PERICORONITIS PERIODONTIA PARTH.M.THAKKAR 10/28/2010A MOST COMMON PERIODONTAL INFECTION FOUND IN THIRD MOLAR AREA.
CONTENTS:INTRODUCTIONCLINICAL FEATURESCOMPLICATIONTREATMENTCONCLUSIONREFERENCESINTRODUCTION:The term pericoronitis refers to inflammation of the gingiva in relation to the crown of an incompletelyerupted tooth.It occurs most frequently in the mandibular third molar area.It may be: ACUTE SUBACUTE or CHRONICCLINICAL 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 accumulationof food debris & bacterial growth 2
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.Acute inflammatory involvement is a constant possibility.Acute pericoronitis is identified by various degrees of involvement of pericoronal flap & adjacentstructures, as well as systemic complication.An influx of inflammatory fluid & cellular exudates results in increase in the bulk of the flap whichinterferes with complete closer of mouth.The flap is traumatizes by contact with the opposing jaw, and the inflammatory involvement isaggravated.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 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.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 itdifficult for the patient to swallow. 3
Depending on severity & extent of the infection, there is involvement of the submaxillary, posteriorcervical, deep cervical, & retropharyngeal lymph nodes.Peritonsillar abscess formation, cellulitis, & Ludwig’s angina are infrequent but nevertheless potentialsequelae of acute pericoronitis.TREATMENT:The treatment of pericoronitis depends on the severity of the inflammation, the advisability of retaininginvolved tooth.Persistent symptoms free pericoronal flaps should be removed as a preventive measures againstsubsequent acute involvement.The treatment of acute pericoronitis is consist 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 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. 4
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. 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. 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. If it is decided to retain the tooth, the pericoronal flap is removed using periodontal knives.It is necessary to removed the distal to the tooth as well as the flap on the occlusal surface. 5
Incising only the occlusal portion of the flap leaves a deep distal pocket, which invites recurrence ofacute pericoronal involvement.After the tissue is removed, a periodontal pack is applied.The pack may be retained by bringing it forward along the facial & lingual surface into the interproximalspace between the second & third molar. The pack is removed after one week.CONCLUSIONIt 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 thesurrounding tissues.Proper & immediate management is necessary to prevent its complication.REFERENCES:CLINICAL PERIODONTOLOGY CARRANZA NEWMANCLINICAL PERIODONTOLOGY B.R.R.VARMA & R.P.NAYAKINTERNET 6