Antibiotic prescribing
Pericoronitis

Pericoronitis, also called operculitis, is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, usually a lower 3rd molar. The inflammation affects the gingiva and the dental follicle as well as the operculum (gum flap) overlying the tooth (arrowed). The area under an operculum can be difficult for the patient to clean.

Pericoronitis is caused by an accumulation of bacteria and debris beneath the operculum, or by mechanical trauma (e.g. biting the operculum with the opposing tooth).

Pericoronitis can be chronic or acute. Chronic pericoronitis can present with no or only mild symptoms and long remissions between any escalations to acute pericoronitis.

Acute pericoronitis is associated with a wide range of symptoms including severe pain, swelling and fever. Sometimes there is an associated pericoronal abscess. This infection can spread to the cheeks, orbits/periorbits, and other parts of the face or neck, and occasionally can lead to airway compromise (e.g. Ludwig's angina) requiring emergency hospital treatment.

The treatment of pericoronitis is through pain management and by resolving the inflammation.

How do you resolve the inflammation?

Operculum removal with a laser.

An operculum can also be removed with electrosurgery, or a scalpel blade mounted in a blake knife holder (below).

Would you extract the upper 3rd molar to relieve pain on the lower?

Retaining the tooth requires improved oral hygiene in the area to prevent further acute pericoronitis episodes. Tooth removal is often indicated in cases of recurrent pericoronitis, extensive decay, or tooth impaction.

How many times might a patient have pericoronitis before you decide the tooth has to be extracted?

When would you give antibiotics?

Recommended doses for pericoronitis:

You should not use powerful “last resort” drugs like Co-Amoxiclav or Clindamycin. They don’t work any better, and can lead to resistance.