Pericoronitis is a localized inflammation of the gum tissue surrounding a tooth that has only partially broken through the gum line (partial eruption). While often associated with wisdom teeth (third molars), this painful inflammation can occur even if wisdom teeth have been removed or have not yet erupted. The underlying cause is the specific biological environment created by the tooth’s incomplete emergence. Understanding this mechanism, recognizing the symptoms, and knowing the appropriate care steps helps manage this common dental issue.
The Mechanism Behind Pericoronitis
Pericoronitis develops when a tooth’s crown is only partially exposed, creating a flap of gum tissue called an operculum over a portion of the chewing surface. A small, difficult-to-clean pocket forms between the gum flap and the tooth. Food debris, plaque, and bacteria easily become trapped in this confined space.
Accumulated debris and the overgrowth of anaerobic bacteria trigger a localized infection and inflammatory response. The resulting inflammation causes the operculum to swell, making it susceptible to mechanical trauma from the opposing tooth during chewing. This cycle of bacterial colonization, inflammation, and trauma is the fundamental mechanism driving pericoronitis, regardless of the tooth involved. Wisdom teeth are the most frequent site because they are the last to erupt and often face space limitations.
When Pericoronitis Affects Other Teeth
The condition can occur around any tooth that is slow to erupt or partially impacted, confirming it is not exclusive to third molars. The most common non-wisdom tooth affected is the second molar, particularly the lower second molar.
This often occurs in adolescents (11 to 13 years old) when these molars are emerging. A temporary gum flap forms over the second molar’s chewing surface, creating the same debris-trapping environment seen with wisdom teeth.
Pericoronitis can also affect other teeth, such as canines or premolars, if they are impacted or slow to emerge. The inflammation requires only a partially exposed crown and an overlying gum flap that harbors bacteria. Even if wisdom teeth have been removed, pericoronitis can still occur if an adjacent second molar is partially erupted and covered by residual soft tissue.
Recognizing Symptoms and Immediate At-Home Care
The primary indicator of pericoronitis is localized pain and swelling of the gum tissue surrounding the affected tooth. Acute symptoms include severe pain, redness, and tenderness of the operculum near the back teeth. More severe infections can lead to the discharge of pus from under the gum flap, an unpleasant taste, and bad breath (halitosis).
If the inflammation spreads, it can cause difficulty swallowing and stiffness in the jaw muscles (trismus). While waiting for a dental appointment, immediate at-home care can manage symptoms. Rinsing the mouth with a warm saltwater solution three to four times a day can soothe the inflamed tissue and reduce swelling.
A saltwater rinse is made by dissolving about one teaspoon of salt in one cup of lukewarm water. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can manage discomfort. Gently brushing the area with a small-headed toothbrush helps remove trapped food particles, but aggressive brushing should be avoided.
Clinical Treatment and Resolution Strategies
Professional treatment depends on the severity of the infection and the long-term prognosis of the affected tooth. For mild cases, the first step is often a thorough professional cleaning, which involves irrigating the space under the gum flap to flush out trapped bacteria and debris. This process may use sterile saline, water, or an antiseptic rinse like chlorhexidine to reduce the bacterial load. If the infection is severe (with fever or extensive swelling), a course of oral antibiotics, such as amoxicillin, will be prescribed.
For recurring or chronic pericoronitis, a more permanent solution is necessary to remove the source of the problem. This may involve an operculectomy, a minor surgical procedure where the excess gum flap is removed with a scalpel or laser to eliminate the bacterial pocket. If the tooth is significantly impacted, misaligned, or unlikely to fully erupt, the most definitive resolution is extraction of the tooth itself. This irreversible procedure permanently removes the anatomical condition that causes pericoronitis. The goal of any treatment is to resolve the inflammation by addressing the partial eruption that created the issue.