Pericoronitis

For most people, teething goes without complications. But sometimes a tooth cannot fully erupt. It is hindered by thick mucosa or incorrect positioning. This is most often observed when erupting third molars. The mucosa covers the crown, food clogs under it, bacterial growth begins, which leads to inflammation – pericoronitis of the wisdom tooth. Lower “eights” are the most prone to such inflammation. There is not enough space on the lower jaw, the teeth begin to grow incorrectly, traumatizing the surrounding tissues. Theoretically, the disease can affect other teeth. but such pathology is rare.

Causes

The inflammatory process is provoked by bacteria. When the tooth has not fully erupted, its part is still covered by a layer of mucosa – the hood. Under it, a moist, dark environment is formed, where food residues constantly get in. All this contributes to the rapid growth of bacterial flora and the accumulation of plaque. In turn, this leads to an inflammatory process.

What contributes to the development of inflammation

• Anatomically narrow jaw
• Improper bite
• Thick gum walls
• Early loss of baby teeth
• Irregularly positioned permanent teeth (retained teeth).

Symptoms

Symptoms depend on the stage of the disease. Acute pericoronitis begins with a catarrhal (superficial) form. It is characterized by:

• Redness and swelling of the hood
• Dull pain when chewing in the place where the tooth erupts
• Pain at mechanical irritation (touch)
• Discharge of clear fluid (exudate)
• Increased lymph nodes

At this stage, many ignore the signs of the disease, limiting themselves to rinses or applications. But the hood remains, which means that the bacteria continue to multiply.

The disease passes into the next stage – purulent:

• Body temperature rises
• Pain increases, goes to the ear, temple.
• A putrid odor appears from the mouth.
• It becomes difficult to open the mouth.
• Swelling and redness may spread to the cheek, throat.
• Pus leaks out from under the hood when pressure is applied.

Sometimes, the ulcers form a ring around the entire gum margin. When the ulcers are cleared of dead tissue, they begin to bleed profusely. This manifestation of the disease is called ulcerative pericoronitis.

In cases where the inflammation is ignored for a long time, it turns into chronic pericoronitis. Symptoms are no longer so pronounced, but ulcers, scars are formed on the hood. On X-rays, changes in the bone tissue become visible: its atrophy (resorption) begins. At this stage, there is a high risk of phlegmon (inflammation of fatty tissue) or the development of osteomyelitis (inflammation of bone tissue). The process can lead to muscle spasm, sometimes so severe that it is impossible to open the mouth. In advanced stages, treatment in the clinic is not possible and the patient needs hospitalization.

Diagnosis

To make a differentiated diagnosis, conduct:

• Collection of anamnesis

The dentist needs to obtain information about the course of the disease, the patient’s complaints, intolerance to medicines, concomitant diseases.

• Clinical examination

Allows you to objectively assess the condition of tissues, the presence of hooding, the degree of severity of symptoms.

• Additional examination

To develop a successful treatment plan, the dentist needs information that can only be obtained by radiation examination. This can be radiography, orthopantomography (panoramic image), computer tomography. In some cases, laboratory tests are necessary.

General methods of treatment

When treating pericoronitis, the dentist needs to solve several problems at once:

• Eliminate the pain syndrome
• Stop the pathologic process
• Preserve all functions of the dento-mandibular system
• Prevent the development of inflammation in the tissues near the tooth

Methods of intervention depend on the stage of the disease. Treatment is complex. Surgical treatment of the focus of infection is combined with antibacterial and antihistamine therapy.

Surgical intervention

If there is enough space for the tooth in the jaw, and it is located correctly, then pericoronarectomy is performed – an operation to excise the hood. The mucous membrane around the tooth is removed from the chewing and lateral surfaces. The intervention is performed under local anesthesia. To excise the mucosa use a scalpel, laser beam, electron knife, cryodestruction (liquid nitrogen).

Stages of surgery

1. Local anesthesia.
2. Excision of the overhanging gingiva.
3. Antiseptic treatment of the wound.
4. Application of iodoform dressing
5. Recommendations to the patient

If it is not possible to expose the lateral surfaces, the hood is incised. Such an operation is called pericoronarotomy. Its main purpose is to ensure the outflow of purulent contents, so that it does not begin to collect at the posterior surface, provoking a posterior molar type of inflammation.

Therapeutic stage

At home, the patient is recommended to make baths (not gargle) with an antiseptic solution, usually chlorhexidine. With pain – take pharmacy analgesics: ibuprofen, paracetomol. Prescribe also anti-inflammatory drugs and antihistamines. Often – antibiotics. Iodoform dressing should be removed independently, the day after surgery.The rehabilitation period takes 5-6 days, in some cases – up to 10. To accelerate healing, physiotherapeutic procedures are prescribed: electrophoresis, UHF, microwave therapy, laser exposure.

Pain after wisdom tooth hood extraction

Pain is a natural reaction of the body to surgical intervention. If you adhere to the recommendations, then after 1-2 days all painful sensations disappear.
In rare cases, infection of the wound occurs due to the fault of the dentist or the patient. If painful sensations do not subside within 3 days, there is weakness, apathy, body temperature rises – it is necessary to immediately consult a doctor. The dentist will disinfect the wound and prescribe medications.

What should not be done after surgery

• Warm the gum
• Visit a bath
• Drink alcoholic beverages
• Smoke
• Mouthwash (baths only)

What is recommended to do after surgery

• Follow all doctor’s orders
• Apply ice
• Baths and applications
• Carefully avoid the surgical site when brushing teeth
• Chew on the opposite side
• Eat soft foods

When tooth extraction is indicated

In some cases, it makes no sense to save the wisdom tooth. Then the patient is recommended to have it removed. This happens if the doctor observes:

• Atypical position of the unit, which traumatizes the mucosa
• Severe forms of caries that have destroyed the crown
• The development of caries of a neighboring tooth as a result of pressure on it third molar
• Tooth mobility as a result of periodontitis
• Impossibility of filling the canals due to their obstruction
• Presence of a cyst
• Root fracture
• Preparation for orthodontic treatment
• Lack of space for a retained tooth

In general, dentists consider wisdom teeth to be atavistic. It is quite possible to do without them. However, it should be considered that any extraction changes the facial oval. In addition, third molars can be useful as supporting teeth in prosthetics. Therefore, the decision to extract a tooth is made only by a dentist who weighs the pros and cons and sees the entire clinical picture.

Complications of pericoronitis

Removal of the hood does not guarantee the absence of recurrences. The surface of the tooth may again become overgrown with tissue and the operation will have to be repeated. This is the most minor complication of the disease.

When the outflow of pus is insufficient, exudate accumulates behind the molar fossa, in the periosteum. An abscess forms. The patient develops posterior molar pericoronitis. Symptoms are similar to acute purulent, but are more pronounced. Pain is borne with difficulty, the temperature rises sharply, which is difficult to bring down. The general condition also worsens. The presence of an infiltrate is determined by the dentist by palpation. Radiation diagnostics is used to confirm the diagnosis. Treatment is surgical with subsequent therapy, typical for pericoronitis.

Phlegmon – inflammation of the fatty fiber that fills the space of the skull. The main feature of phlegmon is that it can spread throughout the cellular spaces, affecting the neck, nasopharynx.

Phlegmons are dangerous because they carry pus to the organs, can cause sepsis (general blood poisoning). But also in the oral cavity phlegmon causes many problems, affecting breathing, chewing and speech.

Osteomyelitis is a pathologic process that involves the entire bone tissue, including the bone marrow. It leads to bone sclerosis, deformities, bone exposure. General condition: weakness, fever, increased lymph nodes. Treatment is multistage, prognosis depends on age, severity of course, general condition of the body.

Prevention