Pericoronitis
Quick Summary Introduction References Photos		Clinical Features Histopathology Treatment Prognosis
Relatively minor enlargement of operculum in third molar region of mandible can be very painful.

 

 

 

 

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Introduction

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The mandibular retromolar pad or operculum is often hyperplastic, pushing against or even overlapping the last molar in the arch. Food debris and bacteria may become entrapped between this pad and the tooth, resulting in acute infection and extreme pain. This pericoronitis was first reported by Gunnel in 1844 as "painful affection."

Pericoronitis typically occurs in teenagers and young adults, presenting shortly after the eruption of the second or third mandibular molars. It presents as an erythematous, tender, sessile swelling of the retromolar pad, sometimes with surface ulceration from continuous trauma from the opposing maxillary molars. Pus may be expressed from the tissue/tooth interface, and a foul taste may be present. Pain may be mild but is usually quite intense and may radiate to the external neck, the throat, the ear, or the oral floor. The patient often cannot close the jaw because of tenderness and extreme pain may, conversely, result in the inability to open the jaws more than a few millimeters (trismus or "lock jaw"). Cervical lymphadenopathy, fever, leukocytosis, and malaise are common signs and symptoms, and the malady may be associated with an ipsilateral tonsillitis or upper respiratory infection.

Pericoronitis is usually surgically removed after a course of antibiotic therapy in order to prevent future painful episodes, hence, active pus production is seldom seen in biopsy samples. The retromolar mass is comprised of an admixture of moderately dense collagenic tissue and edematous granulation tissue, with moderate to large numbers of mixed chronic inflammatory cells throughout. The superior mucosa may be ulcerated with an ulcer bed of fibrinoid necrotic debris. The epithelium immediately adjacent to the offending tooth typically presents with a combination of rete process hyperplasia, degeneration and necrosis, perhaps with associated neutrophils. Bacterial colonies, dental plaque and necrotic food debris may be attached to the epithelium. The pathologist should distinguish this lesion from pyogenic granuloma and routine gingivitis, and this often requires correlation with clinical features.

Acute pericoronitis is treated by local antiseptic lavage and gentle curettage under the flap, with or without systemic antibiotics. Once the acute phase is controlled, the offending molar is extracted or a wedge of hyperplastic pad tissue is removed surgically. Recurrence is unlikely with either of these treatments.

Gennell JS. A remedy for the painful affection produced when cutting the lower dens Salientia or wisdom tooth, etc. Am J Dent Sc 1844; 4:43-44.

Meurman JH, Rajasuo A, Murtomaa H, Savolainen S. Respiratory tract infections and concomitant pericoronitis of the wisdom teeth. Brit Med J 1995; 310:834-836.

Blakey GH, White RP, Offenbacher S, et al. Clinical/biological outcomes of treatment for pericoronitis. J Oral Maxillofac Surg 1996; 54:1150-1160.

Rajasuo A, Jousimiessomer H, Savolainen S, et al. Bacteriological findings in tonsillitis and pericoronitis. Clin Infect Dis 1996; 23:51-60.

Neissen LC. Pericoronitis as a cause of tonsillitis. Lancet 1996; 348:1602-1603.