The preventive measure of pericoronitis associated with wisdom teeth is by removing the wisdom/ third molars before they erupt into the mouth, through preemptive operculectomy.
This treatment option is however controversial, with many questions being posed about the necessity and timing of the removal of asymptomatic, disease-free wisdom teeth.
Proponents of early extraction cite the cumulative risk for extraction over time, the high probability that wisdom teeth will eventually decay or develop gum disease and costs of monitoring to retain wisdom teeth.
Advocates for retaining wisdom teeth cite the risk and costs of unnecessary operations and the ability to monitor the disease through clinical exam and radiographs.
Management of pericoronitis range from simple non- invasive treatment options to complex surgical disimpactions.
Since pericoronitis is a result of inflammation of the pericoronal tissues of a partially erupted tooth, management can include applying pain management gels for the mouth consisting of Lidocaine, a numbing agent.
Preventing the source of inflammation through improved oral hygiene and mouthwash use.
Removal of the plaque stagnation areas through tooth extraction or gingival resection.
Acute pericoronitis is a dental emergency which requires immediate treatment.
Surgical treatment has been shown to resolve the spread of the infection and pain, with a quicker return of function. Also, immediate surgical treatment avoids overuse of antibiotics (preventing antibiotic resistance).
However, surgery is sometimes delayed in an area of acute infection, with the help of pain relief and antibiotics, for the following reasons:
- Reduces the risk of causing an infected surgical site with delayed healing (e.g. cellulitis).
- Reduced efficiency of local anesthetics caused by the acidic environment of infected tissues.
- Resolves the limited mouth opening, making oral surgery easier.
- Patients may better cope with the dental treatment when free from pain.
- Allows for adequate planning with correctly allocated procedure time.
When Surgical treatment options are delayed, it is important that the following is done:
- Firstly, the area underneath the operculum is gently irrigated to remove debris and inflammatory exudate.
- Often warm saline is used but other solutions may contain hydrogen peroxide, chlorhexidine or other antiseptics.
- Irrigation may be assisted in conjunction with Debridement (removal of plaque, calculus and food debris) with periodontal instruments.
- Irrigation may be enough to relieve any associated pericoronal abscess; otherwise a small incision can be made to allow drainage.
- Smoothing an opposing tooth which bites into the affected operculum can eliminate this source of trauma.
Home care may involve regular use of hot salt water mouthwashes/mouth baths.
Antibiotic use in case there are systemic signs and symptoms, such as facial or neck swelling, cervical lymphadenitis, fever or malaise. Common antibiotics used are from the penicillin group,clindamycin and sometimes metronidazole.
If there is dysphagia or dyspnoea (difficulty swallowing or breathing), then this usually means there is a severe infection and an emergency admission to hospital is appropriate so that intravenous medications and fluids can be administered and the threat to the airway monitored.
Sometimes semi-emergency surgery may be arranged to drain a swelling that is threatening the airway.
Definitive treatment involves either sustained oral hygiene improvements or removal of the offending tooth or operculum.
In some cases, removal of the tooth may not be necessary. Meticulous oral hygiene may prevent buildup of plaque in the area.
Long term maintenance is needed to keep the operculum clean in order to prevent further acute episodes of inflammation.
A variety of specialized oral hygiene methods are available to deal with hard to reach areas of the mouth, including small headed tooth brushes, interdental brushes, electronic irrigators and dental floss.
This is a minor surgical procedure where the affected soft tissue covering and surrounding the tooth is removed.
This leaves an area that is easy to keep clean, preventing plaque buildup and subsequent inflammation.
Sometimes operculectomy is not an effective treatment.
Typically operculectomy is done with a surgical scalpel, electrocautery, with lasers or, historically, with caustic agents (trichloracetic acid)
Removal of the associated tooth will eliminate the plaque stagnation area, and thus eliminate any further episodes of pericoronitis.
Removal is indicated when the involved tooth will not erupt any further due to impaction or ankylosis;
if extensive work would be required to restore structural damage; or to allow improved oral hygiene.
Sometimes the opposing tooth is also extracted if no longer required.
Extraction of teeth which are involved in pericoronitis carries a higher risk of dry socket, a painful complication which results in delayed healing.