Pericoronitis is inflammation of the gum tissue surrounding a partially erupted tooth, most frequently a wisdom tooth (third molar). When the tooth only partially breaks through the gumline, a flap of soft tissue, called an operculum, forms over the crown. This fold creates a protected space where food particles, plaque, and bacteria become trapped, leading to a localized infection. Ignoring this infection sets in motion a sequence of escalating complications that extend far beyond simple discomfort.
Initial Progression and Chronic Damage
Neglecting pericoronitis transitions the condition from an acute flare-up to a persistent, low-grade inflammatory state. Bacteria continue to flourish under the operculum, causing ongoing pain, swelling, and tenderness. This constant infection causes structural damage to the surrounding oral architecture, which is often difficult to detect without dental imaging.
The bacteria and acidic byproducts trapped beneath the gum flap significantly increase the risk of dental decay (caries) on both the affected wisdom tooth and the adjacent second molar. Difficulty cleaning the area means plaque accumulates against the distal surface of the second molar, creating a cavity that compromises the structural integrity of this tooth. Simultaneously, chronic inflammation leads to localized periodontal attachment loss, destroying the bone and ligament that support the wisdom tooth. This damage can eventually result in the permanent degradation of the jawbone around the affected area.
Chronic pericoronitis often results in halitosis (bad breath) and a persistent foul or metallic taste. This unpleasant sensation is caused by the ongoing discharge of pus and volatile sulfur compounds produced by anaerobic bacteria thriving in the infected pocket. These symptoms persist until the underlying problem—the trapped tissue and bacteria—is professionally addressed.
Development of Severe Local Infections
If the infection progresses without intervention, the bacterial load can rapidly overwhelm local defenses, leading to the formation of a dental abscess. An abscess is a localized collection of pus, creating intense pressure and severe, throbbing pain. This pocket of infection often presents with noticeable facial swelling, fever, and tender, swollen lymph nodes in the neck or under the jaw.
If the pus cannot drain out through the gum flap, the infection can spread rapidly through the soft tissues of the face and neck, a serious condition known as cellulitis or phlegmon. This diffuse soft tissue infection causes widespread swelling that affects the muscles responsible for jaw movement. The resulting limited ability to open the mouth, known as trismus, makes speaking, eating, and maintaining oral hygiene difficult.
The swelling can also progress to affect the throat muscles, leading to difficulty swallowing, a symptom called dysphagia. These severe local complications are medical emergencies requiring immediate professional intervention. They cannot be resolved by home remedies and necessitate surgical drainage of the pus combined with systemic antibiotics to halt the spreading infection.
Systemic Spread and Life-Threatening Risks
The most dangerous outcome occurs when the infection spreads into the deep fascial spaces of the head and neck. Bacteria can travel along the tissue planes, leading to rare but potentially fatal conditions. One severe complication is Ludwig’s Angina, a rapidly progressing cellulitis affecting the floor of the mouth and the sublingual and submandibular spaces.
Swelling from Ludwig’s Angina can quickly push the tongue upward and backward, causing obstruction and potential compromise of the airway. This condition is a medical emergency requiring immediate hospitalization and often an emergency procedure to secure the patient’s breathing. Beyond this direct threat, bacteria can enter the bloodstream (bacteremia), which can lead to sepsis, a systemic inflammatory response syndrome.
Sepsis represents a life-threatening state where the body’s response to the infection begins to damage its own tissues and organs. If left unchecked, this systemic infection can lead to septic shock, organ failure, and death. Although extremely rare, an uncontrolled infection from the lower jaw can track toward the brain, potentially causing cavernous sinus thrombosis or spreading to the heart valves, resulting in endocarditis.