Inflammatory lesions in the soft tissues surrounding wisdom teeth that are erupting or blocked are called pericoronitis. The age of onset of this disease is between 8 and 35 years. The eruption of the mandibular wisdom teeth in the mandible is inadequate, resulting in the eruption of the lower wisdom teeth is blocked, part of the erupting wisdom teeth and the surrounding tooth nasty identify between the formation of blind pockets, embedded food and bacteria, once encountered with a cold, fatigue and other body resistance to reduce, often induced acute pericoronitis. Pericoronitis of maxillary wisdom teeth is rare.
Clinical manifestations
Initially, there is swelling and discomfort in the posterior region of the affected molar, followed by pain, which is aggravated by chewing and swallowing, and early on it is mostly dull pain. When the infection affects the masticatory muscle fascia, mouth opening may be restricted, or the face (mainly the cheek, submandibular area, parotid bite area) may be swollen. When the local infection is aggravated, fever and malaise may occur. Headache and other systemic symptoms.
2, intraoral examination can be seen obstructed wisdom teeth, surrounding soft tissue congestion, edema, erosion, tenderness, and food residue or purulent exudate in the blind pocket. In some cases, the abscess can be located on the buccal side of the second molar or in the buccal area because the infection spreads downward along the mandible. The lymph nodes under the affected side of the whiskers are enlarged and painful to palpation.
Diagnosis
1.According to the medical history and clinical manifestations.
2.X-ray examination can understand the position, growth direction and root morphology of the blocked wisdom tooth, and also can find the caries in the distal middle neck of the second molar which is not easy to be detected in the mouth.
3.Laboratory examination: the total number of autocytes in blood routine is increased, neutrophils are increased, and the nucleus is right shifted.
4.In addition, it should be distinguished from the pulpitis caused by the distal middle caries of the second molar.
(1) Pain expression is different.
(2) Pulp vitality test: pain from hot and cold stimulation.
(3) Different x-ray performance.
Treatment
1.Local treatment
(1) Blind bag rinsing; available 3% hydrogen peroxide, 1% Ravnol, after rinsing, put iodine glycerin or concentrated Taiwan’s solution in the blind bag. Blind bag rinse and drug on the local inflammation is very important, there are conditions should be once a day.
(2) Mouthwash gargle: such as Dobell’s solution, but also can use light saline gargle.
(3) For facial swelling, external application of Ruyi Jinhuang San can be used.
(4) If abscess has formed, incision and drainage should be performed, and the incision should be parallel to the gum and reach the bone surface.
(5) Acute extraction: When the patient’s general condition is good and the inflammation is more limited, if it is estimated that the surgery is not too difficult, the affected tooth can be considered for extraction.
(2) Systemic treatment: Oral antimicrobial agents such as booster joint levosulfur tablets, tetracycline and erythromycin can be used in less severe cases, and intramuscular injection or intravenous drip penicillin and streptomycin can be chosen in more severe cases.
3. If there is enough clearance in the jawbone, wisdom teeth are orthotropically positioned without bone obstruction, and in cases with fetal relationship, gingive gingivectomy can be considered to preserve the teeth, otherwise, they should be extracted as early as possible.
Prevention and recuperation
Early treatment or extraction of the disease-causing tooth can be more effective in preventing the spread of inflammation to the adjacent tissues.