PERICORONONITIS

• Inflammation of soft tissue surrounding the crown of a partially erupted toot
• Prevalent in lower third molars

• Caused by accumulation of plaque and food debris collecting under the operculum (gum overlying tooth)
• Traumatic occlusion of opposing teeth (maxillary) may exacerbate the problem
• Obligate anaerobic bacteria usually involved

CLINICAL FEATURES

Depends on chronicity

Acute pericoronitis

• Intermittent severe throbbing pain
• Trismus with difficulty eating and swallowing
• Swollen and tender operculum with discharge pus
• Submandibular lymphadenopathy

Subacute pericoronitis

• Operculum is less inflamed with little discharge
• Continuous dull ache
• Pronounced systemic features – fever, tachycardia, tachypnea
• Tender submandibular nodes

Chronic pericoronitis

• Dull ache which occurs periodically
• OPG shows crater like radiolucency
• Paradental cyst formation

TREATMENT

• Gentle irrigation with chlorohexidine (1:1 with water)
• Operculectomy contraindicated in the absence of room for the tooth to erupt
• Warm salt water mouth rinses
• Analgesia
• Amoxicillin 500mg tds 7 days (if lymphadenopathy)

FOLLOW-UP

• Refer to dental surgeon
• Extract (if recurrent inflammation)
• +/- Extract opposing maxillary tooth

Dr George Chu BDSc MBBS
Ed: Dr. Derek Louey MBBS FACEM