Treatment
Acute Pericoronitis — Local Treatment
Irrigation, debridement, and analgesia
- • Irrigation of pericoronal space with saline or 0.12% chlorhexidine using a blunt-tipped syringe
- • Gently remove food debris from under the operculum with a curette
- • Antiseptic mouth rinse (0.2% chlorhexidine) three times daily
- • NSAIDs (ibuprofen 400-600 mg TID) for analgesia and anti-inflammation
- • If opposing maxillary third molar is traumatizing the operculum — consider temporary reduction of opposing cusp or extraction of upper third molar
Antibiotic Therapy
Reserved for moderate-to-severe cases with systemic involvement
- • First choice: amoxicillin 500 mg TID for 5-7 days
- • If penicillin allergic: metronidazole 400 mg TID or clindamycin 300 mg TID
- • Combination: amoxicillin 500 mg + metronidazole 400 mg TID for severe cases
- • NOT indicated for mild local pericoronitis without fever or lymphadenopathy
Definitive Treatment
Surgical management after acute phase resolves
- • Operculectomy: surgical removal of the overlying operculum — only if the tooth has adequate room to erupt and is in favorable position
- • Extraction of the offending wisdom tooth: definitive treatment if tooth is impacted or malpositioned — typically 2-3 weeks after acute infection resolves
- • Fascial space drainage: incision and drain placement if deep space infection has developed
- • Hospital admission and IV antibiotics for airway-threatening infection