4. It occurs most frequently in the
mandibular third molar area.
It may be
ACUTE
SUBACUTE
or
CHRONIC
5. 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 &
overlying gingival flap is an
ideal area for the
accumulation of food
debris & bacterial growth.
6. Even in patients with no clinical signs
or symptoms, the gingival flap is often
chronically inflamed & infected, with
various degrees of ulceration along its
inner surface.
7. Acute inflammatory involvement is a
constant possibility.
Acute pericoronitis is identified by
various degrees of involvement of
pericoronal flap & adjacent structures,
as well as systemic complication.
An influx of inflammatory fluid &
cellular exudates results in increase in
the bulk of the flap which interferes
with complete closer of mouth.
8. The flap is traumatizes by contact with
the opposing jaw, and the inflammatory
involvement is aggravated.
The clinical picture is that of
markedly red,
swollen,
suppurating lesion that is tender,
with radiating pains to ear, throat, &
floor of mouth.
9. The patient is extremely
uncomfortable because of pain, a foul
taste, & an inability to close the jaw.
Swelling of the cheek in the region of
the angle of the jaw & lymphadenitis
are common findings.
The patient may also have toxic
systemic complication such as fever,
leukocytosis, & malaise.
10. COMPLICATION:
The involvement may become
localized in the form of periodontal
abscess.
It may spread posteriorly into the
oropharyngeal area & medially to the
base of the tongue, making it
difficult for the patient to swallow.
11. Depending on severity & extent of the
infection, there is involvement of the
submaxillary, posterior cervical, deep
cervical, & retropharyngeal lymph
nodes.
Peritonsillar abscess formation,
cellulitis, & Ludwigโs angina are
infrequent but nevertheless potential
sequelae of acute pericoronitis.
12. TREATMENT:
The treatment of pericoronitis depends
on the severity of the inflammation,
the advisability of retaining involved
tooth.
Persistent symptoms
free pericoronal flaps
should be removed as a
preventive measures
against subsequent
acute involvement.
13. The treatment of acute pericoronitis is
consist of
(i) Gently flushing the area with
warm water to remove debris &
exudate.
14. (ii) swabbing with antiseptic after
elevating the flap gently from
the tooth with a scalar.
15. Antibiotic can be prescribe in severe
cases.
After the acute symptoms have
subsided, a determination is made as
to whether the tooth is to be retained
or extracted.
This decision is governed by the
likelihood of further eruption into a
good functional position.
16. Following point may be considered to
decide whether the tooth is to be retained
or not.
(1)stage of eruption of tooth.
If a possibility that the tooth will
erupt further into a good functional
position, it is advisable to retain the tooth.
(2)impacted 3rd molar.
If the tooth is impacted, it is better
to extract the tooth as soon as the acute
symptoms have subsided.
17. (3)position of tooth.
Very often the tooth may be buccally
placed with no attached gingiva on the
buccal aspect. It may also be placed very
much distally making it difficult to
removed the gingival tissue adequately to
create an environment which could be
maintained plaque free.
18. Bone loss on the distal surface of the
second molar is a hazard after the
extraction of partially or completely
impacted third molar, & the problem
is significantly greater if the third
molars are extracted after the roots
are formed Or in patients older than
the early twenties.
To reduced the risk of bone loss
around second molar, should be
extracted as early as possible in their
development.
19. If it is decided to retain the tooth,
the pericoronal flap is removed using
periodontal knives.
20. It is necessary to removed the distal
to the tooth as well as the flap on the
occlusal surface.
21. Incising only the occlusal portion of
the flap leaves a deep distal pocket,
which invites recurrence of acute
pericoronal involvement.
After the tissue is removed, a
periodontal pack is applied.
22. The pack may be retained by bringing
it forward along the facial & lingual
surface into the interproximal space
between the second & third molar.
The pack is removed after one
week.
23. CONCLUSION
It is the most common type of
pericoronal infection found mostly in
mandibular third molar.
Clinical features include red, swollen
suppurating lesion along with the pain
which may radiate to the surrounding
tissues.
Proper & immediate management is
necessary to prevent its complication.
