Pericoronitis is caused by two factors. The first is bacterial growth in the ideal incubator that lies below the soft tissue flap covering the crown of the partially or completely unerupted 3rd molar. Beneath the flap there is protection, moisture, warmth, food and darkness. In such an environment bacterial growth flourishes. Frequently the predominat organisms are the fusiform bacillus and spirillum.
The second factor in pericoronitis is traumatic irritation of the mucosa overlying the mandibular third molar by the cusps of the opposing maxillary third molar.
Often, the upper third molar has not only erupted into position, but, being unopposed by the unerupted or partially erupted lower third molar, it actually has erupted into supraocclusion in an attempt to come into articulation.
The patient complains of difficulty in eating and swallowing. Frequently the patient has chills, fevers, general malaise, constipation and a foul odor to the breath. The submaxilalary and cervical lymph nodes may be indurated and tender.
Treatment of Pericoronitis
1. If the case presents with chronic pericoronitis and the removal of the third molar is decided upon, the following procedure is carried:
2. Surgical removal of the overlying flap – It is extremely difficult to remove correctly the thick, dense fibrous tissues overlying the 3rd molars with the usual scalpel or scissors. An easier and better way to remove these flaps is by means of LASER TREATMENT. (1) It is not necessary to create pressure on the tissue to effect a separation of the tissue. (2) The incisions are much less bloody. (3) The possibility of dissemination of the infection is minimized.
3. Removal of the tooth – After treatment of the acute disease and the disappearance of the acute symptoms, with ensuing chronic pericoronitis in which the overlying flap is still inflamed and moderately sore, and from beneath which free pus can be expressed by pressure.
Pain may be slight and restricted to the immediate area of the impacted tooth, or it may be severe, even excruciating,
involving all the lower and upper teeth on the affected side, the ear, any part of the area supplied by the trigeminal nerve
or the entire area supplied by this nerve. This includes temporal pain. Pain may be intermittent, constant or periodic.