A partially erupted or impacted 3rd molar (wisdom tooth) is the most common site of pericoronitis and pericoronal abscesses. The accumulation of food and debris between the overlying gingival flap and crown of the tooth creates a focus for pericoronitis and subsequent abscess formation. The gingival flap becomes irritated and inflamed, and the tissue is repeatedly traumatized by the opposing molar tooth. The inflamed gingival process may eventually become infected and form an abscess. Foul taste, inability to close the jaw, and fever may occur. Swelling of the cheek and angle of the jaw and localized lymphadenopathy are also characteristic. More advanced disease may spread posteriorly to the base of the tongue, oropharyngeal area, and deep cervical spaces with resulting Ludwig angina and peritonsillar abscesses.
Management and Disposition
Superficial incision and drainage of the abscess with warm saline irrigation, analgesia, and antibiotic coverage and referral for possible extraction of the involved teeth are indicated.
Pericoronitis and abscess formation rarely occur in the pediatric population and tend to be late adolescent and adult processes; the mandibular 3rd molar is the most commonly involved tooth.
Airway compromise is a rare but potential complication from posterior extension of a pericoronal abscess.
Pericoronal Abscess. Note the inflamed fluctuant gingival tissue approximating the incompletely erupted third molar. (Photo contributor: James F. Steiner, DDS.)