Pericoronitis or Operculitis

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Pericoronitis also known as operculitis, is inflammation of the soft tissues surrounding the crown of a partially erupted tooth; the gum. The soft tissue covering a partially erupted tooth is known as an operculum which in most cases presents an area which can be difficult to access with normal oral hygiene methods.

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Pericoronitis is caused by an accumulation of bacteria and debris beneath the operculum, or by mechanical trauma (e.g. biting the operculum with the opposing tooth).Pericoronitis is often associated with partially erupted and impacted mandibular third molars (lower wisdom teeth), often occurring at the age of wisdom tooth eruption (15-24).

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Pericoronitis can be chronic or acute.

Chronic pericoronitis presents with no or only mild symptoms and long remissions. Chronic pericoronitis can escalate into acute pericoronitis.

 Acute pericoronitis is associated with a wide range of symptoms

 Severe pain,

Swelling of the gum and sometimes the face

 Fever.

Pus – Sometimes there is an associated pericoronal abscess (an accumulation of pus).

This infection can spread to other parts of the face or neck, and occasionally can lead to airway compromise (e.g. Ludwig’s angina) requiring emergency hospital treatment.

General Signs and symptoms :

Pain

Pain, which gets worse as the condition develops and becomes severe.

The pain may be throbbing and radiate to the ear, throat, temporomandibular joint, posterior submandibular region and floor of the mouth.

There may also be pain when biting.

Sometimes the pain disturbs sleep.

Swelling of the tissues around the involved tooth, which is usually partially erupted into the mouth. The operculum is characteristically very painful when pressure is applied.

Halitosis (bad breath) resulting from the bacteria putrefaction of proteins in this environment releasing malodorous volatile sulfur compounds.

Bad taste in the mouth from exudation of pus.

Signs of trauma on the operculum, such as indentations of the cusps of the upper teeth,or ulceration.

Trismus (difficulty opening the mouth) resulting from inflammation/infection of the muscles of mastication.

Dysphagia (difficulty swallowing).

Cervical lymphadenitis (inflammation and swelling of the lymph nodes in the neck), especially of the submandibular nodes.

Facial swelling, and rubor, often of the cheek that overlies the angle of the jaw.

Pyrexia (fever).

Malaise (general feeling of being unwell).

Loss of appetite.

The radiographic appearance of the local bone can become more radiopaque in chronic pericoronitis.

Partially erupted wisdom tooth in a patient’s lower jaw. Wisdom teeth are the third and last set of molars to emerge in the mouth. In many cases wisdom teeth are unable to emerge fully from the gum due to lack of available space. This may cause severe pain and usually results in their removal.
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