Pericoronitis

Background

• Occurs during tooth eruption through the gingiva
• Food and bacteria can accumulate between the erupting tooth and operculum (flap of gingiva) leading to infection and pain
• The wisdom tooth (3rd molar) is the most common site of pericoronitis

Pericoronitis

Clinical Features

• Pain at site of recent tooth eruption with operculum

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Evaluation

• Clinical diagnosis

Management

Mild to Moderate

• Analgesia (often requires dental block)
• Chlorhexidine rinses (a randomized trial showed green tea was equally effective)
• Penicillin VK 500mg PO QID OR clindamycin 300mg PO QID
• ED debridement of the operculum or debris is usually not indicated

Severe

• Severe infections require intravenous antibiotics and admission
• Complications: Deep soft tissue infection

Disposition

Mild to Moderate

• Discharge with dental follow-up
  • Refer to dentist for surgical excision of the operculum and/or removal of the offending tooth

Severe

• Admit

See Also

• Dental problems
• Dental numbers