4.19 Dental Pain – Pericoronitis

agk’s Library of Common Simple Emergencies

Presentation

The patient is aged 17-25 and seeks help because of painful swelling and infection around an erupting or impacted third molar (wisdom tooth). Occasionally, there can be trismus or pain on biting The site appears red and swollen with a flap that may reveal a partial tooth eruption and purulent drainage when pulled open. There is no pain with percussion of the tooth.

What to do:

• Irrigate with a weak (2%) hydrogen peroxide solution. Purulent material can be released by placing the catheter tip of the irrigating syringe under the tissue flap overlying the impacted molar.
• Prescribe oral analgesics for comfort as well as penicillin over the next 10 days (penicillin VK 500mg qid).
• Instruct the patient on the importance of cleansing away any food particles that collect beneath the gingival flap. This can be accomplished by simply using a soft toothbrush or by using water jet irrigation.
• A dental followup should be provided to observe the resolution of the acute infection and to evaluate the need for removal of the gingival flap or molar.

What not to do:

• Do not undertake any major blunt dissection while draining pus. This could spread a superficial infection into the deep spaces of the head and neck or follow a deep abscess posteriorly into the carotid sheath.

Discussion

Pericoronitis is a special type of acute periodontal abscess that occurs when ginngival tissue (operculum) overlies an erupting tooth (usually a third molar, also known as a wisdom tooth). Recurring acute symptoms are usually initiated by trauma from the opposing tooth or by impaction of food or debris under the flap of tissue that partially covers the erupting tooth.

When dental referral is not readily available, one procedure for releiving the pain is surgical removal of the operculum. inject local anesthetic directly into the overlying tissue and then cut it away using the outline of the tooth as a guide for the incision. Sutures are not required.

Illustration

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