Pericoronitis
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Introduction
- An inflammatory condition of the operculum or gumflap around a partially erupted/impacted tooth
- Common around the lower last molars or wisdom teeth
Classification
- Subacute
- Acute Chronic
- Acute-on-chronic
Aetiology
- Mixed microbial infection
- Food impaction and plaque accumulation under gum flap
- Trauma to gum flap from opposing tooth
- Ulcerative gingivitis
- Reduced resistance
- Anaerobes in plaque
Clinical features
- Soreness and tenderness around partially-erupted tooth
- Pain
- Swelling
- Enlargement of regional lymph nodes
- Fever
- Abscess formation
Investigations
- Radiographs
- To establish the position of the affected tooth and its relationship to the second molar
- May show impacted third molar
Non-drug treatment
- When mouth opening is possible: careful irrigation under the gum flap to clear debris, using warm saline mouthwash
- To be done frequently until stagnation area is removed
- Operculectomy
- Disimpaction of the third molar by surgical extraction
- Occlusal reduction of opposing tooth
- Extraction of opposing tooth to forestall supraeruption and sequelae
Drug treatment
- Appropriate antibiotics
- Analgesics
- Supportive therapy
Possible complications
- Cellulitis
- Ludwig's angina
- Osteomyelitis
- Submasseteric abscess
- Temporomandibular joint ankylosis