Introduction:
Pericoronitis creates swelling in the backmost area of the jaws, often accompanied by fever and inflammation of lymph nodes. Such individuals present with severe dull and radiating pain, usually in the 18-30 age group. It becomes complicated for patients to consume food and other liquids. Clinicians must detect this problem as early as possible and treat it accordingly. Also, case selection is important to decrease postoperative discomfort and provide relief.
What Is Pericoronitis?
The word ‘Pericoronitis’ refers to inflammation around the crown of a tooth. In other words, it refers to swelling around the erupting third molar or wisdom tooth in either the maxilla or mandible. With the evolution of time, the jaw size has decreased to a greater extent. The main disadvantage of this progress is the reduced space for third molars. Lack of space creates many problems for the eruption of wisdom teeth. They erupt in vertical or horizontal directions (impactions) or fail to erupt (embedded).
Due to a lack of space, there is a lot of inflammation characterized by red or fluctuant swelling that may or may not be associated with an orifice or pus. There can be high-grade fever, malaise, or inflammation of lymph nodes. Often, the individuals present with reduced mouth opening (trismus) and an inability to eat with that side. The inflamed gum is called the operculum and is usually tender upon touching. There can also be chances of late reporting due to unexpected eruptions in some individuals.
What Are The Various Types Of Impactions?
Impacted teeth are of various types, ranging from vertical to horizontal. Pericoronitis is usually associated with either mesioangular (mesial tilting) or distoangular (distal tilting) impactions. As the eruption period ranges from 17 to 25 years, no procedure (preferably surgical) is usually done up to 25 years.
Which Microorganisms Frequently Cause Pericoronitis?
Microbes are involved in any infection, and pericoronitis has a microbial preponderance. A variety of microbes are involved, like Porphyromonas gingivalis, Bacteroides melaninogenicus, and Fusobacterium species. There can even be the presence of Treponema denticola too. We employ techniques like simple culturing, PCR (polymerase chain reaction), and dark field microscopy to detect anaerobic microorganisms.
How Does Pericoronitis Occur?
Like other infections, pericoronitis is initiated by microbial infection. It involves the release of endotoxins (Gram-negative bacteria) or exotoxins (Gram-positive bacteria). These toxins initiate a tissue inflammatory response characterized by swelling and pain. Fever increases the severity of infection.
Our body responds to it with neutrophils and lymphocytes. If space is available, the inflammatory response is subsided by either treatment options or medications. But if space is unavailable (either tooth is partially or fully embedded), it causes dull and chronic radiating pain. It may sometimes cause reduced mouth opening and a sore throat. Usually, the pain is not severe, but its chronic nature irritates the patient. Even lymph nodes are tender and swollen enough to palpate. Malaise can be observed, and people even experience a sour taste.
How Is Pericoronitis Diagnosed?
The diagnosis of pericoronitis depends on and is very simple. A clinically inflamed operculum (outer covering of the wisdom tooth) is seen at the backmost portion of the maxilla and mandible. This inflammation, sometimes in the acute stage, is accompanied by severe pain and swelling. This swelling is very sensitive to touch, and the patient cannot swallow anything on that side. This operculum can be partially or fully covered and is expected to close with time, but it creates many problems due to a lack of space or a change in path. The presence of a fever makes the treatment even more complicated. In some cases, the presence of infection gives off a foul smell.
How Can Pericoronitis Be Treated?
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Treatment options start with oral prophylaxis, followed by surgical and non-surgical therapy. Oral prophylaxis includes scaling and root planing with routine once-a-week recalls.
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Oral prophylaxis often follows sub-gingival and supra-gingival irrigation with a povidone water (5%) solution. In some cases, curettage is also performed.
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After one week, whether the lesion has subsided or needs surgical intervention is observed. If it has not subsided, an operculectomy is performed. This procedure involves complete excision of the tooth covering. It is performed under local anesthesia and is usually done after 7-15 days of oral prophylaxis. It enables the tooth to be completely visible. However, some cases are settled after extraction only. They include mesioangular and distoangular impacts.
How Is Mouth Breathing Managed? What Precautionary Steps Are Taken Before Treating Pericoronitis?
Pericoronitis is a severe condition; every effort is made to reduce inflammation and pain. Hence, along with oral prophylaxis, povidone-iodine irrigation is done to maintain hygiene and decrease the microbial count. Even medications are given in extreme cases to reduce the level of discomfort. These include both analgesics and antibiotics. They are given in both local and systemic forms. Since the pericoronitis-affected area is in continuous irritation, chances of recurrence are always present. There can also be chances of complete regeneration.
What Complications Do Untreated Pericoronitis Cause?
Pericoronitis, if untreated, leads to many complications.
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One of the important complications is pericoronal abscess. It arises due to the collection of microbes in the pericoronal flap. An orifice can even form from which pus discharge can occur.
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Pharyngitis and lateral space infections can also be seen in pericoronitis, which can be life-threatening.
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Trismus, characterized by reduced mouth opening, is often a characteristic sign of pericoronitis.
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Some cases have often reported Ludwig’s angina as an extension of lateral pharyngeal space infection.
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Also, in some cases, it increases crowding and malocclusion of remaining teeth.
Hence, pain is not the only problem associated with this condition. These complications can also arise if the condition remains untreated.
How Can Pericoronitis Be Prevented?
Pericoronitis cannot be prevented completely; it can even occur if the person has good oral hygiene.
Some prevention methods are
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Brushing the teeth twice or three times a day.
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Flossing should be done regularly, once a day.
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Antibacterial mouthwash should be used twice a day.
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Regular visits to the dentist for cleaning.
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The dentist's recommendations need to be followed properly.
Will Pericoronitis Subside on Its Own?
Sometimes, pericoronitis occur as the wisdom tooth erupts. In these conditions, the dentist will wait and monitor to see if it subsides independently. If it does not subside, then treatment is required.
Conclusion:
This disease is very progressive and sudden in onset. A microbial infection makes the problem very painful and difficult to manage. The recurring nature of pericoronitis makes the treatment sometimes questionable for both clinicians and patients. Hence, clinicians and patients should be aware of its complications, and problems must be treated systematically.