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 age group of 18-30 years. 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 maxilla or mandible. With the evolution of time, the jaw size has decreased to a larger extent. The main disadvantage associated with this progress is the reduced space for third molars. Lack of space creates a lot of problems for the eruption of wisdom teeth. They either erupt in vertical or horizontal directions (impactions) or fail to erupt (embedded).
Due to lack of space, there is a lot of inflammation characterized by red or fluctuant swelling that may or may not be associated with 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 inability to eat with that side. The inflamed gum is called the operculum and is usually tender on 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 17-25 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 too has 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 various 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 an inflammatory response in tissues which is characterized by swelling and pain. Fever increases the severity of infection.
Our body responds to it with neutrophils and lymphocytes. If space is available, then the inflammatory response is subsided by either treatment options or medications. But if space is not available (either tooth is embedded partially or fully), it causes dull and chronic radiating pain. It may sometimes cause reduced mouth opening and sore throat also. Usually, the pain is not severe, but its chronic nature irritates the patient. Even lymph nodes are also tender and swollen to palpate. Malaise can be observed, and people even experience a sour taste.
How Is Pericoronitis Diagnosed?
The diagnosis of pericoronitis depends and is very simple. Clinically inflamed operculum (outer covering of 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 lack of space or change of path eruption. The presence of fever makes the treatment even more complicated. In some cases, the presence of infection gives 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 is often followed by sub-gingival and supra-gingival irrigation with povidone water (5%) solution. Even curettage is also done in some cases.
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After one week, it is observed whether the lesion has subsided or needs surgical intervention. If the lesion has not subsided, a surgical procedure called operculectomy is done. This procedure involves complete excision of the covering of the tooth. 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 impactions.
How Is Mouth Breathing Managed?What Precautionary Steps Are Taken Before Treating Pericoronitis?
Pericoronitis is a severe condition and every effort is made to reduce the level of 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 a state of continuous irritation, chances of recurrence are always there. 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. There can be even formation of orifice from where 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 which is 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.
Conclusion:
This disease is very progressive and sudden in onset. The presence of 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, both clinicians and patients should be aware of its complications, and problems must be treated in a systematic manner.
