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

Clinical Features

Pericoronitis
  • Pain at site of recent tooth eruption with operculum

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

Other

Evaluation

  • Clinical diagnosis

Management

Mild to Moderate

  • Analgesia (often requires dental block)
  • Chlorhexidine rinses (a randomized trial showed green tea was equally effective)[1]
  • 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

References

  1. Shahakbari R, Eshghpour M, Rajaei A, et al. Effectiveness of green tea mouthwash in comparison to chlorhexidine mouthwash in patients with acute pericoronitis: a randomized clinical trial. Int J Oral Maxillofac Surg. 2014;43(11):1394- 1398