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It is extremely easy for our wisdom teeth to get infected for a variety of reasons. The treatment may or may not involve its extraction. This article will help you understand why the infection occurs, the treatments available, and the best course forward.

What is pericoronitis?

Pericoronitis is the technical term given for inflammation that occurs around the wisdom tooth [1]. It may occur at one wisdom tooth or more than one at the same time. The symptoms associated with wisdom tooth inflammation include pain, tenderness, difficulty in chewing, difficulty in swallowing, discomfort while speaking, repeated trauma to the cheek, and even repeated sore throats [2].

This inflammation can also lead to the formation of a pericoronal abscess which has similar symptoms that are usually more severe and may also be accompanied by a fever. The presence of an abscess can make wisdom tooth removal an emergency and actually increases the likelihood of infection after wisdom tooth removal as well [3].

The reason why pericoronitis occurs can be difficulty in cleaning the tooth adequately due to the incomplete eruption of the wisdom tooth or its eruption in an improper direction, continuous trauma to the cheek, or excessive pressure being applied to the nearby teeth.

Treatment of wisdom tooth infection

There are two main modes of treatment when it comes to pericoronitis. The first is to clean the tooth, prescribe some anti-inflammatory drugs, possibly some antibiotics if an infection has also occurred, and then allow it to heal [4].

A little bit of the gum can also cover the tooth and become very painful since food continues to lodge underneath this covering. If the wisdom tooth is close to erupting completely then this covering (also called as the operculum) can be surgically removed to alleviate the symptoms and allow the tooth to erupt painlessly into the mouth [5].

Of course, while an operculectomy does relieve the symptoms in the short term, there is a risk of the flap of gum re-growing to cover the tooth. In such a scenario, the extraction of the wisdom tooth is advisable.

When is it time to remove the wisdom teeth?

Wisdom tooth removal is carried out very commonly and is performed both as a treatment procedure and preventively. A lot of the times, the dentist can determine with a fair degree of certainty whether a wisdom tooth will erupt into the mouth in the correct position or not [6].

If the space in the jaws seems inadequate then it is advisable to get the wisdom teeth removed preemptively and avoid further complications. Of course, the other, more conservative school of thought is that in many cases wisdom teeth do not end up doing any damage or causing any trouble to the patients.

A wait and watch approach where the wisdom teeth are given the best chance to erupt completely. If they do end up causing some of the symptoms mentioned earlier, then they are removed at that time [7].

Neither of the two approaches is wrong and it is down to the attending doctor to take a call based on an individual clinical assessment.

Wisdom tooth removal to treat pericoronitis

The procedure to remove a wisdom tooth is more complicated when it is done in the presence of infection and inflammation. For one reason, the patient may have a compromised mouth opening which makes gain access difficult. The presence of a pre-existing infection also increases the chances of infection after wisdom tooth removal [8].

The healing after the procedure can be compromised and be much more demanding of the patient.

The dentist will evaluate the affected tooth and then take a call whether the procedure can be performed at that time or a course of medications has to be taken to bring down the inflammation and infection [9].

The kind of extraction that is needed to be performed in the case of wisdom tooth removal can vary between a non-surgical extraction and a surgical extraction. If the wisdom tooth is accessible to the dentist in the oral cavity without having to give an incision or remove some bone then the extraction can be done non-surgically, however, if the tooth is placed in a poor direction, has not erupted completely into the mouth, or is not visible to the dentist then a surgical extraction has to be performed [10].

While a non-surgical extraction of the wisdom tooth is very similar to other extractions, a surgical extraction can take longer to heal and needs to be performed with a great deal of expertise.

Conclusion

Wisdom tooth infection is quite common and can be treated both with or without extracting the tooth. Of course, this decision is based on multiple factors. Given the chance, most patients want to try and avoid going through an extraction but it may actually be the more reliable and definitive treatment procedure in the long run.  

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