Pericoronitis: Symptoms, Types, Causes and Treatment

Pericoronitis is a common dental condition that can range from mildly irritating to severely debilitating, most frequently affecting young adults during the eruption of their third molars (wisdom teeth). Understanding its symptoms, types, causes, and evidence-based treatment options is essential for ensuring effective management and preventing complications. This comprehensive guide synthesizes current research to provide clear, actionable insights for both patients and professionals.

Symptoms of Pericoronitis

Pericoronitis typically presents as an inflammation of the gum tissue around a partially erupted tooth, most often the lower third molar. Recognizing its symptoms early can facilitate prompt treatment and avert more serious complications.

Symptom	Description	Severity/Onset	Source(s)
Pain	Tenderness around affected tooth	Usually acute onset	1 3 6
Swelling	Localized gum enlargement	Mild to severe	1 2 3
Trismus	Difficulty opening the mouth	Functional impairment	1 2 3
Halitosis	Bad breath	Often present	1
Pus	Discharge beneath gum flap	In severe cases	1 2
Bad Taste	Unpleasant taste in mouth	Common	1
Lymphadenopathy	Swollen lymph nodes	Variable	2
Dysphagia	Difficulty swallowing	Sometimes present	2 3

Table 1: Key Symptoms

Pain and Localized Discomfort

The hallmark of pericoronitis is pain centered around the partially erupted tooth. This pain can be sharp, throbbing, or constant, often worsening with chewing or jaw movement 1 3 6. Sometimes, the pain radiates to the ear or neck.

Swelling and Inflammation

Inflammation around the gum (pericoronal flap) leads to visible swelling, redness, and sometimes warmth over the affected area. Severe swelling may extend to adjacent tissues 1 2 3.

Trismus and Functional Problems

Trismus refers to a reduced ability to open the mouth, often resulting from inflammation and spasm of the jaw muscles. This can significantly impact eating, speaking, and oral hygiene 1 2 3.

Additional Signs: Halitosis, Pus, and Taste Changes

Halitosis (bad breath), a bad taste in the mouth, and pus discharge signify infection and tissue breakdown. Lymph node enlargement and difficulty swallowing (dysphagia) may occur in more advanced cases, indicating the spread of infection 1 2.

Types of Pericoronitis

Pericoronitis manifests in different forms, ranging from mild, temporary discomfort to severe, rapidly progressing infections. Classification helps guide appropriate treatment strategies.

Type	Characteristics	Course	Source(s)
Acute	Sudden onset, severe symptoms	Rapid progression	1 4 6
Chronic	Mild, persistent discomfort	Long-term, low-grade	4 6
Abscessed	Pus formation, localized or spreading	Risk of complications	1 4

Table 2: Types of Pericoronitis

Acute Pericoronitis

This form appears suddenly, often with marked pain, swelling, and sometimes pus formation. Acute pericoronitis can escalate quickly, potentially leading to systemic symptoms such as fever or spreading infection 1 4 6.

• Key features: intense pain, marked inflammation, trismus, fever in severe cases.
• May require urgent intervention to prevent complications.

Chronic Pericoronitis

Chronic pericoronitis is characterized by intermittent or low-grade discomfort, mild swelling, and occasional tenderness. It may persist for weeks or months, often flaring up during periods of stress or poor oral hygiene 4 6.

• Key features: mild pain, low-level inflammation, occasional halitosis.
• Often managed conservatively unless symptoms worsen.

Abscess Formation and Complications

In some cases, untreated acute pericoronitis can progress to abscess formation, with pus accumulating under the gum flap. This can remain localized or spread to deeper facial spaces, increasing the risk for systemic infection and more severe complications 1 4.

Causes of Pericoronitis

Understanding what triggers pericoronitis is essential for both prevention and management. Multiple factors—ranging from tooth position to microbial activity—contribute to its onset.

Cause	Description	Risk Factors/Details	Source(s)
Partial Eruption	Gum covers part of tooth	Creates operculum trap	1 6 7
Tooth Position	Angulation and impaction	Mesioangular, horizontal at risk	2 8
Microbial Flora	Anaerobic, spirochetes, fusobacteria	Infection triggers inflammation	5 6 7
Age	Young adults (18–29 years)	Higher incidence	2 8
Trauma	Chewing/antagonist tooth injury	Aggravates inflammation	1
Poor Hygiene	Accumulated plaque/debris	Promotes bacterial growth	1 7 9

Table 3: Main Causes

Partial Eruption and Operculum

Pericoronitis most often develops around partially erupted lower third molars. The gum tissue (operculum) forms a flap over the tooth, creating a pocket where food, plaque, and bacteria accumulate, setting the stage for infection 1 6 7.

Tooth Position and Impaction

The risk of pericoronitis is higher in certain types of tooth impactions:

• Mesioangular Impaction: The tooth is tilted towards the front of the mouth, most commonly associated with pericoronitis 2.
• Horizontal/Transverse Impaction: The tooth lies sideways in the jaw, also at high risk 8.
• Vertical Impaction: Upright teeth at or near the occlusal plane can also be affected, though less frequently 2 8.

Microbial Involvement

The subgingival pocket around the impacted tooth harbors a diverse mix of bacteria, especially anaerobes, spirochetes, and fusiform bacteria. Studies have identified Streptococcus milleri, Actinomyces, Prevotella, and others as major contributors to acute infection 5 6 7.

Age and Other Predisposing Factors

Pericoronitis most commonly affects individuals between 18–29 years—coinciding with the eruption period of third molars 2 8. Trauma from opposing teeth, poor oral hygiene, and stress can all increase susceptibility 1 7 9.

Treatment of Pericoronitis

Effective treatment of pericoronitis requires a tailored approach, balancing immediate symptom relief, infection control, and long-term prevention. Evidence-based recommendations emphasize local therapies and prudent antibiotic use.

Treatment	Description	Indication/Goal	Source(s)
Local Debridement	Cleaning, irrigation, plaque removal	Mild to moderate cases	1 9 11
Analgesics	Pain relief (NSAIDs, etc.)	Symptom management	1 3 11
Antibiotics	Systemic infection or severe cases	Reserved for complications	1 11
Photodynamic Therapy	Antimicrobial laser + dye therapy	Emerging option, initial phase	3 12
Surgical Removal	Extraction of impacted tooth or flap	Definitive, recurrent/severe cases	1 4 8 11

Table 4: Treatment Approaches

Local Debridement and Irrigation

First-line management for uncomplicated pericoronitis involves:

• Removal of debris and plaque from the pericoronal pocket.
• Irrigation with sterile saline or antiseptic solutions (e.g., chlorhexidine, hydrogen peroxide) to reduce bacterial load 1 9 11.
• Sometimes, gentle lifting of the gum flap to allow drainage of pus if present.

This approach is effective for most mild to moderate cases and helps restore oral comfort rapidly.

Pain Management

Non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesics are commonly used to control pain and inflammation. These medications do not address the underlying infection but significantly improve quality of life during recovery 1 3 11.

Antibiotic Therapy: When and Why

Current evidence strongly recommends against routine antibiotic use for pericoronitis. Antibiotics (e.g., amoxicillin, metronidazole) should be reserved for patients with:

• Evidence of spreading infection (fever, lymphadenopathy, cellulitis).
• Systemic involvement.
• Immunocompromised status 1 11.

Overprescription is a recognized issue, contributing to antibiotic resistance and unnecessary side effects 11. Local therapy is preferred for most cases.

Photodynamic Therapy (PDT)

PDT is an emerging treatment that uses a photosensitizing dye (such as methylene blue) and low-level laser light to kill bacteria. Recent studies suggest that PDT can effectively reduce pain, trismus, and microbial load in early-phase pericoronitis, offering a non-antibiotic alternative 3 12.

• Particularly promising for initial disease stages.
• May reduce need for antibiotics and associated risks.

Surgical Options: Extraction or Operculectomy

Definitive management often involves:

• Extraction of the problematic third molar—especially for recurrent or severe cases, or when the tooth has poor prognosis 1 4 8 11.
• Operculectomy (removal of the gum flap) if the tooth is to be retained and symptoms persist 1.

Surgical intervention is typically scheduled after the acute phase has resolved to minimize complications.

Preventing Complications and Recurrence

• Maintain excellent oral hygiene, especially around erupting teeth.
• Early professional evaluation for persistent symptoms.
• Address contributing factors such as trauma from opposing teeth.

Conclusion

Pericoronitis is a prevalent dental condition that can cause significant discomfort and, if left untreated, lead to serious complications. A prompt, evidence-based approach is vital for effective care.

Key Takeaways:

• Symptoms: Pain, swelling, trismus, halitosis, and pus are common, often centered around lower third molars 1 2 3 6.
• Types: Acute, chronic, and abscessed forms exist, dictating the urgency and nature of treatment 1 4 6.
• Causes: Partial eruption, unfavorable tooth angulation, microbial accumulation, and poor oral hygiene are major contributors 1 2 5 6 7 8.
• Treatment: Local debridement and irrigation are first-line; antibiotics are reserved for severe cases; photodynamic therapy is emerging as an alternative; extraction remains the definitive solution when indicated 1 3 9 11 12.

By understanding these aspects, patients and practitioners can work together to ensure timely, effective, and safe management of pericoronitis—minimizing pain, preventing complications, and supporting long-term oral health.