Pericoronitis

What is it?

Wisdom teeth are the very last tooth to come through into the mouth. They usually erupt after 16 years of age.

If there is enough space in the mouth, the wisdom teeth will fully erupt over a few months. 

Often, there is not enough space for the wisdom teeth to come through. When this happens, the tooth is said to be "impacted". The tooth can either be impacted forwards (into the tooth in front) or backwards (into the jawbone). 

An impacted wisdom tooth can often cause "pericoronitis".  Pericoronitis means "inflammation around the crown of the tooth".

peri- = around, coron = crown, -itis = inflammation

This is essentially pain and swelling of the gum around a partially erupted or impacted wisdom tooth. "Partially erupted" means the tooth is half out of the gum and half in the gum. 

It can affect both upper and lower wisdom teeth, but more commonly affects the lower ones.

How is it treated?

Treatment depends on the severity of the symptoms as well the cause of the problem. Options include:

1. Cleaning/irrigation
   An ultrasonic scaler and jet of saline (salty water) or chlorhexidine mouthwash is used to dislodge the food/bacteria stuck under the gum and drain the pus. Sometimes this is done under local anaesthetic but it can be very difficult to numb an area which is infected and inflamed.
   
   Your dentist will recommend you carry out saltwater or chlorhexidine mouthwash (such as Corsodyl) twice a day for 5-7 days to keep the area clean. It is important to keep the gum around the wisdom tooth clean to reduce the risk of pericoronitis. If you are struggling with reaching the back of the mouth, you can use an "interspace brush". This is a narrow toothbrush which cleans the pocket between the tooth and the gum so you can remove any food or bacteria that has built up over the day.
   
   
2. Painkillers
   Ibuprofen, if you are allowed to take it, is one of the most effective painkillers for pericoronitis as it is an anti-inflammatory. It won't treat the underlying cause but it will help reduce the pain and swelling whilst the inflammation settles. If you need to take regular painkillers for more than a few days, you should see your dentist for more specific treatment.
   
   
3. Antibiotics
   Your dentist will only prescribe you antibiotics if there are signs the infection is spreading:
   - facial swelling
   - difficulty opening your mouth
   - raised temperature
   - enlarged glands (lymph nodes)
   
   The first choice of antibiotics for pericoronitis is metronidazole. If you can't take metronidazole, your dentist may prescribe you amoxicillin instead. Antibiotics take 24-48 hours to kick in.
   
   If you've needed two or more courses of antibiotics for pericoronitis from the same tooth, it may be worth considering other treatment options to prevent it from happening again once the infection has settled.
   
   
4. Removing the overlying gum
   The gum overlying a wisdom tooth is known as the "operculum" so removal of this part of the gum is known as an "operculectomy". This small part of the gum is cut away under local anaesthetic to stop food getting stuck underneath or to stop the opposing tooth biting down on it. This can be a good option for short-term relief but often this part of the gum will grow back.
   
   
5. Shaving down or extracting the opposing wisdom tooth
   If the problem is caused by your top wisdom tooth biting down on the gum over the bottom wisdom tooth, your dentist may suggest shaving the biting surface of the top wisdom tooth so it is no longer biting down on this bit of gum. Although this is a good short-term measure, over time the top wisdom tooth will start to grow down and bite on the gum again.
   
   Another option is removing the top wisdom tooth. This is sometimes a better option than removing the bottom wisdom tooth because, generally speaking, top wisdom teeth are easier to remove and.
   
   These options will only be effective if the pericoronitis is caused by trauma, not if it's due to food/bacteria getting trapped around the bottom wisdom tooth!
   
   
6. Wisdom tooth extraction 
   There are strict guidelines dentists must follow in the UK for extracting wisdom teeth with pericoronitis. You can find out more about having your wisdom tooth removed here.
    
7. Coronectomy
   A coronectomy is an alternative to a dental extraction if the roots of your lower wisdom tooth are close to a nerve which runs in the jaw. You can find out more about the procedure here. 
   
   

Pericoronitis is a very common problem in young adults and in the majority of cases, it can be managed by your dentist. In very severe cases where the infection is spreading quickly, you may need to be admitted to hospital for intravenous antibiotics and extraction of the tooth under general anaesthetic.