Pericoronitis is defined as the inflammation of the soft tissues of varying severity around an

erupting or partially erupted tooth with breach of the follicle (OR) Pericoronitis is a red
swelling of the tissues that surround the crown of a tooth that has only partially erupted
Synonyms :

1. Operculitis.

2. Folliculitis.

Pericoronitis was first reported by Gunnel in 1844 as painful affection. Previously in early
20 century it was known as Folliculitis, later KAY changed it as Pericoronitis. It can occur in
relation to any tooth but mandibular third molar is often most commonly involved. Pericoronitis
is the third common odontogenic infection and is also, one of the common cause for removal of
Impacted third molar. Generally ever teeth while erupting under normal conditions develop local
inflammation and tissue degeneration and this condition is termed as Supracoronitis.

Predisposing Factors :

Emotional Stress

Fatigue

Upper respiratory tract infection

Second trimester of pregnancy

Menstruation

Pathogenesis : Food debris and bacteria may become entrapped between the retromolar pad and
the tooth, resulting in acute infection and extreme pain. It usually occurs within 17 to 24 years of
age.
Chronic pericoronitis may be the etiology for the development of paradental cyst, an
inflammatory odentogenic cyst. The swelling ranges from soft to firm and progress to a knob
like mass of tissue that is very painful when you chew, open or close the mouth. It is a result of
bacterial infection caused either by Staphylococcal or Streptococcal bacteria or both.
Clinical Features :
Acute Pain :

Aggrevarted by traumatic occlusion at the retromolar region.

Discomfort Severe Throbbing pain which is radiating to the adjacent regions.

There may be reduced mouth opening(Trismus) due to stimulation of pain receptors

Extra oral swelling Dyspahgia Pyrexia associated with tachycardia

Leucocytosis

Malaise

Increase in pulse

Increase in respiratory rate

 Enlargement of regional lymph nodes which will be tender.

Halitosis.

Intra oral swelling and redness with Purulent discharge

Subacute Phase :

During this phase

Systemic features becomes less acute

Continuous dull pain

Persistant intra oral swelling

Jaw stiffness

Regional lymphadenopathy

Pus discharge from the pericoronal space.

Ulceration of the operculum becomes more pronounced

Pterygomandibular and submasssetric abscess

Chronic Phase :

In this phase there is

complete abscence of systemic features except during acute exacerbation.

Dull pain and discomfort with unpleasent taste in the oral cavity

Halitosis
Histologic Features :

Epithelium of the pericoronal flap showws hyperplasia, intercellular edema, leukocytic

infiltration

Increased vascularity

Diffused infiltration with plasma cells and lymphocytes

Polymorpho nuclear leukocytes.

Differential diagnosis :

Pulpitis

Periodontitis

Trismus

Temporo mandibular joint dysfunction

Tonsilitis

Pre-existing cysts of odentogenic origin.



Management :

Pericoronitis can spread rapidly and develops into cellulitis, so it is important to treat it as
soon as possible. General Management :

Soft, nourishing high protein diet should be prescribed.

Appropriate antibiotic therapy should be given. Pencillins are the drug of choice,
Metronidazole can also be used as resonable alternative.

Suitable analgesics should be prescribed.

Local Treatment :

If there is any abscess then drainage of abscess should be done

Entrapped food debris should be removed.

If the tooth is malpositioned it should be extracted.

 If tooth is partially erupted then the pericoronal flap is incised(surgical removal of the
pericoronal flap is recommended only when the symptoms like pain and infection
subside).

Antibiotics and analgesics should be prescribed which helps to relive the symptoms and
also to prevent the further spread of infection to the adjacent tissue spaces.

Patient is adviced not to apply heat externally since it promots the spread of infction on to
the facial skin.

Frequent warm saline gargling is soothing to the patient.

Folliculitis, impacted teeth problem, impacted third molar, Operculitis, pain near the third molar,
swelling around the third molar.
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