Wisdom tooth infection......pericornitis

A common painful dental problem seen by emergency dentists is what is known as pericoronitis. Pericoronitis is inflammation of the gum tissues surrounding the crown of a partially erupted tooth, including the gingiva and the dental follicle. The gum tissue covering over the partially erupted tooth is what we call an operculum, and this area is particularly susceptible to infection because the operculum creates significant difficulty in accessing the area using home oral hygiene methods. 

Pericoronitis almost always occurs in the gum tissue surrounding a wisdom tooth that has not fully grown into the mouth. This is because a half-erupted wisdom tooth creates a situation in which there is a piece of gum tissue only partially covering the chewing surface of a tooth. This gum flap allows food and other debris to accumulate under the gum tissue creating a perfect loci for bacteria to thrive and multiply resulting in an infection in that area.

Initially patients with pericornitis will usually experience symptoms such as pain and red-ish swollen gum tissue in the gum flap and the gum tissue around the infected tooth. Patients often struggle to chew and bite their teeth together because when they do that swollen area gets irritated and can be extremely painful. Patients experiencing pericornitis may also experience a foul odor and/or unpleasant taste in the mouth, and sometimes exudate (pus) coming from the area. 

When pericoronitis advances and the infection becomes more severe, patients can experience swelling in that portion of the face, inability to open their mouth all of the way and more severe pain. These advanced signs indicate a proliferation and spreading of the underlying infection into the throat and neck potentially causing difficultly breathing, a potentially life-threatening situation. It is because of these risks, that a patient seek treatment immediately if they notice signs of a serious infection such as pericornitis.

How is Pericornitis treated?  First a dentist must complete an examination and evaluate the situation in the mouth, then often take an X-ray of the affected area. If pericornitis is diagnosed then the typical treatment is to irrigate the area in order to flush away the storage of food particles and other potential problematic materials from the area. Following the antimicrobial debridement, most patients will be prescribed a course of oral antibiotics, as well as an antimicrobial mouth rinse to further fight and resolve the infection. For pain, in the majority of cases over-the-counter pain medications such as ibuprofen and acetaminophen are usually sufficient until the infection subsides.

Regularly the next step is to extract the affected wisdom tooth, unless the wisdom tooth is still in the process of eruption and it appears it will eventually come into the mouth normally. However, when symptoms are severe, it can be necessary to surgically remove the flap of gum tissue called the operculum. In other circumstances, it is recommended to remove the opposing tooth (the tooth above or below it) because otherwise the normal process of biting and chewing will continue to irritate the condition.

Pericornitis is a common but potentially serious oral infection. Most patients can be treated effectively with oral and/or localized antibiotics, or typically definitively with extraction of the tooth in the infected area. Nevertheless any infection in the mouth is a serious situation which should be dealt with seriously through a dentist.

Any dental infection is potentially a serious conditition if not addressed appropriately. Dr. Rob Davis at South Kansas City Emergency Dental is available on weekends to address painful issues in patients in Cass County and the surrounding areas. Please call us at 816-601-1817 if you are experiencing a dental emergency.