• For use on the Heatherwood Hospital and Wexham Park Hospital sites

• Based on BAOMS Guidelines from 2005 (guidelines no longer available on BAOMS website), checked August 2015

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition.

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Pericoronitis is inflammation of the soft tissues associated with the crown of a partially erupted tooth and is seen most commonly in relation to the mandibular third molar. The common symptoms and signs are pain, bad taste, inflammation of, and pus expressible from beneath, the pericoronal tissues and aggravation by trauma from an opposing tooth.

It is one of the agreed criteria by the NICE (National Institute for Health and Clinical Excellence) for removal of third molars and is the commonest cited reason for removal of wisdom teeth in the UK though its presence does not necessarily mean that the associated tooth requires removal.

Unless the cause is removed pericoronitis may present as a recurrent condition requiring multiple episodes of treatment. In severe episodes an acute pericoronal abscess may develop which may remain localised or spread to involve one or more of the adjacent deep surgical spaces and may be associated with systemic as well as local signs and symptoms.

Pericoronitis is a condition that presents to both Primary and Secondary care sectors and these guidelines are intended to assist in the management of the condition and the prevention of recurrent episodes.

1. Risk Factors

• Presence of unerupted/partially erupted tooth/teeth in communication with the oral cavity. Vertical and distoangular mandibular third molars most commonly affected.

• Pathological periodontal pocketing adjacent to unerupted/partially erupted teeth.

• Opposing tooth/teeth in relation to pericoronal tissues surrounding unerupted/partially erupted tooth/teeth.

• Previous history of pericoronitis.

• Poor oral hygiene.

• Respiratory tract infections.

2. Diagnostic Criteria

2.1 Presence of unerupted/partially erupted tooth/teeth in communication with the oral cavity.

2.2 Cardinal signs/symptoms of inflammation associated with the pericoronal tissues:

• Local pain/discomfort.

• Swelling.

• Erythema.

2.3 Associated signs/symptoms (variable expression):

• Pus expressible from beneath the pericoronal tissues.

• Restricted mouth opening.

• Abnormal taste.

• Halitosis.

• Cervical lymphadenopathy.

• Presence of associated disease - pericoronal/cervical abscess.

• Systemic signs and symptoms.

• Evidence of trauma by opposing tooth/teeth.

3. Treatment

The following should be considered in the acute phase:

• Irrigation of pericoronal space.

• Use of local agents to cauterise the soft tissues.

• Removal of opposing tooth/teeth if traumatic occlusion with pericoronal tissues present.

• Use of appropriate analgesia.

• Use of appropriate antibiotics in the presence of severe local disease or if systemic symptoms identified.

• Give advice regarding oral hygiene.

• Use of 0.12% chlorhexidine mouthwash.

The following should be considered following resolution of the acute phase:

• Local soft tissue surgery.

• Removal of associated tooth/teeth

• Irrigation of the pericoronal space mechanically removes any debris that may have collected within the space. The irrigant should be sterile. Irrigants used include: water for injection, normal saline, chlorhexidine and local anaesthetic solutions.

• Caustic agents to cauterise the local tissues, if used, should be applied with caution and appropriate care to avoid injury to adjacent tissues.

• Pericoronitis is an inflammatory condition and the NSAIDs should be considered the analgesic of choice unless contra-indicated.

• The use and choice of antibiotics is controversial. The bacterial flora is a complex mixture of gram-positive and gram-negative organisms and consideration should therefore be given to the use of broad spectrum or combinations of antibiotics dependent upon the clinical situation.