What is Pericoronitis?

Wisdom teeth are aptly named as they are the last teeth to erupt in life, usually coming in during your late teens or early twenties when a few more of life’s lessons have been learned. Pericoronitis occurs around a wisdom tooth that has failed to come in or has only partially erupted. A partially-erupted wisdom tooth can leave a flap of gum tissue that collects food particles and other debris - an ideal breeding ground for bacteria.

What are the symptoms of pericoronitis?

  • Unpleasant taste in the mouth, resulting from infected tissue
  • Halitosis (bad breath)
  • Pain and possible discharge of pus in the area of tooth involved
  • Swelling in the back of the mouth, to the point where biting may be difficult due to tissue pinched between teeth
  • Difficulty opening your mouth to its fullest extent

If you experience any of these symptoms, consider rinsing your mouth with warm salt water to help soothe the pain and cope with gum swelling. But be sure to visit the dentist as quickly as possible, as this infection will not clear on its own and may get worse.

How is pericoronitis treated?

First, your dentist will flush away the accumulated food particles and other debris from the area. Then, he or she will prescribe a course of oral antibiotics to clear up the infection. He or she will also recommend an antibacterial oral rinse that you can use to clear the infected area. You can also take over-the-counter pain relievers, or a pain reliever prescribed by your dentist, to manage the pain.

What happens next depends on the status of the wisdom tooth. Sometimes, pericoronitis develops near a tooth that is still in the process of erupting, which will continue to come in normally. In that case, your dentist will monitor the area to ensure that it stays clean and infection does not recur, until the tooth has fully come in. If your symptoms are severe, it may also be necessary to have minor oral surgery to remove the flap of gum tissue (called the operculum).

If it appears that the wisdom tooth will not come in normally, the dentist may recommend that it be removed. Sometimes, the dentist may remove both upper and lower wisdom teeth, to prevent the upper tooth from biting into the lower gum and causing further infection.

 Can I prevent pericoronitis?

Pericoronitis sometimes occurs even with excellent dental care. The best preventive strategy is to brush and floss regularly, use an antibacterial rinse, and follow any other recommendations your dentist gives you for good oral hygiene.

Source: Columbia College of Dental Medicine Dental library

Our clinic acquired The Gemini laser with a PBM adapter, allowing us to offer patients a pain

management therapy for TMJ and other discomfort patients may experience.

Photobiomodulation (PBM), or low-level laser therapy, is a non-invasive photo-chemical reaction where

light energy of a certain wavelength, intensity, and duration is absorbed at a cellular level, improving

local circulation, oxygenation, and enzyme activity. It has been clinically tested and shown to help

improve tissue repair and reduce pain and inflammation. The potential application of the PBM includes,

but not limited to:

  • Pain control after surgery and root canal therapy
  • Improved healing of implants and grafts.
  • Treating dry socket.
  • Eliminating the use of opioids.
  • Nerve regeneration.
  • Treating facial pain and TMD pain.
  • Treating soft tissue lesions such as cold sores and aphthous ulcers.
  • Preventing and/or treating mucositis (inflammation of the soft tissues)
  • Treating dentine hypersensitivity

Our digestive system (and our mouth belongs to it)  contains trillions of bacteria, viruses, fungi, and other microorganisms, that coexist in a delicate balance to regulate everything from your mental health to your skin’s sensitivity. If something happens to disturb this balance, for example, you take a course of antibiotics, you may experience symptoms ranging from digestive issues to psoriasis. The shift to more pathogenic flora causes tooth decay or caries. Oral streptococci, such as Streptococcus mutans and Streptococcus sorbrinus, are considered to be the main etiological agents of tooth decay in children. Other bacteria, such as Prevotella spp. and Lactobacillus spp., and fungus, that is, Candida albicans, are also related to the development and progression of early child caries.

That’s why fermented foods ( like kimchi, sauerkraut, and kefir ) that are rich in probiotic bacteria get such high marks in health circles. Your mouth, as I have mentioned before, is the entry point to your gut, and contains a similar community of important organisms that help to regulate your whole body.

 

Of course, we are all aware of the need to maintain good dental hygiene. What is changing about that now is twofold. One, we are understanding more about how the microbiome can impact things inside and outside our mouths. And two, the idea of “clean at all costs”  is changing.  Bad breath and cavities are signs of an unbalanced gut microbiome. It is a chicken-or-egg situation. They go hand in hand and one can facilitate the other. Some infections in other parts of your body tend to coexist with bacterial imbalances in the mouth. Some ear infections, as well as gum disease, and some infections in the throat can be a sign of problems with the oral microbiome.

teeth

Keeping balance in the microbiome isn’t just about elimination bad bacteria, however. It’s also about letting good bacteria thrive, which brings us to public-health-enemy No.1 for doctors of different specialties: mouthwashes with alcohol and sodium lauryl sulfate (SLS). These ingredients absolutely blast your mouth and give you this intense feeling of cleanliness. But it is ephemeral. If you checked the bacterial balance in your mouth about an hour later, it would be skewed towards the bad bacteria.  A better way to care for your oral microbiome is to keep your tongue clean. The tongue is like a rug, bacteria get into the grooves and stay there under anaerobic (no oxygen) condition. Diet also makes a big difference: the healthier, more versatile and lower in sugar the diet is, the easier it will be to maintain a healthy oral microbiome. 

 

Nasal rinses and mouthwashes, which directly impact the major sites of reception and transmission of human coronaviruses (HCoV), may provide an additional level of protection against the virus. In the experiment, performed by Craig Meyers and his colleagues and published in the Journal of Medical Virology (2020, Sep 17), the researchers created cells grown from human tissue and then infected them with HCoV. HCoV is a human coronavirus 229e played the role of a surrogate for SARS-CoV-2. They subjected the virus to several common, over-the-counter mouthwashes and rinses for 30 seconds, 1 minute, and 2 minutes, and measured how much of the virus was inactivated. The reported results were the following:

• Peroxide Sore Mouth (CVS), Orajel Antiseptic Rinse (Church & Dwight Co.), and 1.5% H2O2 (Cumberland-Swan) — all of which listed hydrogen peroxide as their active ingredient — inactivated less than 90% to as much as 99% of the HCoV, depending on contact time.

• Crest Pro‐Health (Proctor & Gamble) mouthwash inactivated 99.9% to more than 99.99% of the HCoV during all three contact times.

• Listerine Ultra (Johnson & Johnson Consumer), Equate (Wal-Mart Co.) and Antiseptic Mouthwash (CVS) inactivated less than 99.9% of the HCoV at 30 seconds.

• Listerine Antiseptic (Johnson & Johnson Consumer) mouthwash which, according to researchers, had the same or similar inactive ingredients as Listerine Ultra, Equate and Antiseptic Mouthwash inactivated more than 99.9% of the virus at 30 seconds.

However, per Hana Akselrod, MD, MPH, before we start telling our patients to use mouthwash to prevent the spread of the coronavirus, we still need to learn how mouthwashes, nasal rinses and sinus rinses would work in the nose, mouth and throat of individuals infected with COVID-19, not in a simulated environment. We also need to answer questions, like how long would you have to gargle with mouthwash, as well as how often would you have to gargle? Is it safe for people to use mouthwashes and nasal rinses for the purposes of preventing the spread of the coronavirus?

Source: healio.com, PubMed.gov

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