Pericoronitis: all your questions answered!
What is pericoronitis?
Pericoronitis is a term used to describe inflammation or swelling of the gum tissue surrounding a wisdom tooth. It is commonly seen in wisdom teeth that are partially impacted, with only a small portion of the crown seen above the gumline. The lower wisdom teeth tend to be more commonly affected than the upper.
Most of the time, you may see a small flap of gum tissue which partially covers the crown of the erupting wisdom tooth. This flap of tissue can attract and trap bacteria and food debris underneath and around the soft tissue, leading to inflammation and later infection.
What are the symptoms of pericoronitis?
This can vary depending on how long you have had pericoronitis.
In an acute, sudden flare-up you may notice the following:
severe pain near your back teeth
swelling of gum tissue
pain when swallowing
pus discharge from the tooth/ gum tissue
difficulty opening your mouth
If you have had pericoronitis for a while, you may also notice the following:
bad breath
a bad taste in your mouth
a mild or dull ache lasting for one or two days
What are the causes and risk factors of pericoronitis?
Having a partially impacted wisdom tooth with a flap of gum tissue covering part of the crown commonly leads to pericoronitis, as this traps food debris and bacteria and can lead to inflammation and infection. In addition, there are other factors that can increase your risk:
those aged between 20 to 29
poor oral hygiene
excess gum tissue
stress – poor immune system
pregnancy
How is pericoronitis diagnosed?
A dental examination of the painful area will be able to determine if your tooth has partially erupted and if there is a gum flap. You may be asked questions to see if you have any symptoms and an x-ray (full mouth x-ray known as an OPG) is usually taken to assess the wisdom teeth.
What are the complications of pericoronitis?
Apart from the most common complications of pain and swelling, you may have difficulty chewing and opening your mouth fully. Infection is common, and you may notice swelling of your face and surrounding gums with pus discharge from the area. If the infection is not treated, it can spread into the deep head and neck spaces and become known as a life-threatening condition called Ludwig’s angina. This requires urgent treatment in hospital.
How is pericoronitis treated?
After an examination and review of x-rays, you may be offered 3 options for treatment:
Controlling the pain and cleaning the area near the impacted wisdom tooth
Removing the flap of gum tissue covering the wisdom tooth
Removing the wisdom tooth
Managing pain
You may be advised to take simple pain relief such as paracetamol or ibuprofen. Your dentist may clean the gum tissue to remove plaque and prevent the build-up of food debris. A local anaesthetic may be given to make this more comfortable.
If you have signs of infection, antibiotics can help treat signs of infection.
Surgery
Sometimes cleaning the tooth is only a short term solution for the problem, especially if you experience ongoing and recurrent flare-ups of pain and infection. In this case, it may be recommended to either remove the flap of gum tissue or remove the partially impacted wisdom tooth. This is usually the best long term solution as it addresses the source of the problem directly.
Home treatments
In addition to professional treatment, you can try a few things at home to help manage the pain and keep the area clean. This includes:
over-the-counter pain relievers
warm salt-water rinses
oral water irrigators
good oral hygiene, including brushing and flossing
Will it come back?
If the wisdom tooth is removed, it is rare to experience pericoronitis again. However, if you have chosen to have the flap of gum tissue removed only, there is a small chance of it growing back again. Most people completely recover from wisdom teeth surgery in about 2 weeks.
Can I prevent pericoronitis?
Regular dental visits, a good cleaning and preventative care can lessen your chances of getting pericoronitis. Early monitoring of your wisdom teeth with dental x-rays (OPG) can predict if teeth are likely to become partially impacted and pose problems in the future. In this case, early extraction of the wisdom teeth may be a good option for you.