Circuit 3, station 2

Pericoronitis refers to erupting or incomplete eruption with inflammation of the soft tissues around the crown.

The incidence is just under 5%, and lower third molar are affected in 95% of cases, due to their localisation. The age range most affected is 20-29 year olds due to this being the average age of third molar eruption.

Pathology
The transient presence of the operculum is a natural part of the tooth eruption process, and pericoronitis occurs when the eruption does not go perfectly. The operculum will regress naturally in most cases. However when the operculum does not regress naturally, inflammation and infection can occur.
Classification
Transient
• During tooth eruption
Non-transient
• After completion/termination of tooth eruption
Can be acute or chronic, with symptoms varying from mild to severe.

Risk factors
Local
1. Low oral hygiene
2. Plaque retention
3. Localised trauma
4. Entrapment of debris i.e. food
Systemic
• Upper respiratory tract infection(s)
• Psychological stresses
• Impaired wound healing i.e. diabetes mellitus
• Premenstrual phase of hormonal cycle in women
• Smoking

Clinical signs
Inflammation (erythema, swelling, hot to touch/heat, pain, and loss of function)
Pain – can be pulsating and radiates outwards / can disturb sleep / problems with chewing

Diagnosis
Visualisation of soft tissue inflammation around partially erupted tooth
Visualisation on OPG

Differential diagnosis
Dental caries
Pulpitis
Pulp gangrene
Periapical abscess
Food packing
Gingivitis
Mucosal disorders
Periodontal abscess
Alveolar osteitis (dry socket),
Peritonsillar abscess
Pterygomandibular space abscess
Temporomandibular disorders,
Myofascial pain

Investigations
Clinical examination
OPG (aka plain panorama X-ray)

Management
1st episode:
• Good oral hygiene
• Analgesia
• Local interventions (irrigation / plaque removal / drainage of pus
• Oral antibiotics

If more than one episode, as in this case, consider tooth extraction after the above.