Wisdom tooth pericoronitis is an inflammation of the soft tissue surrounding the crown of a wisdom tooth (third molar) when eruption is incomplete or obstructed. Pericoronitis is most common in mandibular wisdom teeth.
1. Etiology
The mandibular third molar is the last tooth to erupt in the dental series, due to the lack of eruption position, can lead to different degrees of obstruction, the crown can be partially or completely covered by the gingival flap, forming a blind pocket, food and bacteria easily embedded in the blind pocket. When the systemic resistance decreases, local bacterial virulence can cause an acute attack of pericoronitis. Wu Huaying, Orthodontic Center, Nanjing Maternal and Child Health Hospital
2.Clinical manifestations
(1) Early molar posterior area distension and discomfort, when eating, swallowing, opening pain increased
(2) Local spontaneous throbbing pain or radiating pain
(3) When the inflammation invades the masticatory muscle, it can cause mouth opening restriction
(4) Systemic symptoms may include chills, fever, and headache to varying degrees
(5) Local examination often shows incomplete eruption of wisdom teeth, redness and swelling of soft tissues and gums around wisdom teeth.
3. Complications
(1) Subperiosteal abscesses are formed in the vestibular sulcus of the first molar by spreading along the external oblique line
(2) Spread to the posterior area of the molar, forming a buccal abscess at the anterior margin of the occlusal muscle and the posterior margin of the buccal muscle, and a buccal fistula
(3) Spread along the lateral side of the mandibular branch to form an inter-occlusal infection
(4) Spread medially along the mandibular branch to form pterygomandibular space infection, parapharyngeal, and peri-tonsillar abscesses
(5) Downward spreading can lead to submandibular space abscess and cellulitis of the floor of the mouth.
4.Treatment
(1) local rinsing: the treatment of pericoronitis of wisdom teeth focuses on local treatment, commonly used 3% hydrogen peroxide, saline repeatedly rinse the gingival pockets until the overflow liquid is clear. Dry the local area, place iodine glycerin into the gingival pocket, and rinse the mouth with warm water or mouthwash 1-3 times a day
(2) Select antibacterial drugs and systemic supportive therapy according to the degree of local inflammation and systemic response
(3) Incision and drainage: If an abscess is formed near the gingival flap, it should be incised and drainage strips placed in a timely manner
(4) pericoronal gingival flap removal: when the acute inflammation subsides, the wisdom tooth with sufficient eruption position and normal tooth position can be removed under local anesthesia to eliminate the blind pocket
(5) mandibular wisdom tooth extraction: mandibular wisdom teeth are not properly positioned, do not have sufficient eruption position, are not properly positioned relative to the maxillary third molar or have been extracted, in order to avoid the recurrence of pericoronitis, mandibular wisdom teeth should be extracted as soon as possible after the acute inflammation is controlled.