Pericoronitis: symptoms, treatment of unbearable pain

Medically reviewed: 26, November 2023

Read Time:15 Minute

Definition and causes of the Pericoronitis

Pericoronitis is an inflammation of the gums during teething associated with the development of an infection. It is accompanied by soft tissue edema and bleeding. Very often with pericoronitis pain is unbearable. What is the right treatment for this?

Most often occurs at the age of 20-29 during the eruption of wisdom teeth, the so-called eights. Sometimes it occurs when the adjacent chewing tooth is erupting – the seven. In children, when changing milk teeth to permanent ones, it rarely develops.

The appearance of pericoronitis is associated with improper teething. There are several theories for the development of this disorder. According to one of them, improper teething is laid during intrauterine development, when the dentition is formed. If a child inherits a small jaw from one parent and large teeth from the other, the rudiments are not positioned correctly. When teething, such teeth may not have enough space and they will shift towards the adjacent teeth.

According to another theory, improper teething is caused by a change in the dentition in the process of evolution. Over time, the width of the dental arch decreased by 10 mm, but the number of teeth did not change. Since the wisdom tooth is the last to erupt, it often lacks space.

Difficulties in erupting wisdom teeth negatively affect the condition of the surrounding soft tissues. The gum adjacent to the tooth is injured when chewing food, becomes inflamed and scarred. This makes it difficult and even stops eruption.

Other reasons that affect the eruption of wisdom teeth include:

  • “dense” bone tissue in the area of ​​eruption of teeth;
  • thick biotype of the gum above the erupting tooth;
  • a denser cortical plate with anomalies in the development of the jaw.

If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!

Does Salt Water Cure Pericoronitis?

Salt is considered one of the most effective treatments for periodontal disease. It stimulates the regeneration of periodontal tissues and relieves inflammation. Salt is effective because it has the ability to draw out moisture. Once in the mouth, salt “takes” liquid from the inflamed area, thus bacteria and microorganisms are deprived of their natural habitat. It is better to use sea salt for treatment, as it is rich in iodine.

What doctor can do if I have pericoronitis?

The diagnosis of pericoronitis of the wisdom tooth can only be made by the attending dentist based on the patient’s complaints and examination of his oral cavity. Sometimes the specialist directs the patient for x-rays to determine the position of the growing tooth, the degree of curvature of the row, and to assess the involvement of bone structures in inflammation.

Why is Pericoronitis worse at night?

At night, you lie with your head resting on a pillow, which causes blood flow to your head and increases the discomfort.

Can Pericoronitis make you feel sick?

Unpleasant painful sensations can be accompanied by nausea, weakness, and even headache. Nausea may be the result of intoxication with severe purulent inflammation of the gums.

How do I know if my tooth infection has spread to my jaw?

Firstly, this is a strong and unbearable pain not only in the tooth itself, but passing to the bone. Symptoms of an abscess, a purulent inflammation of muscle tissue, are high fever, swelling and redness around the inflamed area, symptoms of intoxication – nausea, weakness, pallor of the skin and cold sweat. An abscess is dangerous for blood poisoning, so if you have such symptoms, see a doctor immediately!

Pericoronitis symptoms: how do you know if you have pericoronitis?

The signs of pericoronitis depend on the stage of the disease. In 43% of cases, its development is preceded by an upper respiratory tract infection: rhinitis, pharyngitis, sinusitis, tonsillitis, otitis media, epiglottitis, etc. Another predisposing factor is stress.

Initially, patients complain of dull aching pains in the area of ​​the causative tooth. Subsequently, the pain becomes stronger, makes it difficult to chew food on the problem side, and intensifies when opening the mouth.

Over time, the inflammatory process in the area of ​​the erupting tooth grows:

  • the pain becomes acute, sometimes radiating to nearby areas;
  • redness and swelling of the gums appears;
  • asymmetry of the face occurs due to changes in the contours of the causal area.

The general condition during this period remains satisfactory. Sometimes the body temperature rises to 37-37.5 ° C, a headache develops.

Signs of acute pericoronitis

If the patient does not consult a doctor in a timely manner, then pericoronitis becomes chronic. The symptoms of the disease are dulled due to the outflow of the inflammatory exudate, but in reality, the inflammation process spreads to the soft tissues surrounding the causative tooth.

In chronic pericoronitis, there is a mild reddening of the gums. Serous or, as a rule, purulent exudate is formed, which is accompanied by bad breath. In the submandibular region, from the affected side, you can feel the inflamed regional lymph nodes. These symptoms are accompanied by pain when opening the mouth.

How to define Pericoronitis?

Wisdom teeth usually erupt at the age of 17-25. The process of their appearance can take several weeks or even months. In this case, the tooth does not always erupt completely: part of the crown remains under a thick layer of mucous membrane – a hood.

There is a space between the erupting tooth and the overhanging hood – the periodontal pocket. This warm environment contains food debris, various liquids and anaerobic bacteria such as streptococci, actinomycetes and propionobacteria. Removing them during daily hygienic processing is quite difficult, and sometimes even impossible. Over time, they lead to inflammation and swelling of the overhanging gums, as well as to the development of other diseases, due to which the wisdom tooth often erupts with caries, pulpitis or periodontal cysts.

In advanced cases, due to caries that has arisen, the root of the adjacent tooth can collapse. And with the complete destruction of the bony interalveolar septum between the wisdom tooth and the second molar, after the removal of the wisdom tooth, part of the root of the seventh tooth is exposed – gum recession occurs.

In addition to the effect of pathogenic microflora, the gum area in the eruption area is constantly injured by the opposite tooth (antagonist) while chewing food. As a result, chronic erosion occurs, and local immunity decreases. In the case of repeated exacerbation of the process, zones of cicatricial changes are formed in the gum region of the impacted tooth.

This process is a cyclical condition: inflammation gives rise to edema, edema gives rise to trauma, trauma gives rise to erosion and inflammation, which is accompanied by severe pain.

In the future, due to the spread of infection, the inflammation proceeds according to the type of marginal chronic periodontitis: the gum becomes inflamed not only in the crown region, but throughout the root of the causative tooth. In this area, there is bone atrophy, edema or chronic hypertrophy of nearby soft tissues, and lymph nodes may enlarge.

So we can answer this: pericoronitis is not always an emergency, but it can become an emergency.

Is Pericoronitis an emergency?

In clinical practice, several classifications of pericoronitis are distinguished: along the course and by the type of inflammation of the surrounding soft tissues.

Along the course, pericoronitis is divided into acute and chronic.

The acute form is characterized by a sharp onset, the rapid development of inflammation and vivid symptoms, in particular, acute pain at the eruption site. The patient becomes painful and / or difficult to open his mouth. In case of untimely treatment, this form can turn into chronic pericoronitis.

The chronic form is less acute. Pain sensations are not expressed. There is slight redness and swelling of the soft tissues. The general condition is satisfactory. The lymph nodes are enlarged, but not significantly. Bad breath is possible.

Acute and chronic pericoronitis

Some authors distinguish a third type of course – subacute pericoronitis. It is distinguished from the acute form by less vivid signs of the disease and the absence of problems with opening the mouth.

By the type of inflammation, pericoronitis is catarrhal, ulcerative and purulent.

Catarrhal form is the initial stage of the disease, which can develop into ulcerative or purulent pericoronitis. It is accompanied by painful sensations that intensify while eating. The overhanging edge of the gum is inflamed and painful on palpation. Regional lymph nodes on the side of the lesion become inflamed, enlarged, and become painful on palpation. There is no purulent discharge from under the hood. Opening the mouth is not difficult. With timely treatment, it quickly passes along with concomitant symptoms.

Ulcerative form of pericoronitis

It develops with the destruction of soft tissues against the background of inflammation. Differs in the formation of ulcers on the mucous membrane around the causative tooth. When trying to remove the formed plaque, pain occurs.

Purulent pericoronitis

The purulent form is one of the most severe forms of pericoronitis. The patient looks exhausted, his general condition worsens sharply. There is a persistent increase in temperature up to 38.0 ° C, sharp pain when swallowing and opening the mouth, irradiation to the ear or temple.

Pus is secreted from the causal area into the oral cavity, and upon palpation, the amount of discharge and painful sensations increase. Regional lymph nodes are enlarged and mobile. Not only the hood and gums swell and redden, but also the palatine-lingual arch, the mucous membrane of the cheeks and the soft palate.

Molar pericoronitis

A separate form of the disease is posterior molar pericoronitis. In this form, inflammation is localized below the level of the crown. The process begins superficially, penetrating deeper to the involvement of the periosteum. If the patient does not seek help in a timely manner, a complication in the form of a retromolar abscess may occur.

Does Pericoronitis go away on its own?

Pericoronitis can be dangerous in acute form and, if not treated, cause severe complications. It’s better not to wait, trying to treat it yourself at home, but to contact your doctor as soon as possible.

Teething accompanied by pericoronitis can lead to serious complications:

  • ulcerative gingivitis – the formation of ulcers along the edge of the gingival fold, followed by necrosis of the damaged areas;
  • peri-maxillary phlegmon;
  • periostitis;
  • osteomyelitis;
  • retromolar abscess.

What happens if Pericoronitis is left untreated?

If pericoronitis is left untreated, complications can be very serious. Here are the most common.

Posterior molar abscess

The last four complications are the most formidable. They affect neighboring structures, involving the periosteum and the bone itself in the process of inflammation, passing to the submandibular space.

These complications are accompanied by serious changes in the general condition of the body: the body temperature rises to 37.1-38 ° C, weakness, chills, and headache occur. The mucous membrane turns red, becomes painful, edematous.

Edema of the jaw area appears, which is accompanied by facial asymmetry. Opening the mouth is difficult or impossible. In severe cases, complications can threaten the patient’s life.

Aggravating factors that contribute to the development of complications are: weakened immunity, the patient’s age, concomitant diseases and chronic foci of inflammation in the oral cavity.

Even with self-relieving inflammation with the help of antibiotics, the problem is not solved: the antimicrobial effect will pass over time, but the cause of the inflammation will remain. Therefore, it is impossible to delay a visit to the dentist when signs of acute or chronic pericoronitis appear. Depending on the form of the disease, the doctor will select an effective method of treatment.

How do you know if you have Pericoronitis?

A comprehensive approach is required to make a correct diagnosis. It includes taking anamnesis (medical history), clinical examination with examination of regional lymph nodes and soft tissues, as well as visualization of the state of the oral cavity.

In the process of collecting an anamnesis, the doctor asks the patient questions that allow to find out significant details of the disease. What is important for the doctor to know:

  • how long ago there were unpleasant sensations in the area of ​​tooth eruption;
  • whether there is fever, weakness, pain when opening the mouth;
  • what accompanies the improvement in well-being, and what worsens;
  • what medications were taken, how they affected the course of the disease;
  • whether there have been similar problems with teething before;
  • whether there are concomitant chronic diseases.

After taking the history, the doctor examines the oral cavity for inflammation. Then he conducts palpation of soft tissues to identify exudate that stands out from under the hood, or to make sure it is absent.

Inflammation in the posterior molar area is usually accompanied by inflammation of the lymph nodes. Therefore, after examining the oral cavity, the doctor probes the angle of the lower jaw and the neck area, and also assesses the degree of opening of the mouth, whether there is pain.

Sighting x-rays, computed tomography, or orthopantomography may be required to visualize a misplaced tooth.

X-ray and orthopantomography

During the examination, it is very important to identify the clinical form of pericoronitis, the severity of the course and the prevalence of inflammation. The effectiveness of the chosen treatment method depends on these factors. The form can be determined by the presence / absence of purulent exudate or ulcers, the severity of symptoms and the time of their appearance.

Pericoronitis treatment

Treatment of pericoronitis should be started immediately, except in the following cases:

  • intolerance to drugs and materials used in the treatment process;
  • other acute inflammation in the oral cavity;
  • exacerbation of a chronic disease.

The most effective treatment tactic is a combination of therapeutic and surgical techniques. The first stage is aimed at stopping inflammation. To do this, the doctor rinses the periodontal pocket with an antiseptic solution through a syringe or applies a special bandage to the problem area. Prescribes antibiotics and anti-inflammatory drugs if necessary.

As soon as the inflammation subsides, the doctor resorts to the removal of the overhanging muco-periosteal edge or the causative tooth.

The treatment plan depends on the decision of the question: to keep the erupting tooth or not. To answer it, the doctor needs to examine the X-ray of the problem area and assess the patient’s objective condition at the time of the visit.

If the eruption of a tooth is hampered by its incorrect position, the inflammation periodically worsens and is difficult to treat – it is better to remove such a tooth after removing the acute symptoms of pericoronitis. Refusal to remove in these cases can lead to the development of caries and the formation of an abscess in the area of ​​the adjacent molar, because of which it will be necessary to remove not one, but two teeth at once.

Tooth extraction takes place under local anesthesia. First, the soft tissues are peeled off. Then, using forceps or elevators, the tooth is removed. Quite often it has to be sawed: the decision is made by the surgeon during the planning or the removal procedure itself.

For two hours after the operation, it is recommended to refrain from eating, alcoholic beverages and smoking, not to apply warming compresses. If the extraction of a tooth was difficult due to problems with opening the mouth, the patient may need a sick leave until the inflammation completely subsides. Physical activity during this period is contraindicated.

Extraction of a wisdom tooth

Excision of the resulting hood – pericoronarotomy – allows you to improve the hygiene of the problem area and prevent further spread of inflammation, and in the case of purulent pericoronitis, it improves the outflow of purulent exudate. The operation is performed by a dentist-surgeon using a scalpel or scissors. It is performed under local anesthesia.

Excision of the hood

Rehabilitation after tooth extraction or overhanging gums lasts from three days to two weeks, depending on the complexity of the operation. The day after removal, the doctor prescribes rinsing with antiseptic solutions, such as chlorhexidine. If necessary, pain relievers, medication support in the form of antibiotic therapy and repeated examination are indicated. If over time there is swelling, pain or other discomfort, you should definitely see a doctor.

How to prevent Pericoronitis?

To prevent inflammation from becoming pathological and chronic, when the first signs of acute pericoronitis appear, such as pain in the eruption of a tooth, inflammation of the gums and swollen lymph nodes, it is important to urgently visit a dentist. With timely treatment and therapy, the prognosis is favorable.

If during the treatment it was decided to save the tooth, the patient is recommended to visit the dentist every six months for a preventive examination and professional oral hygiene.

To avoid the development of infection, it is advisable to use a mouthwash after brushing your teeth.

It is possible to exclude the risk of developing pericoronitis during preventive examinations using orthopantomography. Well-formed rudiments of future teeth appear, as a rule, after 16 years. Based on the results of the examination, it is possible to determine how the primordium is located, and to draw a conclusion about the likelihood of problems with the eruption of a particular tooth.

Is it necessary to remove an incorrectly erupting wisdom tooth without signs of pericoronitis, caries and other complications? There is no consensus on this matter. As a rule, doctors do not recommend removing such a tooth: a regular examination and good oral hygiene are enough. However, with age, tooth extraction becomes more difficult due to concomitant diseases, finally formed roots of wisdom teeth and changes in bone tissue.

Home remedies for Pericoronitis

If the disease has just begun, the symptoms are not yet so pronounced, you can try to cope with the disease on your own. It is necessary to often and thoroughly rinse your mouth with chamomile broth, salt and soda solution, furacilin. Cold compresses can be applied to the inflamed gums.

You need to be very careful and attentive, because you can miss the moment, then you cannot do without surgery. If symptoms worsen after a few days, you should see a doctor. Only timely therapy will avoid complications.

Medicines for pericoronitis are antimicrobial, anti-inflammatory drugs of a wide spectrum of action, for example, Amoxicillin, Amoxiclav, Azithromycin. Surgical intervention for pericoronitis of a wisdom tooth, as a rule, consists in excision (removal) of the gum hood over the wisdom tooth.