Pericoronitis

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Pericoronitis (from the Greek fairy , "around", Latin corona "crown" and -itis , "inflammation ") also known as operculitis , is an inflammation of the soft tissues around the crown of some erupted teeth, including the gingiva (gum) and tooth follicles. The soft tissue that partially covers the erupted tooth is known as operculum , an area that is difficult to access with the normal method of oral hygiene. Synonym operculitis technically refers to inflammation of the operculum alone.

Pericoronitis is caused by bacterial accumulation and debris under the operculum, or by mechanical trauma (eg biting operculum with opposing tooth). Pericoronitis is often associated with eruption of the lower third molars of the lower mandible and impaction (low wisdom teeth), often occurring at the age of wisdom tooth eruption (15-24). Other common causes of pain from the third molar region are food impaction that causes periodontal pain, pulpitis of dental caries (tooth decay), and acute myofascial pain in temporomandibular joint disorders.

Pericoronitis is classified as chronic and acute . Chronic pericoronitis can be present with no or only mild symptoms and long remissions between any escalation to acute pericoronitis. Acute pericoronitis is associated with a variety of symptoms including severe pain, swelling and fever. Sometimes there is a corresponding pericoronal abscess (accumulation of pus). These infections may spread to the cheeks, orbites/periorbits, and other parts of the face or neck, and can sometimes cause airway compromises (eg Ludwig's angina) requiring emergency hospital treatment. The treatment of pericoronitis is through pain management and by completing inflammation. Inflammation can be overcome by removing dirt or infection from the pericoronal tissue or by lifting a tooth or an associated operculum. Maintaining teeth requires improvement of oral hygiene in the area to prevent further acute episodes of acute pericoronitis. Tooth extraction is often indicated in cases of recurrent pericoronitis, extensive decay, or dental impaction.

Video Pericoronitis

Classification

The definition of pericoronitis is inflammation of the soft tissues around the dental crown. It covers a wide spectrum of severity, does not distinguish inflammatory levels into adjacent tissues or whether there is an associated active infection ( pericoronal infection caused by microorganisms that sometimes cause pus to fill pericoronal abscess or cellulitis).

Usually the case involves acute pericoronitis of the lower third molar. During "teething" in young children, pericoronitis can occur immediately before the eruption of primary teeth (baby teeth or milk).

International Classification of Disease entry for chronic acute and chronic list of pericoronitis.

Acute

Acute pericoronitis (ie sudden onset and brief, but significant, symptoms) is defined as "varying degrees of inflammatory involvement of the pericoronal flap and adjacent structures, as well as by systemic complications." Systemic complications refer to signs and symptoms that occur outside the mouth, such as fever, malaise or swollen lymph nodes in the neck.

Chronic

Pericoronitis can also be chronic or recurrent, with recurrent episodes of acute pericoronitis occurring periodically. Chronic pericoronitis can cause few symptoms, but some signs are usually seen when the mouth is examined.

Maps Pericoronitis

Signs and symptoms

The signs and symptoms of pericoronitis depend on their severity, and vary:

• Pain, which worsens as the condition progresses and becomes severe. The pain may be pulsating and radiating to the ears, throat, temporomandibular joints, posterior submandibular areas and the floor of the mouth. There may also be pain when it bites. Sometimes pain interferes with sleep.
• Tenderness, erythema (redness) and edema (swelling) of tissue around the tooth involved, which is usually partly erupted into the mouth. This operculum is very painful when pressure is applied.
• Halitosis resulting from bacterial spoilage in proteins in this environment releases sour volatile sulfur compounds.
• Pain in the mouth due to pus exudation.
• Intra-mouth halitosis.
• Formation of pus, which may appear to radiate from below the operculum (ie, pericoronal abscess), especially when pressure is applied to the operculum.
• Signs of trauma to the operculum, such as a curve at the top of the upper teeth, or ulceration. Rarely, soft tissue around the dental crown involved can show a similar appearance to necrotizing ulcerative gingivitis.
• Trismus (difficulty opening your mouth). due to inflammation/infection of the mastication muscle.
• Dysphagia (difficulty swallowing).
• Cervical lymphadenitis (inflammation and swelling of lymph nodes in the neck), especially submandibular nodes.
• Swelling of the face, and rubor, often on the cheek that covers the angle of the jaw.
• Pyrexia (fever).
• Leukocytosis (increase in the number of white blood cells).
• Malaise (general feeling is not healthy).
• Loss of appetite.
• Local bone radiographic features may become more radiopaque in chronic pericoronitis.

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Cause

Pericoronitis occurs because the operculum (soft tissue that directly covers part of the erupted tooth) creates a "plaque stagnation area", which can accumulate food waste and micro-organisms (especially plaque). This causes an inflammatory response in adjacent soft tissues.

Sometimes pericoronal infections may spread to adjacent potential spaces (including sublingual spaces, submandibular spaces, parapharyngeal spaces, pterygomandibular spaces, infratemporal spaces, submasseteric spaces and buccal spaces) to the neck or face area resulting in facial swelling, or even airway compromise (called Ludwig's angina).

Bacteria

Inadequate cleaning of the operculum space allows bacterial stagnation and accumulation of debris. This could be the result of poor access due to the limited space in the 3rd molar case. Pericoronal infections are usually caused by a mixture of bacterial species present in the mouth, such as Streptococci and various anaerobic species. This can lead to the formation of an abscess. If left untreated, the abscess may spontaneously flow into the mouth from below the operculum. In chronic pericoronitis, drainage may occur through the sinus tract approximately. The chronic inflamed soft tissues around the teeth may provide little if any symptoms. This can suddenly become a symptom if new debris is trapped or if the host's immune system becomes disrupted and fails to keep chronic infection in check (eg during influenza or upper respiratory tract infection, or stress period).

Tooth position

• When opposing teeth bite into the operculum, it can initiate or aggravate pericoronitis resulting in a spiral cycle of inflammation and trauma.
• Over-erupting of opposing teeth into the empty space left by a stopping teeth eruption is a risk factor for operculum trauma from biting.
• Teeth that fail to erupt completely (generally mandibular lower third molars) are often the result of limited space for eruption, or the non-ideal gear angle that causes the impact teeth.
• The presence of supernumerary teeth (extra teeth) makes pericoronitis more likely.

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Diagnosis

The presence of dental plaque or infection under inflamed operculum without other obvious causes of pain will often lead to pericoronitis diagnosis; Therefore, elimination of pain and other inflammation is very important. For pericoronal infections, the affected tooth should be exposed to the oral cavity, which can be difficult to detect if exposure is hidden under thick tissue or behind adjacent teeth. Severe and limited swelling of the mouth may limit the examination of the area. Radiography can be used to rule out other causes of pain and correctly assess the prognosis for further eruption of affected teeth.

Sometimes the "migratory abscess" of buccal sulcus occurs with pericoronal infections, where the pus from the lower third molar region traces forward in the submucosal plane, between the mandibular body and the buccinator muscle attachment to the mandible. In this scenario, pus may spontaneously exit through the intra-oral sinus located above the second or the lower second molar, or even the second premolar.

Causes of similar pain, some that may occur together with pericoronitis may include:

• Dental caries (cavities) of wisdom teeth and distal surfaces of second molar teeth are common. Tooth decay can cause pulpitis (toothache) to occur in the same region, and this can cause pulp necrosis and periapical tooth-related abscess formation.
• Food can also be trapped between the wisdom teeth and the front teeth, called food packaging, and cause acute inflammation in the periodontal pockets when bacteria are trapped. Periodontal abscess can even be formed by this mechanism.
• Pain associated with temporomandibular joint disorders and myofascial pain is also common in the same region as pericoronitis. They easily miss the diagnosis in the presence of mild and chronic pericoronitis, and the latter may not contribute greatly to individual pain (see table).

Very rarely does pericoronitis occur in association with both mandibular third molars at the same time, despite the fact that many young people will have both lower wisdom teeth partially erupted. Therefore, bilateral pain from the lower third molar region is unlikely to be caused by pericoronitis and more likely to be muscular.

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Prevention

Prevention of pericoronitis can be achieved by eliminating the impact of third molar teeth before eruption into the mouth, or through preemptive surgchectomy. A medication controversy exists about the need and timing of asymptomatic removal, the wisdom teeth affected by illness that prevent pericoronitis. The initial extraction advocates cite cumulative risks for extraction over time, the high probability that wisdom teeth will eventually decay or develop gum disease and monitoring costs for dental wisdom is maintained. Advocates for maintaining wisdom teeth mention unnecessary risks and operating costs and the ability to monitor the disease through clinical and radiographic examination.

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Management

Because pericoronitis is the result of pericoronal tissue inflammation of partially erupted teeth, management may include the application of oral pain management gel consisting of Lignocaine, a numbing agent. Definitive treatment can only be done by preventing sources of inflammation. This either through improvement of oral hygiene or by removing plaque stagnation areas through tooth extraction or gingival resection. Often the acute symptoms of pericoronitis are treated before the underlying cause is overcome.

Acute pericoronitis

If possible, immediate definitive treatment of acute pericoronitis is recommended because surgical treatment has been shown to overcome the spread of infection and pain, with faster return of function. Immediate treatment also avoids the use of excessive antibiotics (preventing antibiotic resistance).

However, surgery is sometimes delayed in areas of acute infection, with the help of pain relievers and antibiotics, for the following reasons:

• Reduce the risk of causing infected surgical sites with delayed healing (eg osteomyelitis or cellulitis).
• Avoid decreasing local anesthetic efficiency caused by the acidic environment of the infected tissue.
• Overcoming a limited mouth opening, making mouth surgery easier. â € <â € <
• Patients may be better off handling dental care when free of pain.
• Allow for adequate planning with properly allocated time of procedure.

First, the area under the operculum is carefully irrigated to remove debris and inflammatory exudate. Often warm salt is used but other solutions may contain hydrogen peroxide, chlorhexidine or other antiseptics. Irrigation can be assisted simultaneously with debridement (removal of plaque, calculus and food waste) with periodontal instruments. Irrigation may be sufficient to remove associated pericoronal abscesses; otherwise, a small incision may be made to allow drainage. Smoothing the opposing teeth that bite the affected operculum can eliminate the source of this trauma.

Treatment at home may involve the routine use of saline water mouth/mouth bath. A randomized clinical trial found rinse green tea mouth effective in controlling pain and trismus in acute cases of pericoronitis.

After treatment, if there are systemic signs and symptoms, such as swollen face or neck, cervical lymphadenitis, fever or malaise, oral antibiotics are often prescribed. Common antibiotics used are from the antibiotic group? Lactam, clindamycin and metronidazole.

If there is dysphagia or dyspnoea (difficulty in swallowing or breathing), then this usually means severe infection and emergency admission to the appropriate hospital so that intravenous and fluid medications can be given and threats to the airway are monitored. Sometimes semi-emergency surgery can be set to drain swelling that threatens the airway.

Definitive treatment

If the tooth will not continue to erupt completely, definitive treatment involves improvement of oral hygiene or removal of the offending teeth or operculum. The last surgical treatment option is usually chosen in the case of affected teeth without the potential for further eruption, or in the case of recurrent episodes of acute pericoronitis despite oral hygiene instructions.

Oral hygiene

In some cases, removal of teeth may not be necessary with careful oral hygiene to prevent plaque buildup in the area. Long-term maintenance is required to keep the operculum cleaner to prevent further acute inflammatory episodes. A variety of special oral hygiene methods are available to deal with inaccessible mouth areas, including small head toothbrushes, interdental brushes, electronic irrigators and dental floss.

Operculectomy

This is a small surgical procedure in which the soft tissues that cover and surround the teeth are removed. It leaves an area that is easy to clean, preventing plaque buildup and subsequent inflammation. Sometimes an operculectomy is not an effective treatment. Normally an operectectomy is performed by surgical scalpel, electrocautery, by laser or, historically, with a caustic agent (trichloroacetic acid)

Tooth extraction

Removal of related teeth will remove the plaque stagnation area, and thereby eliminate further episodes of pericoronitis. Removal is indicated when the teeth involved will not erupt further due to impaction or ankylosis; if extensive work will be needed to restore structural damage; or to enable improved oral hygiene. Sometimes opposing teeth are also extracted when they are no longer needed.

Tooth extraction involved in pericoronitis carries a higher risk of dry sockets, a painful complication that results in delayed healing.

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Prognosis

Once the stagnation area of ​​the plaque is removed either through complete tooth eruption or tooth extraction then pericoronitis is likely to never return. Unaffected teeth can continue to erupt, reaching a position that removes the operculum. Temporary and mild pericoronal inflammation often continues as this eruption of teeth is completed. With enough room for improved oral hygiene methods, pericoronitis will never return. However, when relying on oral hygiene alone for impaction teeth and partial eruptions, chronic pericoronitis with acute exacerbations is occasionally expected.

Dental infections such as pericoronal abscess can progress to septicemia and are life-threatening in people who have neutropenia. Even in people with normal immune function, pericoronitis can cause the spread of infection into the potential chambers of the head and neck. Rarely, the spread of infection from pericoronitis may suppress the airway and require hospitalization (eg Ludwig's angina), although most cases of pericoronitis are localized to the teeth. Other potential complications of pericoronal abscess spread include the formation of peritonsillar abscesses or cellulitis.

Chronic pericoronitis may be the etiology for the development of paradental cysts, inflammatory odontogenic cysts.

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Epidemiology

Pericoronitis usually occurs in young adults, around the time when the flower teeth erupt into the mouth. If the individual has reached his twenties without a pericoronitis attack, it becomes very unlikely to happen afterwards.

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References

Source of the article : Wikipedia