Wisdom teeth are the last set of molars to erupt in the back of the mouth. Most often, they appear between the ages of 17 and 25. It is possible, however, for their eruption to occur later in adulthood, or not at all. During prehistoric times, wisdom teeth were very important for the types of food consumed by early humans. They are less essential, however, for modern diets. “Wisdom” refers to something “ancient;” thus the name originates from the previous significance of these teeth.
Over time, the human jaw has evolved to become smaller in size. For many adults, there is insufficient space, and only enough room for 28 teeth. Because of this limited jaw space, problems can develop if and when wisdom teeth erupt. As a result, they are often impacted. In other cases, these teeth lie in an abnormal position under the gums, making it impossible for them to erupt (i.e. sideways).
When unable to pass through the gums properly, impacted wisdom teeth can cause significant pain. They also apply pressure to the adjacent second molars, causing shifts in the alignment of other teeth.
Partially erupted wisdom teeth are prone to infections of the surrounding gums and soft tissues which can produce even more pain. This condition known as pericoronitis. It is possible for such infections to spread to areas of the face, neck, and the sinuses.
In this article, we will address the following questions:
- What is pericoronitis?
- How is it treated?
- Are their ways to prevent it?
What Happens in Cases of Pericoronitis?
When any tooth erupts, the surrounding gum tissue becomes mildly inflamed due to the movement of the tooth below the gum line. This is normal. As the tooth breaks through, the inflammation gradually decreases as the tooth fully erupts. In cases of pericoronitis, the soft tissues surrounding the tooth become infected. The infection settles within the space that surrounds the erupting tooth, called the follicular sac. As the tooth pushes through the gums, this sac is exposed, creating a space for bacteria to thrive and food particles to accumulate. Once bacteria have infiltrated the entire follicular sac, they can spread to the underlying bone, nearby tissues, and other areas of the face.
A variety of normal bacterial flora live within the mouth. These “healthy bacteria” suppress the growth of harmful bacteria and fungi to maintain overall oral health. However, when teeth erupt, the surface of the the gums is disrupted, and harmful bacteria find spaces to proliferate, resulting in an infection.
Because they are located in difficult to reach areas of the mouth, erupting wisdom teeth become a hotbed for bacterial infections. Symptoms of pericoronitis include:
- Painful, swollen gums around the erupting wisdom tooth.
- Foul odors coming from the oral cavity.
- A bad taste in the mouth.
- Accumulation and drainage of pus around the affected area.
- Swollen lymph nodes.
- Facial swelling
- Facial numbness on the affected side
- Inability to eat and/or speak properly.
Transient vs. Persistent Pericoronitis
It is possible to experience transient pericoronitis. During such cases, the infection is only present as the wisdom tooth passes through the gum line. Once the tooth has fully emerged, this area of the mouth is much easier to clean, and the infection resolves.
However, if a wisdom tooth cannot progress to full eruption (as is usually the case) persistent pericoronitis may develop. The gums are continuously subject to this tooth’s pressure, and the exposed follicular sac allows the accumulation of food debris and bacteria around the tooth.
This scenario is quite common, and the partially erupted wisdom tooth is a challenge to clean. With numerous crevices and spaces between and around the tooth and gums, this area of the oral cavity is particularly at risk when dental hygiene is poor.
Complications Secondary to Pericoronitis
There are certain factors that contribute to the severity of pericoronitis. Some cases are a one time occurrence, but other individuals experience more than one episode.
Is it possible for pericoronitis to worsen and become life-threatening? In theory, yes. Any infection that occurs inside of the mouth can be difficult to treat due to the moist, warm environment facilitates bacterial growth. Because of potential spread to underlying bone or other areas of the faces, these infection can be difficult to manage.
When treatment is delayed or first-line antibiotics are ineffective, the infection can also spread to other areas of the body. A network of small blood vessels lie within the gums and soft tissues through which oral bacteria can travel into the bloodstream. As bacteria travels throughout the body, it can cause systemic symptoms such as a fever, body aches, and fatigue. One organ that is at high risk of complications from oral bacteria is the heart. Bacteria can cause endocarditis, inflammation of the inner lining of the heart, and can permanently damage heart valves. Insufficiently treated pericoronitis can also result in a life-threatening blood infection known as septicemia. In this situation, organs of the body gradually shut down due to toxins released by the bacteria.
Prompt treatment of pericoronitis can prevent such complications. It’s also important to closely monitor the progress of treatment to identify when other measures may be necessary. The advice of a health professional is imperative when healing is not going as expected.
Initial management of pericoronitis involves cleaning out the infected area, and draining any accumulated pus. Dentists then flush the area with a medicated solution, and remove accumulated debris or food that has become lodged in small crevices.
For mild symptoms, your dentist may recommend a cleaning regimen and antiseptic rinse that may be done at home. However, this should only be attempted if advised by a dentist. Most cases of pericoronitis require care at a dental office.
After cleaning the infected area, dentists prescribe antibiotics. Although there is concern about over prescribing and antibiotic resistance, this is still an important aspect of treatment. Your dentist may test of sample of any fluid that is drained to be sure you are taking the correct antibiotic. It is important to complete the full course of antibiotics to avoid a treatment failure. Partially treated infections can result in growth of drug-resistant bacteria. This means that, if and when the infection recurs, first-line antibiotics may be ineffective.
Pain control is also an important component of managing pericoronitis. There is pain from both the impacted tooth and the infection. Oral over-the-counter non-steroidal antiinflammatory medications are the recommended pain relievers in most cases (i.e. ibuprofen). More severe pain can be managed with local injections and topical pain medications.
In addition to oral medications, dentists will also recommend the use of an antiseptic oral rinse to reduce the levels of harmful bacteria within the oral cavity. The most commonly prescribed type is chlorhexidine. Hydrogen peroxide is an alternative option.
Extracting the Wisdom Tooth
Depending on the severity of the pericoronitis and type of wisdom tooth impaction, it may be necessary to remove the problematic tooth. If the infection has progressed to the point of facial swelling, nerve irritation, or infection of nearby lymph nodes, extraction will likely be recommended. There are also certain medical conditions in which recurrent pericoronitis can lead to other complications, so wisdom tooth extraction is the best option. This includes individuals who are immunocompromised or have heart valve problems.
Before the wisdom tooth can be removed, however, it’s imperative to wait for the infection to clear. Operating during the height of an infection can spread the bacteria into the bloodstream, and may result in sepsis. If the prescribed antibiotic is taken properly, the acute infection should resolve within a week.
Following the extraction, an additional course of antibiotics may be prescribed. This is a preventive measure, killing off any residual bacteria that may still be present. Surgical sites are particularly prone to post-operative infections.
Diligent oral hygiene will also be necessary. Until the area has fully healed, a soft diet will be recommended. A full recovery can be expected within one to two weeks after the surgery.
Can Pericoronitis Occur Around Any Tooth?
In theory, pericoronitis can affect any tooth, but 95 percent of cases are associated with wisdom teeth. During infancy and childhood, every emerging tooth has a ‘partially emerged phase” as it erupts. As teeth break through their follicular sac, they leave a space for bacteria to enter and thrive.
The primary reason that wisdom teeth are at risk of pericoronitis is because of their specific locations, and time of eruption. As these teeth erupt, space is limited. It is also more difficult to brush teeth in the back of the mouth, so food particles can easily become trapped, allowing bacteria to grow. Pericoronitis is more common in individuals who have a relatively smaller jaw space.
Pericoronitis may seem like a simple dental infection, but it can lead to serious and life-threatening complications. Seeking prompt medical attention at the first sign of a problem can help reduce poor outcomes.
For those whose wisdom teeth are only just erupting, keep an eye on them! Or better yet, visit your dentist as soon as possible to assess your future risk of pericoronitis. In the meantime, practice good dental hygiene.