Dental Care

Wisdom Teeth Problems - Pericoronitis

Wisdom teeth problems exist in different form, but one of the most common, painful and potentially dangerous conditions is pericoronitis. 

This painful condition is a bacterial infection located in the soft tissues of the gum surrounding the emerged portions (the crown) of a partially-erupted wisdom tooth. 

In other words, in pericoronitis the gum tissue around the visible portion of a partially impacted wisdom tooth becomes swollen and infected. 

Typically, pericoronitis develops during or after the wisdom tooth eruption process, so it is frequently seen in people in their late teens or early twenties, the age range when wisdom teeth usually emerge through the gums.

Causes of Wisdom Teeth Problems

When a wisdom tooth only partially erupts through the gum, an opening is created for bacteria to enter the surrounding tissues.  If the environment is hospitable to bacterial growth, an infection (pericoronitis) is the likely result. 

Food particles and/or plaque, a bacterial film that remains on the teeth after eating, can easily get caught and accumulate beneath a flap of gum (operculum) around the partially-erupted tooth. 

This accumulation of food and/or plaque, if not thoroughly removed through regular, effective daily oral hygiene, is what ultimately leads to pericoronitis. 

Of course, the location of the wisdom teeth in the rear of the mouth makes brushing and flossing awkward at best, so pericoronitis is not an unusual occurrence. 

It is made even more likely when a partial wisdom tooth impaction is coupled with malocclusion (misalignment) of the adjacent second molar or the opposing wisdom tooth.  Once again, the malocclusion makes achieving proper oral hygiene highly problematic.

As long as the wisdom tooth remains partially erupted and virtually impossible to brush and floss properly (which could be indefinitely for an impacted wisdom tooth if it is not extracted), repeated episodes of pericoronitis are possible. 

If a pericoronitis infection becomes severe, the infection and associated swelling can extend beyond the jaw into the cheek and neck.

Symptoms of Wisdom Teeth Problems

The symptoms of pericoronitis include tenderness, swelling and redness of the gum surrounding the wisdom tooth's eruption site, a foul odor or taste in the mouth, difficulty in opening the mouth, and pain which can extend through the jaw, face and potentially into the neck. 

The lymph nodes in the neck can become swollen.  It is possible for untreated pericoronitis to progress into a much more severe and extensive infection. 

In some cases, the pain associated with pericoronitis is quite severe.

Diagnosis of Wisdom Teeth Problems

You dentist will examine your wisdom teeth, evaluate how well they are coming in, and determine whether any are partially erupted or impacted. 

Your wisdom teeth might be X-rayed periodically to evaluate their alignment. 

In addition, your dentist will examine you for swelling, infection and other symptoms of pericoronitis, as well as look for the presence of an operculum around a wisdom tooth.

Treatment of Pericoronitis

Pericoronitis should be evaluated and treated by your dentist.  In relatively mild cases your dentist will prescribe antibiotics to combat the infection. 

He or she will also show you how to irrigate (flush out) the space between the wisdom tooth and the surrounding gum with warm salt water.  This irrigation procedure can help keep the bacterial population in the region minimized.

If your tooth, jaw, cheek or even neck are swollen and painful, make sure you visit your dentist immediately, because these symptoms indicate a more severe case of pericoronitis. 

Once again, your dentist will likely prescribe antibiotics, but he or she may also recommend a prescription pain medication.  If not, you can take an over-the-counter pain reliever such as ibuprofen, aspirin or acetaminophen.

As time progresses, the partially-erupted wisdom tooth may erupt from the gum more completely.  In this situation, the potential for future pericoronitis infections will diminish. 

In other cases, however, the wisdom tooth may not ever emerge fully or be positioned properly.  Your dentist will probably recommend extraction if this happens, because the tooth and the surrounding area will always remain at risk for developing recurring wisdom teeth problems.

Oral surgery to either remove the operculum or, preferably, the affected wisdom tooth itself, is the most effective treatment when pericoronitis is severe and/or recurring. 

Wisdom tooth extraction is preferable to removal of the operculum due to the significant risk of nerve damage during an operculectomy.  This nerve damage can result in permanent or temporary numbness of the tongue. 

As a result, wisdom tooth extraction has become the standard treatment.  And, after all, if the affected tooth is removed it can no longer be affected by pericoronitis.


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