32191725 pericoronitis perio

7/30/2019 32191725 Pericoronitis Perio

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CONTENTS:

INTRODUCTION

CLINICAL FEATURES

COMPLICATION

TREATMENT

CONCLUSION

REFERENCES


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INTRODUCTION:

The term pericoronitis refers to

inflammation of the gingiva in relationto the crown of an incompletely eruptedtooth.


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It occurs most frequently in the

mandibular third molar area.It may be

ACUTE

SUBACUTE

or

CHRONIC


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CLINICALFEATURES:The partially erupted or impacted

mandibular third molar is the mostcommon site of pericoronitis.

The space between thecrown of the tooth &overlying gingival flap is an

ideal area for theaccumulation of fooddebris & bacterial growth.


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Even in patients with no clinical signs

or symptoms, the gingival flap is oftenchronically inflamed & infected, withvarious degrees of ulceration along its

inner surface.


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Acute inflammatory involvement is a

constant possibility.Acute pericoronitis is identified byvarious degrees of involvement ofpericoronal flap & adjacent structures,as well as systemic complication.

An influx of inflammatory fluid &cellular exudates results in increase inthe bulk of the flap which interferes

with complete closer of mouth.


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The flap is traumatizes by contact withthe opposing jaw, and the inflammatory

involvement is aggravated.

The clinical picture is that of

markedly red,

swollen,

suppurating lesion that is tender,

with radiating pains to ear, throat, &

floor of mouth.


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The patient is extremely

uncomfortable because of pain, a foultaste, & an inability to close the jaw.

Swelling of the cheek in the region ofthe angle of the jaw & lymphadenitisare common findings.

The patient may also have toxicsystemic complication such as fever,leukocytosis, & malaise.


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COMPLICATION:

The involvement may becomelocalized in the form of periodontal

abscess.

It may spread posteriorly into the

oropharyngeal area & medially to thebase of the tongue, making itdifficult for the patient to swallow.


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Depending on severity & extent of the

infection, there is involvement of thesubmaxillary, posterior cervical, deepcervical, & retropharyngeal lymph

nodes.Peritonsillar abscess formation,

cellulitis, & Ludwigs angina areinfrequent but nevertheless potentialsequelae of acute pericoronitis.


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TREATMENT:

The treatment of pericoronitis depends

on the severity of the inflammation,the advisability of retaining involvedtooth.

Persistent symptomsfree pericoronal flapsshould be removed as a

preventive measuresagainst subsequentacute involvement.


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The treatment of acute pericoronitis isconsist of

(i) Gently flushing the area withwarm water to remove debris &exudate.


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(ii) swabbing with antiseptic after

elevating the flap gently fromthe tooth with a scalar.


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Antibiotic can be prescribe in severecases.After the acute symptoms have

subsided, a determination is made asto whether the tooth is to be retainedor extracted.

This decision is governed by thelikelihood of further eruption into agood functional position.


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Following point may be considered todecide whether the tooth is to be retained

or not.(1)stage of eruption of tooth.If a possibility that the tooth will

erupt further into a good functionalposition, it is advisable to retain the tooth.(2)impacted 3rd molar.

If the tooth is

impacted, it is better to extract the toothas soon as the acute symptoms havesubsided.


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(3)position of tooth.Very often the tooth may be buccally

placed with no attached gingiva on thebuccal aspect. It may also be placed verymuch distally making it difficult to

removed the gingival tissue adequately tocreate an environment which could bemaintained plaque free.


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Bone loss on the distal surface of thesecond molar is a hazard after the

extraction of partially or completelyimpacted third molar, & the problemis significantly greater if the third

molars are extracted after the rootsare formed Or in patients older thanthe early twenties.

To reduced the risk of bone lossaround second molar, should beextracted as early as possible in their

development.


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If it is decided to retain the tooth,the pericoronal flap is removed using

periodontal knives.


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It is necessary to removed the distalto the tooth as well as the flap on the

occlusal surface.


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Incising only the occlusal portion of

the flap leaves a deep distal pocket,which invites recurrence of acutepericoronal involvement.

After the tissue is removed, aperiodontal pack is applied.


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The pack may be retained by bringingit forward along the facial & lingualsurface into the interproximal spacebetween the second & third molar.

The pack is removed after oneweek.


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CONCLUSION

It is the most common type ofpericoronal infection found mostly inmandibular third molar.

Clinical features include red, swollensuppurating lesion along with the painwhich may radiate to the surrounding

tissues.Proper & immediate management isnecessary to prevent its complication.


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REFERENCES:

CLINICAL PERIODONTOLOGYCARRANZA NEWMAN

CLINICAL PERIODONTOLOGY

B.R.R.VARMA & R.P.NAYAK

INTERNET


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32191725 pericoronitis perio

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