Pericoronitis of the wisdom tooth, also known as Pericoronitis of the third molar refers to an oral health condition that involves the inflammation of the soft tissues that surround the crown of a partially erupted wisdom tooth. It mostly occurs among the young people who are in the period of wisdom tooth eruption at the age of 18 to 30. Pericoronitis of the wisdom tooth is one of the common diseases in the oral maxillofacial surgery clinic.

Causes of Pericoronitis of the wisdom tooth

The third molar in the mandible is also called wisdom tooth which is the last tooth to erupt in the dentition. Therefore, there’s no enough space for it to erupt and consequently result in impaction in different degrees. In the process of impacted wisdom tooth and wisdom tooth eruption, the crown can partially or completely be covered by the gingival flap. The blind pouch between the gingival flap and crown will come into being and become a natural place to harbor food debris and breed bacteria. Additionally, the gum of the crown is frequently damaged due to food chewing, and then ulceration comes into being. When systemic resistance is reduced and local bacterial virulence increases, acute onset of pericoronitis can be caused. Therefore, pericoronitis mostly occurs among the young people who are in the period of wisdom tooth eruption at the age of 18 to 30 and the patients who are suffering from uncompleted impacted wisdom tooth.

Clinical Manifestation

Acute Pericoronitis

Acute pericoronitis is defined as "varying degrees of inflammatory involvement of the pericoronal flap and adjacent structures, as well as by systemic complications." Systemic complications refer to signs and symptoms occurring outside of the mouth, such as fever, malaise or swollen lymph nodes in the neck.

Chronic Pericoronitis

Pericoronitis may also be chronic or recurrent, with repeated episodes of acute pericoronitis occurring periodically. Chronic pericoronitis may cause few if any symptoms, but some signs are usually visible when the mouth is examined.

Treatment Solutions

If the tooth will not continue to erupt completely, definitive treatment involves either sustained oral hygiene improvements or removal of the offending tooth or operculum. The latter surgical treatment options are usually chosen in the case of impacted teeth with no further eruption potential, or in the case of recurrent episodes of acute pericoronitis despite oral hygiene instruction.

Oral hygiene

In some cases, removal of the tooth may not be necessary with meticulous oral hygiene to prevent buildup of plaque in the area. Long term maintenance is needed to keep the operculum clean in order to prevent further acute episodes of inflammation. A variety of specialized oral hygiene methods are available to deal with hard to reach areas of the mouth, including small headed tooth brushes, interdental brushes, electronic irrigators and dental floss.

Operculectomy

This is a minor surgical procedure where the affected soft tissue covering and surrounding the tooth is removed. This leaves an area that is easy to keep clean, preventing plaque buildup and subsequent inflammation. Sometimes operculectomy is not an effective treatment.Typically operculectomy is done with a surgical scalpel, electrocautery, with lasers or, historically, with caustic agents.

Tooth extraction

Removal of the associated tooth will eliminate the plaque stagnation area, and thus eliminate any further episodes of pericoronitis. Removal is indicated when the involved tooth will not erupt any further due to impaction or ankylosis; if extensive work would be required to restore structural damage; or to allow improved oral hygiene. Sometimes the opposing tooth is also extracted if no longer required.

For more information in regard to Pericoronitis of the wisdom tooth, please make an appointment with the dentists at Shenzhen A.K.J Stomatological Hospital to seek advice.