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.
Wisdom Teeth
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 14th June 2011