Pericoronitis: Symptoms, Treatment, and Prevention (2023)

Pericoronitis (also called operculitis) is a condition involving inflammation and swelling of the soft tissue that surrounds a tooth that is partially erupted.Eruption is the process of tooth development in which a tooth becomes visible as it “erupts’’ through the gingiva (gum tissue). Pericoronitis may also affect a tooth that has not yet come in.

The soft tissue that covers a tooth that is not fully erupted is called an “operculum.”One reason this soft tissue area may become easily inflamed is that it often collects food particles and debris and it can be difficult to reach when performing oral hygiene.As it collects food particles, this dark, moist areaprovides the perfect medium for bacteria to grow.

The tooth that is most often affected by pericoronitis is the lower third or final set of molars sometimes called wisdom teeth. In fact, it is rare that pericoronitis involves any teeth other than the bottom wisdom teeth. Pericoronitis often affects those in their late teens or early adulthood, because that is the time the lower wisdom teeth usually erupt.

Pericoronitis: Symptoms, Treatment, and Prevention (1)

Symptoms

Mild symptoms

Mild symptoms of pericoronitis may include:

  • Painful, swollen gum tissue (near the tooth that is affected)
  • Difficulty biting down (without hitting the swollen area)
  • A discharge of pus from the inflamed area
  • A bad taste in the mouth or unpleasant smell

Severe Symptoms

Severe symptoms of pericoronitis may include:

  • Difficulty opening the mouth
  • Swelling of the face (on the side of the face that the inflamed tooth is on)
  • Swollen lymph nodes (called lymphadenitis)
  • Fever
  • Ludwig’s angina (a rare bacterial infection of the floor of the mouth that sometimes occurs after a tooth infection)
  • Spasms of the jaw (sometimes referred to as lockjaw)

Severe symptoms may indicate that the swelling has spread to the neck and throat, this could impact normal breathing and should be considered a medical emergency that could potentially impair the ability to swallow or breathe and could be life-threatening.Those who have severe symptoms of pericoronitis should immediately contact a dentist, or other healthcare provider.

Symptoms of pericoronitis are grouped into three different categories according to their frequency and intensity, these include:

  1. Acute-involves limited mouth opening and more severe symptoms
  2. Sub-acute-lower intensity of symptoms without mouth opening discomfort
  3. Chronic-involves low grade pain without severe symptoms

The treatment of pericoronitis is often dependent on the level (acute, sub-acute or chronic) of the disease a person is experiencing.

Causes and Risk Factors

Those at higher risk of getting pericoronitis include:

(Video) Pericoronitis Treatment | Causes & Symptoms

  • Those in the age group of early adulthood or late adolescence
  • Having wisdom teeth that have not yet erupted
  • Having a developed operculum (flap surrounding the teeth, which encourages bacterial growth)
  • Experiencing chewing trauma (damage to the affected tissue from an opposing tooth)
  • Those with poor oral hygiene
  • Engaging in smoking (regardless of the number of cigarettes smoked per day)
  • Having conditions that put a strain on the immune system (such as viral recovery, severe fatigue or emotional stress)
  • Being pregnant

Study

A 2019 study, performed in Greece, aimed to determine the factors that impact the prevalence of pericoronitis (including social and risk factors, demographics and more).
The study discovered several factors related to the prevalence of pericoronitis, including:

  • The prevalence of pericoronitis was 4.92% of the 20 to 25-year-old study participants.
  • Oral hygiene was found to be a marginally significant factor in the prevalence of the disease.
  • Smokers were found to be more susceptible to pericoronitis (but the frequency of smoking was not impactful).
  • The chronic type of pericoronitis was the most frequent form of the disease.
    “The use of mouthwash along with the adequate frequency of teeth-brushing appeared to be related to a statistically significant decrease of the disease [pericoronitis],” concluded the study authors.

Diagnosis

Diagnosis of pericoronitis is usually made by a dentist, by performing an oral examination, and sometimes involves taking diagnostic X-rays (to evaluate the unerupted wisdom tooth).

Treatment

Home Treatment

Although there are several home treatment modalities that the dentist may recommend, home treatment should not replace professional medical intervention.The dentist may prescribe home treatment modalities such as:

  • Warm salt-water rinses (particularly after eating to remove food and debris)
  • Oral water irrigation systems (using commercial equipment)
  • Meticulous/regular oral hygiene (including brushing and flossing)
  • Pain relievers (such as ibuprofen [Advil] or acetaminophen [Tylenol] or other over-the-counter pain relievers prescribed by the dentist).

Note: Avoid the use of hot compresses (which may increase the swelling) particularly for those with severe symptoms of pericoronitis such as fever or swelling of the neck or face)

Medical Treatment

Treatment for pericoronitis may involve:

  • Dental cleaning/flushing of food and other debris from the area
  • Antibiotic administration (to take by mouth)
  • An antibacterial oral rinse
  • Pain relief (either over-the-counter pain relievers or prescription medication may be suggested by the dentist)

Once the infection is cleared up, subsequent treatment depends on the severity and category of the pericoronitis symptoms (including acute, sub-acute or chronic categories) and may involve:

  • Observing the tooth to ensure the infection doesn’t return and that the tooth will erupt normally
  • Referral to an oral and maxillofacial surgeon to evaluate the need for oral surgery
  • Removal of the infected wisdom tooth (if the dentist/oral surgeon deems that it may not erupt normally)
  • Removal of both the lower and upper wisdom teeth on the affected side (to prevent the upper tooth from biting into the inflamed lower gum and causing subsequent infection).
  • Performing a procedure called an operculum (minor oral surgery to remove the flap of skin over the affected tooth

Sometimes the flap will grow back after it is removed, and the operculum procedure will need to be performed again.

Aftercare

If the wisdom tooth has been removed, it usually results in complete healing, and pericoronitis symptoms may subside within one to two weeks after surgery.Follow up treatment may include:

  • Follow up appointments with the dentist or oral surgeon to monitor the rate of healing and level of tooth pain, if present
  • Adhering strictly to aftercare instructions if a wisdom tooth was extracted (such as abstaining from smoking, eating soft foods, etc.)
  • Home treatments (such as antibiotic oral rinsing, over-the-counter pain medication and more)
  • Meticulous oral hygiene (including regular brushing and flossing)
  • Quitting smoking (for those who smoke)

Prevention

Preventative care and regular dental visits may lower the risk of getting pericoronitis because the dentist can keep a close eye on your wisdom teeth and intervene before infection occurs when the third molars do not appear to be erupting normally.

Regular dental cleanings may also help to prevent pericoronitis because they help to keep the teeth clean and free of food and debris.Prevention of pericoronitis may be possible with regular oral hygiene practices involving brushing, flossing and using an antibiotic oral rinse; but despite such interventions, some people will still develop the condition.

5 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Wehr C, Cruz G, Young S, Fakhouri WD. An insight into acute pericoronitis and the need for an evidence-based standard of care. Dent J (Basel). 2019;7(3):88. doi:10.3390/dj7030088

  2. Katsarou T, Kapsalas A, Souliou C, Stefaniotis T, Kalyvas D. Pericoronitis: A clinical and epidemiological study in greek military recruits. J Clin Exp Dent. 2019;11(2):e133-e137. doi:10.4317/jced.55383

  3. Columbia College of Dental Medicine. Pericoronitis.

  4. Renton T, Wilson NH. Problems with erupting wisdom teeth: signs, symptoms, and management. Br J Gen Pract. 2016;66(649):e606–e608. doi:10.3399/bjgp16X686509

  5. Galvão EL, da Silveira EM, de Oliveira ES, da Cruz TMM, Flecha OD, Falci SGM, Gonçalves PF. Association between mandibular third molar position and the occurrence of pericoronitis: A systematic review and meta-analysis. Arch Oral Biol. 2019 Nov;107:104486. doi: 10.1016/j.archoralbio.2019.104486

    (Video) How to Treat Pericoronitis

Additional Reading

(Video) Pericoronitis: Types, Causes, Signs, Symptoms, Treatments

Pericoronitis: Symptoms, Treatment, and Prevention (2)

By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.

FAQs

What is the treatment for pericoronitis? ›

They can treat the infection with antibiotics (usually penicillin, unless you are allergic). Minor surgery to remove the operculum: If the pain and inflammation are severe, or if the pericoronitis recurs, it may be necessary to have oral surgery to remove the gum flap or wisdom tooth.

How can pericoronitis be prevented? ›

Prevention of pericoronitis may be possible with regular oral hygiene practices involving brushing, flossing and using an antibiotic oral rinse; but despite such interventions, some people will still develop the condition.

Which medicine is best for pericoronitis? ›

Metronidazole or amoxicillin are usually effective in treating such infections. The duration of treatment depends on the severity of the infection and the clinical response but drugs are usually given for 3 days.

Can pericoronitis spread? ›

Pericoronitis, when untreated, can lead to the spreading of the localized infection to the nearby head and neck spaces: sublingual, submandibular, parapharyngeal, pterygomandibular, infratemporal, submasseteric, buccal spaces.

How pericoronitis is caused? ›

Pericoronitis occurs when the wisdom teeth do not have enough room to erupt through the gums. As a result, they may only partially come through the gum, which may lead to inflammation and infection of the soft tissue around the wisdom tooth. If wisdom teeth only partially erupt, gum flaps may develop.

How long does pericoronitis take to heal? ›

Generally, pericoronitis resolves between one and three weeks. However, it can reoccur if you leave the original cause untreated.

Is pericoronitis permanent? ›

Once the plaque stagnation area is removed either through further complete tooth eruption or tooth removal then pericoronitis will likely never return. A non-impacted tooth may continue to erupt, reaching a position which eliminates the operculum.

How much is it to treat pericoronitis? ›

To treat Pericoronitis, as mentioned, your dentist will either perform an operculum resection procedure, or recommend to have your wisdom tooth removed. To remove the tissue encasing the tooth expect to pay between $350-500. If your wisdom tooth has to be removed, your price range will be between $400-$600.

Can I remove pericoronitis at home? ›

If a wisdom tooth has pericoronitis or another type of abscess, a saltwater rinse can help clean the infected area until the source is treated. Dissolve a small amount of salt in warm water and swish for 30 seconds one to two times per day.

Can mouthwash prevent pericoronitis? ›

It's also advisable to use mouthwash when impacted wisdom teeth grow to get rid of food or bacteria that gets trapped between the gum and the wisdom tooth. ¹ Rinsing with an anti-bacterial mouthwash will also help decrease the risk of developing pericoronitis, an inflammatory gum condition.

What mouthwash is good for pericoronitis? ›

Rinse your mouth with a chlorhexidine-based mouthwash.

Can pericoronitis make you sick? ›

Pericoronitis, which comes from ancient Greek which literally means “inflammation from around the crown”, happens when the gum tissue around the crown of a tooth becomes infected with harmful bacteria. Symptoms that stem from this infection can mimic a common cold or give an “off-and-on” feeling of malaise.

Is ice good for pericoronitis? ›

Patients should not place hot or cold compresses on the cheek surface as this may increase the size of the swelling. If the condition recurs, the dentist may recommend removal of the gum flap that is causing the problem. In case of serious infections, the wisdom tooth may be removed.

Does pericoronitis smell? ›

Over time an inflammatory condition called pericoronitis can come about caused by the bacteria harnessing in the area. In most instances patients feel pain and a foul odor coming from their mouth.

Will pericoronitis heal? ›

Mild pericoronitis can heal in a few days or weeks with the proper pericoronitis antibiotics. Severe pericoronitis may heal in several weeks or months to heal with proper dental surgeries. Severe pericoronitis healing may take several months if you only use antibiotic treatments without surgery.

Can you kiss with pericoronitis? ›

Is pericoronitis contagious? While sharing food and drinks or kissing can transmit “bad” bacteria to your mouth that contribute to gum disease, gum disease on its' own is not contagious.

What makes pericoronitis worse? ›

It is a bacterial infection that can be brought on or made worse by: Bits of food-getting trapped and packed underneath the gum over the wisdom tooth and then festering.

What is the fastest way to cure pericoronitis? ›

They can treat the infection with antibiotics (usually penicillin, unless you are allergic). Minor surgery to remove the operculum: If the pain and inflammation are severe, or if the pericoronitis recurs, it may be necessary to have oral surgery to remove the gum flap or wisdom tooth.

When should I worry about pericoronitis? ›

If the pain is severe and the simple home treatments do not provide enough relief, then it is time to take the next step. It is possible that prescription medications can help manage the symptoms until they resolve themselves.

What will a dentist do for pericoronitis? ›

How is pericoronitis treated? First, your dentist will flush away the accumulated food particles and other debris from the area. Then, he or she will prescribe a course of oral antibiotics to clear up the infection. He or she will also recommend an antibacterial oral rinse that you can use to clear the infected area.

How long does pericoronitis take to heal? ›

Generally, pericoronitis resolves between one and three weeks. However, it can reoccur if you leave the original cause untreated.

Can I remove pericoronitis at home? ›

If a wisdom tooth has pericoronitis or another type of abscess, a saltwater rinse can help clean the infected area until the source is treated. Dissolve a small amount of salt in warm water and swish for 30 seconds one to two times per day.

Can you treat pericoronitis without antibiotics? ›

The pain caused by acute pericoronitis can be managed with over-the-counter painkillers, such as ibuprofen (Advil) and acetaminophen (Tylenol). If the infection hasn't spread considerably, the dentist can possibly administer local anesthesia and clean the region to eliminate the infection.

Is pericoronitis permanent? ›

Once the plaque stagnation area is removed either through further complete tooth eruption or tooth removal then pericoronitis will likely never return. A non-impacted tooth may continue to erupt, reaching a position which eliminates the operculum.

How common is pericoronitis? ›

Pericoronitis is a dental condition that causes infection and inflammation of the soft tissues surrounding a partially erupted tooth, as an article in the British Journal of General Practice (BJGP) explains. Approximately 81% of people in their 20s experience this condition at some time.

Is mouthwash good for pericoronitis? ›

¹ Rinsing with an anti-bacterial mouthwash will also help decrease the risk of developing pericoronitis, an inflammatory gum condition.

Can pericoronitis make you sick? ›

Pericoronitis, which comes from ancient Greek which literally means “inflammation from around the crown”, happens when the gum tissue around the crown of a tooth becomes infected with harmful bacteria. Symptoms that stem from this infection can mimic a common cold or give an “off-and-on” feeling of malaise.

What makes pericoronitis worse? ›

It is a bacterial infection that can be brought on or made worse by: Bits of food-getting trapped and packed underneath the gum over the wisdom tooth and then festering.

What is the fastest way to cure pericoronitis? ›

They can treat the infection with antibiotics (usually penicillin, unless you are allergic). Minor surgery to remove the operculum: If the pain and inflammation are severe, or if the pericoronitis recurs, it may be necessary to have oral surgery to remove the gum flap or wisdom tooth.

Is salt water good for pericoronitis? ›

If the pericoronitis is limited to the tooth (for example, if the pain and swelling has not spread), treat it by rinsing your mouth with warm salt water. You should also make sure that the gum flap has no food trapped under it.

Can you kiss with pericoronitis? ›

Is pericoronitis contagious? While sharing food and drinks or kissing can transmit “bad” bacteria to your mouth that contribute to gum disease, gum disease on its' own is not contagious.

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