Pericoronitis

Oral Surgery

1. PERICORONITISPERICORONITIS

2. DEFINITION
• Pericoronitis  inflammation of the gum tissue
surrounding the crown portion of an incompletely
erupted tooth.
•Usually affects the Partially erupted lower 3
rd

molar (wisdom) tooth where gum tissue overlaps
the chewing surface of the tooth.

3. DEFINITION
•Chronic pericoronitis is a mild persistent
inflammation of the area. 
•Acute pericoronitis is when the symptoms
intensify to fever, swelling, and pain, which
indicate a spreading infection.

4. 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 of the tooth may further
complicate the soft tissue architecture

5. •The sac is penetrated.
•The sac is a non-cleansable area.

6. 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

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

8. •Markedly red, swollen suppurating lesion
•tender
•Radiating pain to the ear, throat, and floor of the
mouth.
•Foul taste, Bad Odor
•inability to close the jaws.

9. •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.

11. 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.

12. TREATMENT
1.Non-surgical
1.Management of pain and resolving the
infection
•Subside acute Symptoms
•Further eruption into a good functional position.

13. Non- Surgical
•To manage the pain, over-the-counter medications
such as acetaminophen or ibuprofen are used
•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
 amoxicillin or erythromycin

14. •If gingival flap is swollen and fluctuant, an
anteroposterior incision to establish drainage is
made with a # 15 blade.

15. 1.Operculectomy
2.Removal of the tooth
Surgical

16. •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.
Retain or Extract the
tooth???

20. 1.stage of eruption of tooth
2.impacted 3rd molar
3.position of tooth
•Is the most common treatment method since
wisdom teeth oftentimes are poorly positioned
and do not erupt completely. This method
eliminates any future occurrences
of pericoronitis.
Removal (extraction) of the tooth

21. 1.It is the most common type of pericoronal
infection found mostly in mandibular third
molar.
2.Clinical features include red, swollen
suppurating lesion along with the pain which
may radiate to the surrounding tissues.
3.Proper & immediate management is necessary
to prevent its complication.
CONCLUSION

22. Thank You