Editing Toothache (section)

=====Pericoronitis=====
{{multiple image
| align     = right
| direction = vertical
| header    = Clinical & xray correlation of pericoronitis
| width     = 175
| image1    = 38 pericoronitis with pus.jpg
| alt1      = clinical shot of pericoronitis
| caption1  = An operculum (green arrow) over a partially erupted lower left third molar tooth. There is minimal inflammation and recurrent swelling.
| image2    = 38 pericornitis xray.jpg
| alt2      = xray of pericoronitis
| caption2  = A radiograph of the above tooth showing chronic pericoronitis, operculum (blue arrow) and bone destruction (red arrow) from chronic inflammation. Tooth is slightly disto-angular.
}}
[[Pericoronitis]] is inflammation of the soft tissues surrounding the crown of a partially erupted tooth.<ref name=Douglass2003>{{cite journal|last=Douglass|first=AB|author2=Douglass, JM |title=Common dental emergencies.|journal=American Family Physician|date=February 1, 2003|volume=67|issue=3|pages=511–6|pmid=12588073}}</ref> The lower [[wisdom tooth]] is the last tooth to erupt into the mouth, and is, therefore, more frequently impacted, or stuck, against the other teeth. This leaves the tooth partially erupted into the mouth, and there frequently is a flap of gum (an operculum), overlying the tooth. Bacteria and food debris accumulate beneath the operculum, which is an area that is difficult to keep clean because it is hidden and far back in the mouth. The opposing upper wisdom tooth also tends to have sharp cusps and over-erupt because it has no opposing tooth to bite into, and instead traumatizes the operculum further. Periodontitis and dental caries may develop on either the third or second molars, and chronic inflammation develops in the soft tissues. Chronic pericoronitis may not cause any pain, but an acute pericoronitis episode is often associated with pericoronal abscess formation. Typical signs and symptoms of a pericoronal abscess include severe, throbbing pain, which may radiate to adjacent areas in the head and neck,<ref name="Carranza11th"/><ref name="Fragiskos 2007" />{{rp|122}} redness, swelling and tenderness of the gum over the tooth.<ref name="Wray 2003">{{cite book|vauthors=Wray D, Stenhouse D, Lee D, Clark AJ |title=Textbook of general and oral surgery|year=2003|publisher=Churchill Livingstone|location=Edinburgh [etc.]|isbn=978-0-443-07083-9}}</ref>{{rp|220–222}} There may be [[trismus]] (difficulty opening the mouth),<ref name="Wray 2003" />{{rp|220–222}} facial swelling, and [[rubor]] (flushing) of the cheek that overlies the angle of the jaw.<ref name="Carranza11th"/><ref name="Fragiskos 2007">{{cite book|author=Fragiskos FD|title=Oral surgery|year=2007|publisher=Springer|location=Berlin|isbn=978-3-540-25184-2|url=https://books.google.com/books?id=wJHV_TqpL_sC&q=9783540251842}}</ref>{{rp|122}} Persons typically develop pericoronitis in their late teens and early 20s,<ref name=Zakrzewska2009 />{{rp|6}} as this is the age that the wisdom teeth are erupting. Treatment for acute conditions includes cleaning the area under the operculum with an antiseptic solution, painkillers, and antibiotics if indicated. After the acute episode has been controlled, the definitive treatment is usually by tooth extraction or, less commonly, the soft tissue is removed (operculectomy). If the tooth is kept, good oral hygiene is required to keep the area free of debris to prevent recurrence of the infection.<ref name="Carranza11th"/>{{rp|440–441}}