Pericoronitits
 

What is Pericoronitis?

Pericoronitis is a posh name for saying that the tissue or gum around the top of your wisdom tooth is infected.


'Peri' meaning around, 'coron' meaning the top or crown of the tooth and 'tis' meaning swelling of.

The classic complaint is a worsening pain for a few days on the one side of the mouth usually at the back, plus difficulty biting together, chewing and opening your mouth. It may have happened before but this time, there is a more swelling, it hurts to swallow and you feel generally unwell.

What are the Signs and Symptoms?

  • You have a partially erupted wisdom tooth or are around the age (18 give or take a few years) when the wisdom tooth is coming through
  • Redness, tenderness and swelling of the gum overlying the wisdom tooth
  • Bleeding, discharge or pus coming from the area- this may taste foul and smell rather nasty
  • Limited jaw opening (trismus)- you cannot open as wide as normal because the swelling/ inflammation has spread to affect the muscles that move your jaw. In much the same way as if you had hurt your knee -it would swell up and you would have limited movement.
  • Pain/soreness at the back of your mouth
  • Raised temperature
  • Feeling generally unwell
  • Glands are up (lymphadenopathy)- you get pain on swallowing because you are fighting the infection in the lymph glands in your neck.

What are the Causes?

It is a bacterial infection that can be brought on or made worse by:

  • Bits of food-getting trapped and packed underneath the gum over the wisdom tooth and then festering
  • Trauma from the opposing wisdom tooth biting down on top of it
  • Bad hygiene in that area
  • Stress
  • Other mouth and throat infections.

How do you treat Pericoronitis?

Treatment depends on the symptoms that you present with, but essentially the aim is to treat the infection and remove the cause. Your dentist may consider the following:

  • Draining. If pus is present this should be drained where possible. The infection can spread in various ways at the back of your mouth depending on the angle of the tooth, and the relationship to the other teeth, bone and muscle attachments. Sometimes it will point like a big spot or pimple either inside or (very rarely) outside the mouth depending on the path of the infection. This makes it much easier to drain. At other times it may be a firm swelling that is, or has the potential to impinge on the air-way and cause difficulty breathing. In these rare cases, referral to hospital and a general anaesthetic will be required.
  • Cleaning/washing. The area will need to be cleaned out. To do this, the dentist is likely to wash under the gum with an antibacterial such as 'my dear Chlorhexidine', making sure any trapped food particles are removed. Sometimes they might use saline (salt water) to flush the rubbish out. If the dentist can get the area numb, they may use a scaler to clean down there as well, but because of the swelling in that area, this is not always possible or sensible if there is a lot of infection.
  • Take out the top wisdom tooth. If the opposing wisdom tooth is through the gum and causing trauma on the bottom when you bite, it should be taken out. Top wisdom teeth are amongst the easiest teeth in the mouth to extract- heavily impacted bottom ones are the teeth you hear the dodgy stories about. Patients often say 'but it is the bottom one that hurts'- yes, but this will often relieve the pressure and the pain- let the infection subside and give room for the lower tooth to come through a bit more- allowing for an easier extraction later.
  • Painkillers. You are going to want to take some painkillers such as Ibuprofen to help ease the pain and reduce the inflammation whilst it settles down. Your dentist can advise you on what is best. The chances are you will have already started taking something for a few days before actually going to the dentist in an attempt to avoid the visit... tut tut tut.
  • Antibiotics. If the infection is showing signs of spreading (temperature is up, glands are hurting and you feel unwell) then antibiotics may be needed. If the swelling is considerable, access for cleaning will be very limited and an antibiotic can help settle things down- bear in mind it generally takes 24 hours to kick in. The most commonly prescribed antibiotics for this situation are metronidazole and amoxicillin- your dentist will complete the appropriate prescription and ensure they are suitable for you to take.

In the vast vast majority of cases, this condition is managed routinely with your dentist. It can however, on occasions lead to a severe spreading infection that puts you at considerable risk, requiring hospital admission, intravenous antibiotics and perhaps surgery under general anaesthetic.

Do I need to have the Tooth Extracted?

The general rule is- two bouts of pericoronitis and you should consider having the tooth removed. But it depends on a number of factors. If the tooth is never likely to be useful, for example, because the top wisdom tooth has been removed, or it is impacted and trapping food, generally it would be better off removed (assuming there is not a high risk of complication).

If the infection was just once and now the tooth has come all the way through the gum and is nicely in line and there are no other problems then there is no reason to take it out. It is a matter of weighing up the benefits of removing wisdom teeth versus the risks of having it out.