Pericoronitis

Background

Dental Numbering

Classic dental numbering.

• Adult (permanent) teeth identified by numbers
  • From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
• Children (non-permanent) teeth identified by letters
• Common landmarks:
  • 1: Right upper wisdom
  • 8 & 9: Upper incisors
  • 16: Left upper wisdom
  • 17: Left lower wisdom
  • 24 & 25: Lower incisors
  • 32: Right lower wisdom

Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.

• 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

Clinical Features

Pericoronitis

• 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