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4.19 Dental Pain - Pericoronitis


Presentation

The patient is aged 17-25 and seeks help because of painful swelling and infection around an erupting or impacted third molar (wisdom tooth). Occasionally, there can be trismus or pain on biting The site appears red and swollen with a flap that may reveal a partial tooth eruption and purulent drainage when pulled open. There is no pain with percussion of the tooth.

What to do:

What not to do:

Discussion

Pericoronitis is a special type of acute periodontal abscess that occurs when ginngival tissue (operculum) overlies an erupting tooth (usually a third molar, also known as a wisdom tooth). Recurring acute symptoms are usually initiated by trauma from the opposing tooth or by impaction of food or debris under the flap of tissue that partially covers the erupting tooth.

When dental referral is not readily available, one procedure for releiving the pain is surgical removal of the operculum. inject local anesthetic directly into the overlying tissue and then cut it away using the outline of the tooth as a guide for the incision. Sutures are not required.


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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