PERICORONITIS

DEFINITION
• It is infection of soft tissues around the crown
of a partially impacted tooth.
• Overlying flap is called pericoronal flap
 PREDISPOSING FACTORS
• Transient decrease in host defence
– Fatigue , stress , URTI.
• Trauma
– Impingement of max 3rd molar.
• Entrapment of food under operculum
• MICROBOILOGY
– Strepto coccus ,pepto Strepto coccus
– Fusobacterium , Bacteroides
– Anaerobes
• COURSE
– Acute
– Subacute
– Chronic
 CLINICAL FEATURES
• General
– FEVER , Malaise
• Pericoranal Tissues
– Swollen , Tender , Ulcerated , Pus discharge
• Trismus , Painful deglutation
• Foetor oris
• Lymphadenopathy
• Alveolar abscess / discharging sinus
 TREATMENT
– Antibiotics , Analgesics.
– Ext/Grinding of opposite impinging cusp.
– Saline mouthwashes.
– Mechanical cleaning of operculum.
• H2O2 , Chlorhexidine.
• Mechanical removal of debris.
• Liberation of o2  reduced no of anaerobic bacteria.
– Removal of impaction
– Operculectomy if liable to erupt.
– I&D
– Complications.
• Increase incidence of dry socket if SR during acute Pericoronitis.
 COMPLICATIONS of Exodontia
• Local complications
• Systemic complications
 LOCAL COMPLICATIONS
(IMMEDIATE)
• Failure to achieve L.A (use other inj tech)
• Fracture of tooth/alveolus /Max tuberosity /mand
• Oro -Antral communication
• Displacement of tooth/ root in
– Buccal tissues, lungs ,stomach
– Spaces, Max sinus , suction
• Sub Luxation / Dislocation of
– Adjacent tooth (If small)
– TMJ
• Damage to
– Soft tissues , lip (Thermal , self biting)
– Nerves
 LOCAL COMPLICATIONS
DELAYED
• Pain , swelling
• Trismus
– inj or hematoma of Med ptery
• Hemorrhage
– primary,
– Reactionary (few hrs)
– secondary (14 days)
• Dry socket (localized Osteitis)
• Acute Osteomylitis
• Oro antral fistula
• Nerve damage
 LOCAL COMPLICATIONS
LATE
• Ch osteomylitiis
• Osteo radio necrosis
• Nerve damage
• Chronic pain
SYSTEMIC COMPLICATIONS (DIM PACT)
• Immediate
– Faint (vasovagal attack)
– Hypoglycemia
– Hyper ventilation
– Convulsions /fits
– Myocardial infarction
– Adisonian crises
– Respiratory obstruction
• Late
– Infective endocarditis
– Transmissible viral infections eg hepatitis
 FRACTURE OF MAX TUBEROSITY
• Predisposing Factors
– Large Antrum
– Divergent Roots
– Fusion of unerrupted 3rd molar to root of 2nd molar
• Treatment
– Small fragment removed by raising buccal flap
– Large fragment
• Leave the extraction
• Wait for 8 to 12 week for fracture to heal.
• Remove tooth by surgical resection
 NERVE DAMAGE
• Mental
– Over extended vestibular relieving incision between premolars
– Lip, Chin Paresthesia
• Lingual
– Supra periosteal location , lingual to 3rd molar
– Lingual tissue reflection, Burs, Vibrations
– Lingual Protection
• Inferior Alveolar nerve
– Roots close contact , grooved, perforated
– Radiographic signs of close proximity of canal & roots
• Radio lucent band over tooth roots -grooved or perforated
• Deviation of Canal
• Narrowing of Canal
• Loss of Tram lines (Cortical outline of canal)
 DRY SOCKET
• It is localized osteitis involving whole or part of condensed
bone overlying a tooth socket (lamina dura) without
association of infection
• Incidence
– 3% of all extractions
– 14 – 37% of lower 3rd molar
• Causes
– Exact not known
– Results from lysis of blood clot before its replacement with
granulation tissue.
– Fibrinolysis
• Tissue activators released from damaged bone convert
plasminogen to plasmin causing break down of clot.
 PREDISPOSING FACTORS
• Infection of Socket
– Activates plasminogen t0 plasmin
• Excessive Socket Trauma
– Devitalization of socket & thrombosis of vascular plexuses
– Increased release of plasminogen activator
• Dense Bone
– Decreased blood supply. Mand > Max.
• Vasoconstrictor in L.A
• Cigarettes
• Pregnancy & oral Contraceptive drugs
 SIGNS & SYMPTOMS
• Pain.
– 3-4rth post op day
– Dull, throbbing
– Moderate to Sever
• Foetor oris
• Bad Taste
• Empty socket with exposed bone
• Swollen gingival margins
• Lymphadenopathy
 TREATMENT
• Aim .
– Relief of pain
– Promotion of healing
• Prophylactic Measures
– Metronidazol for 3 days
– Pre surgical chlorhexidine rinses
– Copious saline irrigation
– Placing antibiotic in socket
 TREATMENT
• Irrigation – Saline
• Gentle debridment of degenerated clot
• Removal of sharp bony spicules
• White Head varnish pack (on gauze)
– Idoform, Benzoin
• Obtundant Dressing
– Zinc oxide ,topical anesthetic eg Benzocaine
• Analgesics
• No antibiotic
• Hot saline mouth rinses