What could be the cause of an ulcer near the wisdom tooth?

Question

Hello doctor,

I am a 22-year-old male, and I have a habit of smoking. I have an ulcer at the back of my mouth that has given me a lot of pain and discomfort. It began around five days ago. I am unsure if it is still an ulcer. It is at the back of my mouth near the wisdom tooth.

I am worried that I have this ulcer due to gingivitis or pericoronitis. I also think it could be gingivitis or pericoronitis because my gums bleed when I brush my teeth.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand the pain you are going through right now, and I will do my best to help you.

Yes, your assumptions are correct. However, this is a case of acute pericoronitis (a short-term inflammation of the gums surrounding a partially erupted or erupting tooth) with cheek bite marks on the buccal mucosa opposite to the related tooth, as seen in the attached images (attachments removed to protect the patient's identity).

I can well appreciate the edematous tissue with the presence of pus and blood. Pericoronitis can occur due to improper eruption or incorrect positioning of the third molars.

You can have an ulcer due to improper eruption or a lack of space in the area of the third molar eruption. In addition, food lodgement beneath the flabby tissue helps to aggravate the condition as the presence of food particles helps in harboring and nurturing the bacteria.

Please get an IOPA (intra-oral periapical) X-ray done in relation to teeth 37 and 38. If IOPA is not possible due to pain, then go for OPG (orthopantomogram).

Rinse the oral cavity with lukewarm saline water twice a day. You may expect mild edema at an early stage, but it will eventually disappear. Do not quit brushing, as the place needs to be cleaned regularly.

Use a soft-bristle toothbrush, and do not apply force to the area. Use the mouthwash two times a day and do not consume food or drink 30 minutes before and after using the mouthwash. It is good to know that you are trying to quit smoking, and I encourage you to stop smoking for at least a month. Try sugar-free chewing gums instead.

I suggest you take the tablet Amoxicillin and Clavulanic acid 625 mg twice daily for three days after having a meal. You can also take the tablet Ibuprofen or Acetaminophen 250 mg or 500 mg twice daily for three days after meals. In addition, I suggest you use Chlorhexidine mouthwash 5 ml diluted with water for 14 days.

Consult a specialist doctor, discuss with them, and take medications with their consent. Consult an oral surgeon if the condition persists after 1.5 weeks. In that case, the flabby tissue might be removed surgically under local anesthesia.

Please upload the X-ray and CBC (complete blood count) report in the follow-up section and the status of the allergic conditions you suffer from. This treatment needs a regular follow-up for the next two to three weeks.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.