Today’s topic is about pericoronitis. I hope you all are familiar with the term pericoronitis, but most of us won’t know much in detail about this.
If you or your family members or your friends ever experienced pain in the wisdom teeth? Did you or they ever ask is this pain is normal? In some cases, you might have tolerated the pain and done with some home remedies, or sometimes you might not be able to afford the pain after 2 to 3 days and end up with consulting a dentist.
This condition is known as Pericoronitis.
In our oral cavity, each tooth has its own room to erupt. The incisors will erupt in the front rooms, the canine will erupt near to their rooms, and molars will erupt in the back rooms. So when the time for wisdom teeth to erupt comes and it doesn’t have enough space in the room for eruption they erupt only partially through the gums. This leads to inflammation, swelling, fever, etc.
In other terms, It is nothing but inflammation or swelling of your gum tissue. In most cases, they are seen when your lower wisdom teeth erupt and in rare cases, they are seen when your upper wisdom teeth erupt.
In this condition when we observe the mouth there will be a flap that covers the partially erupted or not fully visible wisdom teeth. In some cases, there will be readiness seen in the flap and swelling.
This condition is commonly seen during the late teens that is at the age of 18 to 20 yrs. This condition can be acute pericoronitis, chronic pericoronitis, and subacute pericoronitis. If the condition is acute then the patient experiences pain, fever, swelling, and weakness.
In chronic cases, there will be inflammation in that area.
Table of Contents
WHAT ARE THE RISK FACTORS?
The main risk factor is age as we discussed earlier. They are commonly seen under the age of 18 to 20 years. This is the time when the crown of wisdom teeth erupts.
Poor oral hygiene
Improper brushing habits lead to the accumulation of food debris and infection.
Emotional stress can also cause pericoronitis
Upper respiratory tract infection
The upper respiratory tract infection contains many microorganisms that are pathogenic and lead to infection.
WHAT ARE THE CAUSES?
Imagine a partially erupted wisdom teeth, you can see a thin soft tissue covering above this wisdom teeth and it is called an operculum. The bacteria, food debris, germs, etc will get trapped under the operculum. When they get trapped under the operculum it causes an opening for the bacteria to enter inside which causes inflammation and swelling. The first thing is that you won’t be able to do proper brushing in that area due to your severe pain. So they get accumulated. When this stays there for many days it causes infection and swelling.
WHAT ARE THE SYMPTOMS OF PERICORONITIS?
The main symptom of pericoronitis is pain. The patient comes with pain and swelling in the involved area.
When we observe clinically there will be pus discharge under the pericoronal flap in some cases.
Due to severe pain, the patient complained of inability to open their mouth, and the condition is known as trismus.
When we observe above the flap there can be indentation of the upper tooth on the flap.
In acute cases, there is fever and malaise. When we examine the lymph node we can see lymph node enlargement. When we examine tender on percussion it is positive.
HOW WILL YOU DIAGNOSE?
First, the dentist will diagnose the path of eruption of the teeth to check whether they are partially erupted or not. The next step is to go for a radiographic examination. It is done to see the alignment of the tooth and also to check whether there is any abscess, cyst, etc. involved. The next step is that the dentist would check the infection, swelling, etc.
WHAT ARE THE TREATMENT FOR PERICORONITIS?
First will examine the involved area and the adjacent teeth and check for complications.
The area is gently washed with warm water to remove the debris and local anesthesia is given.
If the infection is spread to the vestibular area then we need to drain the abscess.
First, the area is swabbed with antiseptic and the flap is gently elevated from the tooth the debris is removed and the area is flushed with warm water.
In the initial stage, excessive curettage and surgical procedures are not done.
What are the instructions given to the patient?
Hourly rinse with a solution of a teaspoon full of salt in a glass of warm water. Antibiotics are taken in case of systemic complications.
The next visit is done after 24 hours. The patient’s condition is improved. In the first visit if a drain is inserted then it has to be removed. Then we will gently separate the flap from the mouth and the area is flushed with warm water.
The third visit is done when the acute infection subside then the impacted tooth is either removed or the pericoronal flap is excised.
The medication commonly given is aspirin, ibuprofen, and acetaminophen.
WHAT DO YOU MEAN BY OPERCULECTOMY?
Operculectomy is a surgical procedure done for pericoronitis. The term operculectomy means the surgical procedure for the removal of the operculum. The operculum fibrous flap covers about 50 percent of the occlusal surface of the partially erupted wisdom teeth. The removal of this flap is known as operculectomy. The removal of the operculum is not an easy task because this fibrous tissue is freely movable and slides away beneath the scalpel or scissor. The scalpel is the instrument used for this procedure.
Periodontal surgery is another surgical procedure for pericoronitis.
This procedure is done using a periodontal knife or electrosurgery. First local anesthesia is given. For the removal of the wisdom teeth, we need to give inferior alveolar nerve block, lingual, and buccal nerve block. When It gets anesthetized a wedge-shaped incision is made to section the tissue that includes the gingival flap with the tissue distal to the involved tooth as well. After the tissue is removed a periodontal pack is placed. The patient is asked to follow the instructions and medication. Recall checkup is done after 10 days.
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