Pericoronaritis

The pathological process affects the soft tissues, and appears most frequently during the eruption of the lower and upper third molars (the so-called "wisdom teeth"), to the right and left of the dental arch respectively.

In the case of pericoronaritis, the gum appears swollen, reddened and painful at the affected site. The pain often extends to the entire angular area of the jaw and becomes particularly intense during chewing. In the presence of acute pericoronaritis, the pain may also radiate to the ear and neck.

The main cause of pericoronaritis is the lack of space in the dental arch for the eruption of the tooth that is included and/or partially covered by the gingiva.

What is pericoronaritis?

Pericoronaritis refers to inflammation of the tissues surrounding the tooth and acute inflammation of the gum surrounding an erupting tooth.

In the case of pericoronaritis, there is gingival redness. In addition, the inflamed and reddened gingiva often causes pain in the affected area. Often, the pain extends to the entire jaw area and becomes especially intense when chewing. In the case of acute pericoronaritis, the pain may also extend to the ear and neck.

Therefore, therapy will largely depend on the severity and symptomatology and will involve different options. Antibiotics and anti-inflammatory drugs are generally used in the acute phase, combined also with specific oral care techniques such as rinsing with chlorhexidine-based mouthwashes, cleaning with a brush, etc. The definitive solution to pericoronaritis is, on the other hand, extraction of the tooth or periodontal surgery, the choice of one treatment or the other will be made by the dentist on a case-by-case basis.

As we will see in the next section, the inflammatory phenomena underlying pericoronaritis can also be induced by pressure on the erupting tooth, mechanical trauma and the accumulation of food debris in the pericoronal recess or under the operculum. It can be favored by oral bacteria present between the tooth and the gingiva, resulting in an infectious process.

Causes

Pericoronaritis is caused by acute inflammation of the gum surrounding the crown of an erupting tooth (including or not fully erupted).

The most common pericoronaritis are those of the wisdom teeth (third molars), especially the lower ones: if these do not find their eruptive space, being included or partially covered by the gum, they can lead to the formation ofa space, in which bacteria can easily nest and give rise to an infection.

Triggering and promoting factors

Factors that can predispose and maintain the inflammatory process are:

• Infections. Infection can be triggered and sustained by an infection. Bacteria normally present in the oral cavity can penetrate the space between the tooth and the gingiva, colonizing it and causing inflammation of the adjacent tissues. In some cases, the active infection associated with pericoronaritis may evolve into a pericoronal abscess (pus) or odontogenic facial cellulitis. These pathologic processes may also extend to the throat or cheek.
• Food debris. The inflammatory phenomena underlying pericoronaritis may be favored by the accumulation of food particles under the operculum or in the pericoronal space.
• Trauma and irritating factors. If the upper wisdom tooth erupts before the lower wisdom tooth, it may impact the operculum, increasing irritation. Therefore, pericoronaritis may be promoted by pressure from the erupting tooth and mechanical trauma (e.g., biting the operculum with the opposing tooth).
• Tooth position and anatomical reasons. Pericoronaritis can also occur when the distance between the tooth germ and the eruption area is too wide. Other times, there is no space for the wisdom tooth to fit.

Who is most at risk?

Pericoronaritis is mainly associated with the eruption of the mandibular molars (lower wisdom teeth), so the inflammation predominantly affects those between 15 and 24 years of age.

In young children, the disease may appear during teething, immediately before the eruption of the milk teeth.

Symptoms

The main symptoms are:

• Pain on one side of the face.
• Swollen and reddened gums.
• Bad taste in the mouth caused by pus in the affected tissues.
• Difficulty in opening the jaw (trismus).
• Difficulty swallowing (dysphagia).
• Swollen lymph nodes in the neck and sore throat.
• Loss of appetite.

At the site of tooth eruption, there is typically pain in the jaw, discomfort that increases with chewing. At the same time, the gum becomes red and swollen. Pericoronaritis can then become aggravated, causing more intense pain all the way to the ear, which can lead to a severe headache.

Pericoronaritis is associated with a wide range of symptoms and, depending on the stage, pericoronaritis inflammation can be of two types:

• Acute pericoronaritis almost always occurs suddenly and is of short duration. This form affects the pericoronal flap and adjacent structures.
• Chronic pericoronaritis occurs periodically alternating with long remissions. Diagnosis of chronic pericoronaritis can be difficult because it may present few symptoms, but some signs of the inflammatory process are evident when the mouth is examined during a visit to the dentist.

Treatment

The main treatments are:

• Analgesic medications.
• Mouthwash based on chlorhexidine.
• Amoxicillin-based antibiotics.
• Surgery
• Extraction of dental pieces.

There are three types of treatment for pericoronaritis, depending on the stage of the pathology: first, the pain is controlled and then the inflammation or pericoronal infection is treated. After that, the underlying gingival tissue can be removed with minor oral surgery.

Ibuprofen-based analgesics may be taken to treat the symptoms and relieve pain. If the infection is localized and not widespread, the dentist will usually perform a thorough cleaning of the area with local anesthesia. The dentist may then prescribe daily rinses with a chlorhexidine-based mouthwash to maintain the area.

For more severe cases, in which inflammation of the gums or fever may be observed, antibiotics based on amoxicillin are prescribed.

When it is desired to keep the third molar in the mouth, minor surgery can be performed to remove the overlying flesh flap. This will clean the area more effectively and prevent the accumulation of food debris and bacteria. The risk, however, is that the flap will grow back and the problem will recur later.

The most effective remedy is usually the extraction of the tooth: this method eliminates any possibility of the wisdom tooth infection recurring in the future.

The prognosis is usually good: symptoms may last for days or weeks depending on the severity, but with timely remedies and treatment, the problem can be easily controlled and eliminated. The condition should resolve within a week or two after treatment. However, if the initial cause of the infection is not treated, the problem is likely to recur.

Prevention of pericoronaritis

• Always maintain meticulous daily oral hygiene.
• Do not apply too much pressure when brushing your teeth.
• Use a soft-bristled toothbrush to avoid bleeding gums.
• Avoid tobacco and alcohol.

Dentistry offers many remedies for the prevention of pericoronaritis. First of all, maintaining good oral hygiene at all times and visiting the dentist at least once a year are basic actions; avoiding smoking can also help, as well as eating healthy foods.

Brushing teeth with proper pressure is very important to prevent gum inflammation and bleeding.

The use of a Mouthwash with chlorhexidine to relieve discomfort and care for the health of the teeth, especially in case of inflamed or often bleeding gums. The special action of chlorhexidine counteracts bacterial proliferation and helps prevent the formation of biofilm and dental caries.

By following these simple tips, it is easy to keep the area clean to prevent the problem from recurring and contribute to a better management of the initial situation, while preventing the occurrence of other complications such as periodontitis or dental implant infections.

However, if these measures are not sufficient and pericoronaritis tends to recur periodically, other treatmentmay be necessary .