Pericoronitis: how to recognise an infection of the wisdom tooth

Pericoronitis is the inflammation and/or infection of the tissue covering a tooth that has not fully erupted, most commonly a wisdom tooth. This dental condition causes pain, swelling of the cheek and, sometimes, serious complications if left untreated.

For this reason, pericoronitis requires a specialist consultation with a dentist for a correct diagnosis and appropriate treatment.

Pericoronitis is a condition that occurs when the gum tissue surrounding a partially erupted wisdom tooth becomes inflamed due to a build-up of bacteria and food debris.

As the area is difficult to clean properly, it can create an environment conducive to the development of infection. Although it can affect any tooth that has not fully erupted, pericoronitis is most commonly found in the lower wisdom teeth, particularly in young adults.

“When pericoronitis occurs, the cheek is often swollen, the patient experiences discomfort when opening and closing their mouth, or pain that radiates towards the ear, neck or shoulder,” explains Dr Mihnea Grigore, a cosmetic dentist at the DENT ESTET clinics. 

There are three types of pericoronitis, which correspond to the stages of this infection:

• Congestive (early-stage) pericoronitis
• Acute pericoronitis
• Chronic pericoronitis

The table below sets out the main differences between the three forms of pericoronitis, based on symptoms and progression. 

The main causes are:

• partial eruption of a tooth or wisdom tooth;
• poor oral hygiene;
• food retention;
• trauma to the gums, most commonly caused by an incorrect bite in relation to the opposing tooth;
• the build-up of bacterial plaque and tartar. 

Pericoronitis frequently presents with:

• pain in the wisdom tooth area;
• swollen, red gums around the tooth;
• pain when chewing;
• tenderness to the touch;
• an unpleasant odour caused by accumulated debris;
• pus discharge in more advanced cases;
• fever;
• difficulty opening the mouth;
• pain radiating to the ear, throat or shoulder.

Serious symptoms of pericoronitis requiring treatment by a dentist:

• a high fever, above 38°C;
• rapid swelling of the cheek or throat;
• difficulty breathing or swallowing;
• pain when opening the mouth;
• the presence of pus in the affected area.

“Our advice is that anyone experiencing any of these symptoms should seek dental treatment on the same day the symptoms appear, or as soon as possible. The dentist will assess the hygiene of the affected area and, if necessary, administer local treatment by cleaning the affected site, or prescribe medication if there is a risk of the infection spreading.” – Dr Mihnea Grigore 

The first step is to visit the dentist’s surgery, where the dentist will make the correct diagnosis.  

During the consultation, the dentist will carry out a thorough and proper cleaning of the area, using local rinses with antiseptic solutions, such as chlorhexidine, to remove food debris and reduce the bacterial load.  

Professional treatment  

Depending on the severity of the infection, the dentist may recommend anti-inflammatory treatment and, where necessary, a course of antibiotics to control the infection. If pericoronitis is accompanied by an abscess, drainage of the pus-filled collection may also be required.

Once the acute episode has subsided, the dentist will assess the position of the wisdom tooth and the risk of the infection recurring. Extraction of the wisdom tooth is necessary when episodes of pericoronitis become frequent, or if the wisdom tooth is impacted or partially impacted and poses a risk of complications or damage to neighbouring teeth. 

Home treatment

Following treatment at the dentist’s surgery, it is essential to follow the dentist’s advice to ensure full recovery and prevent recurrence.  

The patient is advised to continue rinsing with antiseptic solutions, as instructed, and to maintain rigorous oral hygiene, paying particular attention to the affected area.

If necessary, the dentist may prescribe anti-inflammatory or pain-relieving medication to manage pain and inflammation, depending on the patient’s general state of health and any possible contraindications.  

Adherence to follow-up appointments and the recommended treatment plan helps to reduce the risk of pericoronitis recurring.

Although many cases of pericoronitis are confined to the tissues surrounding the wisdom tooth, if left untreated or inadequately treated, the condition may lead to local complications and, more rarely, to severe complications.

Possible complications of pericoronitis:

• pericoronal abscess;  
• spread of inflammation to neighbouring tissues;  
• trismus (difficulty opening the mouth);
• difficulty chewing and eating;  
• breathing difficulties (in severe cases). 

Pericoronitis can be easily prevented by:

• maintaining good oral hygiene;
• brushing your teeth correctly twice a day, in the morning and in the evening;
• monitoring wisdom teeth during regular check-ups;
• extracting wisdom teeth if necessary.