Pericoronitis

Pericoronitis (also known as operculitis, and derived from Greek peri, "around", Latin corona "crown" and -itis, meaning a disease involving inflammation), is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle. Most commonly pericoronitis occurs with a partially erupted or partially erupted and impacted mandibular third molar (lower wisdom tooth). Periocoronitis is a common dental problem, often occurring in young adults (15-24), since this is roughly the age when the wisdom teeth are erupting into the mouth .

The soft tissue covering a partially erupted molar tooth is known as an operculum. Pericoronitis may occur for several reasons, usually involving an inflammatory response in the soft tissues because bacteria, food debris and plaque have accumulated beneath the operculum, an area which can be difficult to access with normal oral hygiene methods. An upper tooth may also start to bite into the soft tissues over a lower tooth and cause inflammation.

The signs and symptoms of pericoronitis are variable. Chronic inflammation may cause few if any symptoms, whereas an acute episode of pericoronitis, often associated with the formation of a pericoronal abscess (a collection of pus within the soft tissues), can cause significant pain and swelling. Sometimes the infection can spread to other parts of the face or neck, and rarely the swelling can start to threaten the airway and the individual is treated in hospital. Food impaction causing periodontal pain and pulpitis (toothache) secondary to dental caries (tooth decay) are also possible causes of pain associated with a third molar. The treatment of acute pericoronitis is normally addressed first by cleaning the area underneath the operculum with an antiseptic solution, and with painkillers, regular hot salt water mouthwashes/mouthbaths and improved oral hygiene in the affected area. Once the acute symptoms are controlled, the underlying cause is assessed and a decision is made as to whether to remove or retain the affected tooth. Often this is related to whether the tooth will continue to grow into the mouth and reach a normal position, or whether it is stuck against another tooth, and to other factors such as the presence of decay or periodontal disease in the area. If the tooth is retained, it usually requires improved oral hygiene in the area thereafter to prevent another episode of acute pericoronitis.