Pericoronitis Symptoms and Treatment

The term pericoronitis refers to inflammation of gingiva in relation to crown of an incompletely erupted tooth.

Pericoronitis occurs more frequently in mandibular third molar area.

Pericoronitis Clinical Features

The partially erupted or impacted mandibular third molar is the most common site for pericoronitis.
The resultant clinical picture consists of markedly red, edematous suppurating lesion that is extremely tender with radiating pain to ear, throat and flor of mouth.
Patient is uncomfortable because of foul taste and inability to close jaws.
In addition to pain, swelling of cheek in region of angle of jaw is seen.
Lymphadenitis can be present.
Toxic symptomatic symptoms such as fever, malaise and leukocytosis are also present.

The treatment of pericoronitis depends on:

Area is gently flushed with warm water to remove superficial debris and exudates followed by application of topical anesthetic solution.
Marginal gingiva is reflcted with scalar and underlying debris is, also removed and area is flshed with warm water.
Instructions to patient include hourly rinses with solution of tea spoonful of salt in a glass of lukewarm water, rest, copious fluid intake and administration of systemic antibiotics, if toxic symptoms are present.
If the gingival flap is swollen and fluctuant an anteroposterior incision to establish drainage is made with No. 15 blade, followed by insertion of ¼th inch gauze.

In the next visit, determination is made as to whether the tooth is to be retained or extracted. If it is decided to retain the tooth, the necessary surgical procedures are performed using a periodontal knife or electrosurgery. Under anesthesia, a wedge-shaped incision is made to section a tissue that includes gingival flp with tissue distal to the involved tooth as well.
After tissue is removed, a periodontal pack is placed.

The involvement may become localized in form of pericoronal abscess.
Pericoronitis occurs in partly erupted vital tooth, it may give rise to cyst formation.
Pericoronitis may spread posteriorly into the oropharyngeal area and medially into base of tongue, making it difficult for patient to swallow.
Depending on severity, there is involvement of submaxillary, cervical, deep cervical and retropharyngeal lymph nodes.
Peritonsillar abscess formation, cellulitis and Ludwig’s angina are infrequent but nevertheless potential sequelae of pericoronitis.