What is pericoronitis?

Pericoronitis is inflammation of the tissue surrounding a third molar, otherwise known as a wisdom tooth. The condition most often occurs in molars that are partially impacted, or not fully visible. It’s also more common in lower molars than in the upper ones.

Most people with pericoronitis have a flap of gum tissue partially covering the crown of the erupting tooth.

Your doctor may recommend having the flap removed or extracting the tooth, based on a number of factors. Sometimes, only treating the actual symptoms is the best course of action.

What are the symptoms of pericoronitis?

The symptoms of pericoronitis vary, based on whether the condition is acute or chronic.

The symptoms of acute pericoronitis include:

  • severe pain near your back teeth
  • swelling of gum tissue
  • pain when swallowing
  • the discharge of pus
  • trismus (lockjaw)

Chronic pericoronitis can include the following symptoms:

  • 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?

Pericoronitis usually occurs when a molar is partially impacted. Bacteria then accumulates around the soft tissue, causing inflammation.

The following factors can increase your risk of pericoronitis:

  • age between 20 to 29
  • wisdom teeth that haven’t properly erupted
  • poor oral hygiene
  • excess gum tissue
  • fatigue and emotional stress
  • pregnancy

Overall health hasn’t shown to be a risk factor for pericoronitis.

How is pericoronitis diagnosed?

Your dentist will examine your tooth to see if it’s partially erupted and to check for a gum flap. They’ll note your symptoms and may take an X-ray.

What are the complications of pericoronitis?

The main complication of pericoronitis is pain and swelling around the molar. You may also have difficulty biting down or experience lockjaw. In some cases, infection can spread from the affected tooth to other areas of your mouth.

While rare, a person experiencing pericoronitis can develop a life-threatening complication called Ludwig’s angina, in which the infection spreads into their head and neck. An infection that spreads to the bloodstream, otherwise known as sepsis, is also a rare, life-threatening complication.

How is pericoronitis treated?

Your dentist will take a number of factors into consideration when deciding how to treat your pericoronitis. The three treatment options are:

  • managing or alleviating the pain near the molar
  • removing the flap covering the tooth
  • removing the tooth

Managing pain

If the tooth is expected to fully erupt on its own, your dentist may decide to help you manage the symptoms without removing the flap or the tooth. In this case, ibuprofen (Advil) or acetaminophen (Tylenol) can be helpful. Your dentist will also clean the gum tissue around your tooth to prevent buildup of plaque and food particles. They may use local anesthesia to help with the pain during this process.

If you experience swelling or infection, you may be prescribed antibiotics like penicillin or erythromycin (Erythrocin Stearate).

Surgery

Your dentist may refer you to an oral and maxillofacial surgeon if they decide the tooth or flap should be removed. In some cases, the flap grows back, and a second surgery is needed. Removal of the tooth usually rectifies the problem. But there are sometimes instances when it’s beneficial to retain the tooth if possible.

Home treatments

While it’s important to see your dentist or oral surgeon for a tailored treatment plan, they may also recommend home treatments. These should be performed in conjunction with, not in place of, professional treatment. Home remedies include:

  • over-the-counter pain relievers
  • warm salt-water rinses
  • oral water irrigators
  • good oral hygiene, including brushing and flossing

Avoid using hot compresses, and seek medical attention if you have a fever.

What is the outlook for pericoronitis?

Once a tooth has been removed, pericoronitis rarely returns. In cases where a flap of gum tissue is removed, the tissue can sometimes grow back. People usually recover from treatment in about two weeks’ time after a removal, and within one or two days for symptom-specific treatment for acute pericoronitis.

Preemptive care and dental visits can lessen your chances of this condition. Your dentist can monitor the third molars as they erupt in order to extract a tooth early if necessary. They can also perform regular cleanings to prevent inflammation.