • The primary underlying cause for pericoronitis is wrongly aligned tooth bud of the third molar. The tooth bud does not get enough space sometimes, and this leads to the eruption path of the third molar at wrong angles. This is a more severe condition called tooth impaction and has an entirely different line of treatment. (3)

Diagnosis

Clinically, pericoronitis can be quickly diagnosed by a dentist’s naked eye just by looking at the inflamed tooth region. Sometimes intraoral X-ray known as IOPA might be needed to confirm the diagnosis and to see the position of the erupting tooth.

What is a pericoronal abscess?

This is a condition which sometimes occurs secondary to pericoronitis. A pericoronal abscess is a discontinuity in the gum or underlying tissue due to continuous trauma from the opposing tooth and accumulation of food.

This results in pus discharges with or without bleeding from the operculum and sometimes extends even below the unerupted tooth. The only method to get rid of this is to treat the primary issue, that is, pericoronitis. (4)

Treatment

There are three treatment options of pericoronitis depending upon the severity of the condition –

  • Management of pain
  • Minor oral surgery to remove the operculum (operculectomy)
  • Removal of the wisdom tooth if necessary

Pain management

Pain management can be done using over the counter pain medication like NSAIDs Ibuprofen and acetaminophen. But visiting your dentist for proper prescription pain medication and antibiotics is highly advisable.

Also, a thorough cleaning (scaling) done by a dentist or dental hygienist is advisable for prompt relief.

At home pain management

  • Applying ice packs externally till you get to see the dentist can help with the pain. Ice chips can be soothing too when kept intraorally over the affected area.
  • Lukewarm salt water gargle can also ease out the pain for a while.

Operculectomy

Removing the overlying gum hood is possibly the best treatment for pericoronitis. This manages the pain for good and gets rid of the inflammation. The infection is reduced over time, and there are no more gum related symptoms.

This is a simple procedure involves a minor incision with a laser point or scalpel under local anesthesia followed by pain medication and antibiotics.

Extraction of third molar (Disimpactiothe n surgery)

When nothing works out then the third molar or wisdom tooth removal is the only option with a dentist. This is known as a  disimpaction surgery and involves removal of a part of the attached bone to the third molar.

This has to be followed by post-op maintenance therapy and regular irrigation of the site with antibiotics and sterile solutions by the dentist.

Preventing Pericoronitis

Prevention of pericoronitis may be challenging but achievable by maintaining oral hygiene, regular dental checkups, and care. The dentist can keep this potential problem at bay by cleaning and determine the need for removal of the operculum.

Alternatively, your dentist can also keep a check on the eruption path of the third molars and identify the need for early extraction of these teeth in time. Removal of the wisdom teeth before eruption can prevent pericoronitis completely.

Over to you on Pericoronitis

Pericoronitis is a widespread problem when you are in your late teens or early adulthood. This is treatable before it leads to life-threatening conditions like Ludwig’s Angina and sometimes Cellulitis.

So as soon as you see a tooth peeking out of the gums and areas of pain and swelling surrounding it, run to your dentist for prompt action. Other than this, brush twice daily and use an antibacterial mouthwash after brushing to keep all oral health issues at bay.

Pericoronitis is swelling of the gums around a specific tooth, usually wisdom tooth. It is of two types as acute and chronic pericoronitis