Acute pericoronitis (including erupting teeth in children)
Brief description of the condition
Infection under the operculum, i.e. the gingiva (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 the gingiva around a partially erupted tooth; can extend to facial swelling, especially with lower molar tooth)
- Discomfort with swallowing
- Limited mouth opening
- Unpleasant taste or odour from the affected area
- Fever
- Nausea
- Fatigue
Initial management
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 care via NHS 24 or call 999.
If the airway is not compromised:
For adults:
- Recommend optimal analgesia (see Appendix 2).
- 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.
For children:
- Advise optimal analgesia, soft tooth brushing around affected area and rinsing the mouth after food.
Subsequent care
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.