PERICORONITIS

DEFINITION Pericoronitis is an acute infection with accompanying inflammation of gingival and contiguous soft tissues around the crown of an incompletely erupted tooth.

ANATOMIC RELATIONSHIP The occlusal surface of an involved tooth may be partly covered by a flap of tissue, the operculum, which exists during the eruption of the tooth and may persist afterwards. Varying degrees of eruption, malposition, or impaction may further complicate the soft tissue architecture

CLINICAL FEATURES The partially erupted or impacted mandibular third molar is the most common site of pericoronitis. The space between the crown of the tooth and the overlying gingival flap is an ideal area for the accumulation of food debris and bacterial growth

An influx of inflammatory fluid and cellular exudates results in an increase in the bulk of the flap. Difficulty in complete closure of the jaws. The flap is traumatized by contact with the opposing jaw, and the inflammatory involvement is aggravated.

Markedly red, swollen suppurating lesion Exquisitely tender Radiating pain to the ear, throat, and floor of the mouth. Foul taste, and an inability to close the jaws.

Swelling of the cheek in the region of the angle of the jaw and lymphadenitis. Mandibular movement is limited (Trismus). toxic systemic complications - fever, leukocytosis and malaise.

COMPLICATIONS The involvement may become localized in the form of a pericoronal abscess. It may spread posteriorly into the oropharyngeal area and medially to the base of the tongue, making swallowing difficult.

Involvement of sub maxillary, cervical, deep cervical and retropharyngeal lymph nodes. Peritonsillar abscess formations, cellulites, Ludwig’s Angina are infrequent but potential sequel of acute pericoronitis.

PATHOGENESIS Bacteria gain entry Migration of Leucocytes Area Walled Off Leucocytes and Micro-organisms Tissue Necrosis + Liquefaction of Central Area PUS Vessel Thrombosis Fibrinous Blockade

Streptococcus Viridans is the most common facultative isolate. Obligate anaerobes – 90.2% Gram –ve anaerobic rods – 59%.

TREATMENT Gently flush the area with warm water to remove debris and exudates. Swab with antiseptic after elevating the flap gently from the tooth with a scaler. The underlying debris is removed, and the area is flushed with warm water. Antibiotics can be prescribed in severe cases.

If gingival flap is swollen and fluctuant, an anteroposterior incision to establish drainage is made with a # 15 blade. Retain or Extract the tooth??? If tooth is retained, the pericoronal flap is removed using periodontal knives or electro surgery.

The tissue distal to the tooth is removed along with the occlusal portion of the flap to avoid formation of a deep distal pocket, which invites recurrence of acute pericoronitis. Periodontal pack is applied.

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