Acute pericoronitis (including Erupting Teeth in Children)
Brief description of condition
Infection under the operculum i.e. the gingival (gum) tissue covering a partially erupted tooth. Pain associated with erupting teeth in children (both primary and permanent teeth).
Key signs and symptoms
- Pain (usually well-localised around a partially erupted tooth)
- Swelling (swelling of gingival (gum) around a partially erupted tooth; can extend to facial swelling, especially with mandibular molar tooth)
- Discomfort with swallowing
- Limited mouth opening
- Unpleasant taste or odour from the affected area
Determine if the airway is compromised: the patient is unable to swallow their own saliva or they are unable to push their tongue forward out of their mouth.
If the airway is compromised:
Send the patient immediately to emergency medical care via NHS 24.
If the airway is not compromised:
- Recommend optimal analgesia
- Do not prescribe antibiotics unless there are signs of spreading infection (e.g. limited mouth opening, facial swelling), systemic infection, or for an immunocompromised patient
- Advise the patient to rinse their mouth with 0.2% chlorhexidine mouthwash
- Advise the patient to seek urgent dental care.
- Advise optimal analgesia, soft tooth brushing around affected area and rinsing the mouth after food.
For adults, consider:
- Ultrasonic scaling and/or debridement to remove any foreign body lodged around the partially erupted tooth, under local anaesthesia, where possible.
- Irrigating under damaged tissue with 0.2% chlorhexidine.
- Extracting the tooth, if there are repeated episodes of pericoronitis associated with the same tooth.
- Extracting or adjusting an opposing tooth, where there is trauma to the inflamed operculum, if the position of the tooth suggests that it is unlikely to achieve function in future.
- American Academy of Periodontology. Parameter on acute periodontal diseases, Journal of Periodontology 2000; 71 (5 Suppl): 863–6.
- SDCEP. Drug prescribing for dentistry: dental clinical guidance, 2nd edition. Dundee: Scottish Dental Clinical Effectiveness Programme; 2011.
- NICE. Guidance on the extraction of wisdom teeth, 2000.
The maximum recommended dose of painkillers that takes into account the patient's age and is within the normal safe limits.