Exodontia.Info
Pericoronitis
Diagnosis:

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:

  • 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%
trichloroacetic 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 traumatising 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.


Useful Website & Articles:

MedicineNet

Wikipedia.Org

Colgate Professional


JMBR 2007.  Acute Pericoronitis & the Position of the Mandibular Third Molar in
Nigerians

J Irish Dent Assoc 2009.  Pericoronits - Treatment & A Clinical Dilemma
Photos of Pericoronits / Operculitis effecting Lower Jaw Wisdom Teeth
Pericoronitis is an inflammatory reaction of the
operculum
(this is the dense, fibrous flap that covers
about 50% of the biting surface of a completely or
partially erupted lower jaw wisdom tooth) covering an
erupting or impacted tooth, usually the lower wisdom
tooth.

Predisposing Factors:

  • 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
Last Updated 3rd December 2014