CONTENTS: INTRODUCTION CLINICAL FEATURES COMPLICATION TREATMENT CONCLUSION REFERENCES
INTRODUCTION:The term pericoronitis refers toinflammation of the gingiva in relationto the crown of an incompletely eruptedtooth.
It occurs most frequently in themandibular third molar area. It may be ACUTE SUBACUTE or CHRONIC
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.
Even in patients with no clinical signsor symptoms, the gingival flap is oftenchronically inflamed & infected, withvarious degrees of ulceration along itsinner surface.
Acute inflammatory involvement is aconstant possibility.Acute pericoronitis is identified byvarious degrees of involvement ofpericoronal flap & adjacent structures,as well as systemic complication.An influx of inflammatory fluid &cellular exudates results in increase inthe bulk of the flap which interfereswith complete closer of mouth.
The flap is traumatizes by contact withthe opposing jaw, and the inflammatoryinvolvement 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.
The patient is extremelyuncomfortable because of pain, a foultaste, & an inability to close the jaw.Swelling of the cheek in the region ofthe angle of the jaw & lymphadenitisare common findings.The patient may also have toxicsystemic complication such as fever,leukocytosis, & malaise.
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.
Depending on severity & extent of theinfection, there is involvement of thesubmaxillary, posterior cervical, deepcervical, & retropharyngeal lymphnodes.Peritonsillar abscess formation,cellulitis, & Ludwig’s angina areinfrequent but nevertheless potentialsequelae of acute pericoronitis.
TREATMENT:The treatment of pericoronitis dependson the severity of the inflammation,the advisability of retaining involvedtooth. Persistent symptoms free pericoronal flaps should be removed as a preventive measures against subsequent acute involvement.
The treatment of acute pericoronitis isconsist of(i) Gently flushing the area with warm water to remove debris & exudate.
(ii) swabbing with antiseptic after elevating the flap gently from the tooth with a scalar.
Antibiotic can be prescribe in severecases.After the acute symptoms havesubsided, a determination is made asto whether the tooth is to be retainedor extracted.This decision is governed by thelikelihood of further eruption into agood functional position.
Following point may be considered todecide whether the tooth is to be retainedor not.(1)stage of eruption of tooth. If a possibility that the tooth willerupt further into a good functionalposition, it is advisable to retain the tooth.(2)impacted 3rd molar. If the tooth is impacted, it is betterto extract the tooth as soon as the acutesymptoms have subsided.
(3)position of tooth. Very often the tooth may be buccallyplaced with no attached gingiva on thebuccal aspect. It may also be placed verymuch distally making it difficult toremoved the gingival tissue adequately tocreate an environment which could bemaintained plaque free.
Bone loss on the distal surface of thesecond molar is a hazard after theextraction of partially or completelyimpacted third molar, & the problemis significantly greater if the thirdmolars are extracted after the rootsare formed Or in patients older thanthe early twenties.To reduced the risk of bone lossaround second molar, should beextracted as early as possible in theirdevelopment.
If it is decided to retain the tooth,the pericoronal flap is removed usingperiodontal knives.
It is necessary to removed the distalto the tooth as well as the flap on theocclusal surface.
Incising only the occlusal portion ofthe flap leaves a deep distal pocket,which invites recurrence of acutepericoronal involvement.After the tissue is removed, aperiodontal pack is applied.
The pack may be retained by bringingit forward along the facial & lingualsurface into the interproximal spacebetween the second & third molar. The pack is removed after oneweek.
CONCLUSIONIt is the most common type ofpericoronal infection found mostly inmandibular third molar.Clinical features include red, swollensuppurating lesion along with the painwhich may radiate to the surroundingtissues.Proper & immediate management isnecessary to prevent its complication.