Pericoronitis (pericoronaritis) of the tooth

We provide quick and minimally invasive treatment of inflamed gums

At the dental clinic of authorial prosthetics "Kiadent," we treat pericoronitis at any stage. For this, a minimally invasive operation is prescribed—pericoronarotomy or wisdom tooth extraction. Both procedures are completely painless and are performed by a certified dental surgeon.

What is Pericoronitis?

Pericoronaritis, or pericoronitis, is a condition in which the gum over an erupting tooth becomes inflamed.

Most often, it occurs in the area of the lower wisdom teeth, which dentists also call third molars or "eights." Less frequently, cases are observed when the gum over the seventh tooth becomes inflamed. This is usually due to the small size of the jaw.

Food particles and bacteria get trapped under the formed "hood," which is almost impossible to clean on your own. This leads to the development of not only an inflammatory process in the gum but also tooth decay. Over time, enamel and dentin destruction causes pulpitis—an inflammation of the tooth nerve.

To stop the inflammation, preserve the tooth, and prevent complications, the mucous hood, under which food particles and bacteria get trapped, must be removed.

Pericoronarotomy is a micro-surgical procedure that helps to:

preserve the tooth;
remove the hood that caused the inflammation;
prevent the development of caries, pulpitis, periodontitis;
avoid dangerous complications: periostitis , osteomyelitis, phlegmon, which arise due to the spread of inflammation.

“Gum hood” over the wisdom tooth—occurs at the age of 20.

Wisdom teeth usually begin to erupt around the age of 20-21. For some, this process happens later, and the wisdom tooth appears by the age of 29. Most often, the third molar does not have enough space in the jaw and cannot fully erupt, remaining partially or completely under the mucosa. Often, the problem is complicated by the incorrect positioning of the tooth.

Price

The cost of the service will depend on the type of procedure. To find out the exact cost of treatment, schedule a consultation with a dental surgeon.

Full list of services for wisdom tooth pericoronitis:

Consultation with a dental surgeon
Antiseptic treatment of the mucosa in the area of one tooth
Pericoronarotomy (hood excision) in the area of one tooth
Simple tooth extraction
Extraction of an impacted tooth

Symptoms of Pericoronitis

Mild Stage

In the early stages of the disease, the patient notices the following symptoms:

pain when chewing;
the tooth is covered with swollen, reddened mucous membrane;
lymph nodes in the submandibular area are enlarged and painful;
the gum is painful when touched, but there is no discharge from under the mucous hood.

This stage of pericoronitis is relatively easy for the patient and does not affect overall well-being. If timely treatment is prescribed, the inflammatory process and symptoms are quickly relieved.

Intermediate Stage

This stage is characterized by signs such as:

constant pain behind the third molar;
swallowing and opening the mouth causes pain;
weakness appears, and the temperature rises to 37.5 °C;
the pain intensifies when chewing and can radiate to the temple or ear;
the gum over the tooth is swollen, and when pressed, purulent discharge is released.

If such signs appear, it is recommended that the patient see a doctor as soon as possible to prevent the further spread of the inflammatory process.

Severe Stage

In this stage, the symptoms worsen, indicating the development of complications:

sleep is disturbed;
it is difficult to open the mouth;
the skin becomes pale, and the temperature rises to 38.5 °C;
the pain becomes so intense that chewing becomes impossible.

These symptoms are typical for posterior molar periostitis. In this condition, the patient should urgently seek medical attention to prevent even more dangerous complications.

How urgent is the surgery?

You should consult a dentist at the first symptoms. In the early stages of pericoronitis, the surgeon can immediately remove the overhanging hood to prevent the development of the inflammatory process. If the disease is accompanied by swelling and pus formation under the gum, surgery is scheduled after the inflammation is controlled. On the day of the visit, the gum pocket is flushed with an antiseptic, and antibiotics are prescribed. A few days later, a pericoronarotomy is performed.

Types of Pericoronitis

The dental condition occurs in both acute and chronic forms, each with its own symptoms.

According to statistics, pericoronitis during the eruption of lower third molars is observed in 65-70% of patients. Without proper treatment of the inflammatory process, dangerous complications can develop.

Acute Pericoronitis

The disease arises due to bacteria that provoke the inflammatory process, as well as from trauma to the mucosa by the upper tooth. The acute stage of the disease has both catarrhal and purulent forms, each characterized by specific symptoms.

Catarrhal

This form develops at the onset of the disease. The patient feels pain when chewing in the area of the erupting wisdom tooth. The gum over the tooth is inflamed. There is no discharge from under the hood. The general condition is normal, and there is no fever. There is no swelling of the perimaxillary tissues, and the mouth opens freely. The submandibular lymph node is enlarged and painful when touched.

Purulent

There is constant pain in the area of the wisdom tooth. The pain worsens when chewing and radiates to the ear and temple. It becomes painful to swallow and open the mouth. The general condition worsens, and the temperature rises to 37.5 °C. Submandibular lymph nodes enlarge and become painful on palpation. The inflammatory process in the mucosa over the tooth spreads to adjacent tissues. Pressing on the gum hood causes sharp pain and purulent discharge.

Chronic Pericoronitis

If acute pericoronitis did not lead to complications, the disease progresses to a chronic form. There are no sharp pains or high fever, but the inflammatory process does not completely subside. The submandibular lymph nodes remain enlarged and slightly painful. There is slight restriction when opening the mouth. The gum over the tooth is hyperemic. Pressing on it causes mild pain, and a small amount of serous fluid is released.

Pericoronitis — Hood Excision or Tooth Extraction

The treatment plan will depend on the tooth's position in the jaw and the stage of the inflammatory process. To choose the right strategy, the dentist conducts an examination and studies X-ray data.

Treating Pericoronitis Without Tooth Extraction

To stop the inflammatory process, the dentist performs a pericoronarotomy and prescribes medication.

Pericoronitis treatment includes 3 steps:

1. Step. Anesthesia
Anesthetic is administered to numb the mucosa. For a lower wisdom tooth, a conduction anesthesia is used, which numbs the cheek, half of the jaw, including half of the tongue and lip.
2. Step. Hood removal
The effect of the anesthesia is checked. The overhanging mucosa is excised with a laser or scalpel. The patient does not feel any pain during this procedure.
3. Step. Antiseptic treatment
The wound is thoroughly rinsed with an antiseptic, the tooth is inspected, and a healing dressing is applied. If there is tooth decay, the patient is scheduled for therapeutic treatment in 7-10 days.

Treating Pericoronitis with Tooth Extraction

If the wisdom tooth is severely damaged or has caused displacement of other teeth, the surgeon recommends extraction.

1. Step. Anesthesia
To remove the wisdom tooth, the doctor administers conduction anesthesia. The patient initially feels tingling, and then the sensation in the cheek, half of the lower lip, and tongue disappears. The effect of anesthesia lasts for 3–5 hours.
2. Step. Access formation
An incision is made in the gum to detach the mucosa. If the erupting tooth is partially in the bone, it is removed with a bur.
3. Step. Tooth extraction
The wisdom tooth is carefully loosened with a luxator. In some cases, the tooth is cut into parts and removed piece by piece. At the end of the operation, an X-ray is taken to ensure all fragments of the tooth are removed.
4. Step. Suturing
To speed up healing and prevent food particles from entering the socket, the edges of the wound are brought together and sutured. The removal of stitches is scheduled for 7-10 days after the surgery.

Possible Complications of Pericoronitis

Lack of timely treatment can lead to the following complications:

Retromolar Periostitis

A purulent infection spreads from under the hood to the soft tissues and periosteum of the retromolar space, forming an abscess. The condition exhibits all clinical symptoms of pericoronitis but in a more pronounced form. The patient complains of increasing pain

, worsening general health, and poor sleep. Body temperature rises to 38–38.5 °C. Opening the mouth becomes difficult. Chewing food becomes impossible due to pain.

Osteomyelitis

A purulent-necrotic process develops in the bone tissue. The pain intensifies when pressure is applied to the jaw. The face becomes asymmetrical due to swelling. The patient experiences headaches, general weakness, and a fever of up to 39 °C. Neighboring teeth become mobile. Some patients experience numbness in the lips, and their taste sensations become dulled.

Phlegmon

With pericoronitis and periostitis, the purulent process spreads from the retromolar area to neighboring tissues. The patient's condition worsens, the temperature rises, and sweating increases. There is sharp pain in the jaw. Difficulty and restriction in opening the mouth and swallowing are noted. Significant swelling develops in the face and neck area. A patient with phlegmon requires emergency surgical intervention.

Recovery After Surgery

The duration of the rehabilitation period depends on the chosen surgical treatment method and the patient’s overall condition. If only the overhanging mucous hood was removed, recovery takes 3-5 days. After complex extraction of a partially erupted tooth, the gum heals in about 2 weeks.

To alleviate pain, avoid complications, and help the mucosa heal faster, the surgeon prescribes pain relievers and antibiotics. After hood excision, the dentist recommends rinsing the mouth with an antiseptic. If a tooth was removed, instead of rinsing, oral baths are recommended to avoid dislodging the blood clot from the socket.

On the third day after the extraction of the third molar, swelling may develop. This is a normal reaction of the body to the surgery. Gradually, the swelling will subside along with the painful sensations. However, if after a few days the patient feels increased pain, notices a rise in temperature, and the swelling persists, they should see a dentist.

Questions and Answers

Is it possible to avoid surgical treatment?
Antiseptic treatment and antibiotics will reduce the inflammation. However, this treatment without surgery will only provide temporary relief. Food particles and bacteria will get trapped under the hood again, and pericoronitis will return. In addition, decay or pulpitis may develop on the wisdom tooth. Sometimes, the destruction becomes so severe that the tooth must be removed, even if it is in the correct position in the dental arch.