The tooth, during eruption, must penetrate the soft tissues of the gums to gain access to the oral cavity and contribute to a harmonious occlusion.
Most commonly in posterior teeth, molars, the gum tissue around the dental crown becomes inflamed and infected. These changes are called pericoronitis.
The wisdom molar is most commonly affected by pericoronitis. Being the last tooth to erupt, the space in the oral cavity may be reduced and gum caps may remain at any level of the crown. These are high level and exposed to irritants.
In response, inflammation and then supra-infection occurs due to the septic environment created by colonizing bacteria.
Causes
Wisdom molar eruption – a complete eruption unimpeded by adverse conditions in the oral cavity does not produce pericoronitis or any other pathology. However, incomplete eruption with remnants of the gingival cap allows bacterial penetration and the development of infectious pathology.
Plaque and tartar – these factors are not triggers of pericoronitis, but only facilitate its onset. Tartar deposits, by detaching the gum from the tooth, create spaces where bacteria can develop their invasion. Dental plaque itself is a growth medium for bacteria.
Irritating foods – hard foods, with their ability to damage and irritate the gingival mucosa, can facilitate bacterial dissemination but may themselves have bacterial potential after decomposition.
Signs and Symptoms. How do we recognize pericoronitis?
Gingival edema – the smooth, shiny, inflamed and reddish appearance of the gums;
Infection – cardinal signs such as fever, purulent collection and pain may occur in the development of pericoronitis;
Halitosis – is the unpleasant taste experienced by both the patient and the entourage;
Limitation of mouth opening – the wisdom molars being the most posterior teeth, near the maxillary ascending ramus where muscle groups involved in mandibular movements are located. Inflammation at this level interferes with the full capacity of the mouth opening and thus the inability to feed properly;
Pain – due to infection but also to edema compressing nerve structures. It can be localized to the tooth in question but can also radiate to nearby structures. It can have a pulsatile character when there is a significant purulent collection under the gum socket.
Treatment of pericoronitis
Being the consequence of the remnants of the gingival cap at the level of the wisdom molar, normally by ensuring a good hygiene of that area, we achieve healing.
If the infection is severe, your doctor will prescribe antibiotics. Pain killers will only be administered in case of persistent pain.
If the symptoms do not improve, a surgical removal of the gum may be necessary. Wisdom molars normally erupt around the age of 18-20 years. However, deviations are common, almost always resulting in delayed eruption.
Sometimes the wisdom molars remain embedded in the bone or submucosa and are not detectable in the oral cavity. The dentist will be able to determine the condition of the teeth and the treatment required by means of a clinical examination as part of a regular check-up.
In order to detect non-erupted molars, X-ray examination is absolutely necessary. With the data obtained from the examination, a more complete treatment plan can be established.
