Inflammation during teething in adults and children, wisdom tooth pericoronitis, symptoms and diagnostic features

The inflammatory process of the periodontal soft tissues that occurs during complicated or improper teething is called pericoronitis. Inflammation during teething can occur in both adults and children, regardless of the location of the problem tooth, but most often pericoronitis of the wisdom tooth develops (it is also often called the “eight” or third molar).

Causes of inflammation and swollen gums during teething

The main prerequisites for the development of pericoronitis are:

Mechanical injuries to the gingival tissue over the tooth germs due to hard foods, too hard toothbrushes, as well as due to other damaging factors.
Long-term or difficult teething.
Favorable conditions in the mouth for the accumulation of bacterial plaque and food particles under the gingival margin (insufficient hygiene, peculiarities of microflora in the oral cavity).

Swollen gums during teething are easily susceptible to traumatic influences, which leads to the development of inflammation. In this case, teething itself can be difficult for the following objective reasons:

Dense bone tissue in the “eight” zone; bone compaction is most often formed because there are no milk teeth in this zone.
There is not enough space for the “eight” in the dentition.
Thickening of the gums and periosteum in the posterior part of the jaw is usually explained by the characteristics of embryogenesis.

Even one of these factors can cause the disease.

How to help a child?

It is impossible to speed up the process of teeth appearing - sometimes it drags on for weeks (for one tooth). The maximum that parents can do is to reduce the number of unpleasant symptoms.

Vibucol suppositories can be used as a sedative.
As a pain reliever - children's versions of Nurofen and Panadol.
As a hygiene product for the oral cavity - gel-based anti-inflammatory toothpastes for children from 0 years old. Asepta Baby paste is designed for little ones. It does not contain fluorides, parabens, or abrasives. Gently cleans teeth, saturating them with calcium. The paste tastes good and is safe - if the child wants, he can swallow it without harm.

Read more about ways to help your baby during teething in other articles in this section.

Features and risk factors

During difficult and prolonged eruption, the tooth germ practically does not change its position, and a significant part of its chewing surface is covered with a flap of gingival or mucoperiosteal tissue, the so-called “hood”. The flap covering the tooth germ forms a kind of pocket in which food debris and bacterial plaque accumulate. A moist nutrient medium creates optimal conditions for the intensive reproduction of pathogenic microorganisms, which, in turn, actively secrete waste products that are toxic to our body. This provokes the development of an infectious-inflammatory process in the tissues surrounding the problematic tooth germ.

Most often, inflammation of the gums occurs when a wisdom tooth erupts in the lower jaw, which is due to the anatomical structure of the jaw and the lack of space for third molars. In modern people, the jaw arch is approximately 1-1.2 cm smaller than in our distant ancestors, but the size of the teeth has remained the same. This is why the “eights” are cut much later, when the body as a whole and the dental system in particular have already formed - and because of this, it is difficult for the new tooth to find the “right” place on the dental arch.

Since wisdom tooth pericoronitis is the most common type of disease, people over the age of 18 are primarily at risk (usually “eights” are cut at the age of 20-25, but for some this process can take up to 30 years) . As for pericoronitis in children, it usually occurs against the background of insufficient oral hygiene in a child or with infectious diseases of the oral cavity (caries, gingivitis, stomatitis), which complicate teething in children and require treatment. Accumulations of plaque and hard dental deposits significantly increase the risk of developing the disease, so timely and regular removal of tartar can serve as a good preventative method.

Pericoronitis, symptoms and types

With pericoronitis, the symptoms largely depend on the form of the disease - acute or chronic. Acute pericoronitis is characterized by:

Aching intense pain in the area of the cutting tooth, the pain intensifies under the influence of food and mechanical irritants (hygienic procedures, chewing, touching, etc.).
Difficulty chewing food, complicated swallowing. A few days after the onset of inflammation, it becomes difficult to open the mouth and severe pain appears.
Swelling and hyperemia of the mucous membrane.
Enlargement of regional lymph nodes, sometimes the lymph nodes become painful when touched.
Externally noticeable swelling of the cheeks a few days after the onset of the inflammatory process.
General deterioration in health - weakness, lethargy, prolonged low-grade fever (increased temperature to 37-37.5 degrees).
Bad breath, which is caused by the decomposition of food particles and the active activity of microorganisms in the “hood” space.

Acute pericoronitis can occur in a serous (catarrhal) or purulent form: in the first case, the signs of inflammation are more pronounced, the pain is more intense, and there is no purulent discharge. In the second case, purulent exudate flows freely from the inflammatory focus, due to which tissue tension is somewhat reduced and the symptoms are less pronounced. A person may feel like their condition is gradually improving, when in fact the infection is simply spreading to other tissues in the mouth.

If treatment for acute pericoronaritis was not carried out or was carried out at home, the disease gradually becomes chronic: the severity of symptoms decreases, while exacerbations of pain and discharge of pus into the oral cavity are periodically observed. In this case, there is a high risk of developing severe complications.

Types of pericoronitis

Depending on the complexity and localization of inflammation, pericoronitis is divided into:

Spicy.
The initial stage of the disease, which is characterized by pain, hyperemia and swelling of the gums. In case of acute pericoronitis of a wisdom tooth, there is no purulent discharge and the general condition of the patient does not suffer. With proper timely treatment, this type of disease disappears in 3-5 days.
Ulcerative.
The disease develops against the background of epithelium damaged by fusospirochetes. A characteristic symptom of ulcerative pericoronitis is the appearance of a necrotic rim along the edges of the gums. Small ulcers form on the mucous membrane. When plaque is removed from the gum surface, bleeding begins.
Purulent
Pericoronitis, as a rule, occurs in a subacute form and is manifested by severe pain. Pus is released from the source of inflammation, and the temperature rises. In the absence of timely treatment, the disease can provoke the formation of abscesses, phlegmon and periostitis.
Posteriormolar.
The disease develops when molars erupt incorrectly. A gingival hood forms, which then becomes infected due to the active proliferation of bacteria.

Complications of the disease

In the case when treatment of the gums during complicated tooth eruption was not carried out, serious complications of the inflammatory process develop:

Cyst treatment

A dental cyst is treated either with therapeutic methods or with surgical intervention. The first ones are used in simple cases.

Surgery involves two types of operations - cystotomy and cystectomy. In both cases, local anesthesia is used. With cystomy, only the anterior wall of the cyst is removed. This is a less traumatic option, as it allows you to preserve the rudiments of permanent teeth during surgery on milk teeth.

Cystectomy is performed if the size of the cyst does not exceed 1.5 cm. This operation is more difficult, but postoperative recovery is much faster.

No matter how small and insignificant the swelling may seem to you, contact your dentist. This will avoid complications. And the problem will be resolved more easily and in a short time. Remember that no rinses, infusions or other folk remedies can guarantee recovery.

Pericoronitis, treatment in children and adults

It should be noted right away that for pericoronitis, treatment at home can only reduce the symptoms of inflammation, but not solve the problem. Therefore, all home methods (rinsing with antiseptics, applying anti-inflammatory ointments, etc.) can only be used as a way to relieve inflammation during the eruption of wisdom teeth and reduce pain - this is a temporary measure before visiting the dentist.

In a dental clinic, in case of complicated teething, treatment will depend on whether the problem tooth should be preserved or whether it should be removed. If preserved, the doctor performs surgical excision of the “hood” under local anesthesia. This eliminates conditions for the accumulation of food and the growth of bacteria, and also facilitates teething. After excision of the “hood,” the patient is prescribed antiseptic therapy (rinses, baths) and, if necessary, antibiotic therapy.

In cases where tooth extraction is indicated due to their incorrect position on the jaw, lack of antagonists, or insufficient space for full eruption, the doctor immediately removes the problematic tooth and prescribes antiseptic therapy to the patient.

In some cases, at the initial stages of the inflammatory process, conservative therapy can be preliminarily applied - local treatment with antiseptic rinses and the introduction of an iodoform tampon into the “hood”. However, local therapy does not always give a positive result; moreover, it is appropriate only at the initial stage of the disease; in other cases, surgical intervention will be required.

When it comes to teething in children, treatment is always aimed at preserving the teeth (except for those cases when dystopia is clearly expressed and the doctor sees that preserving is useless).

A lump on an area of the gum where there is no tooth yet: what to do in this case?

A couple of weeks before the tooth erupts, a cyst may appear on the gum, looking like a lump filled with a clear or bluish liquid. Such bumps are by no means common: dentists do not consider such formations to be a pathology requiring treatment. In addition, such formations on the gums in no way indicate an inflammatory process.

According to statistics, a small percentage of children are affected by the appearance of such a cyst. The child may not even suspect that he has a lump in his mouth, because if he touches it, there is no pain. However, a dental examination is still necessary, because the inflammatory process may still begin, in which case intervention will be required. The presence of inflammation is indicated by such signs as increased body temperature, pain when touching the lump, and swelling of the mucous membrane.

Most parents do not like the fact that their child has a lump in his mouth: in this case, you can ask the dentist to make an incision under anesthesia, as a result of which the fluid inside the cyst will come out. As a rule, when part of the cyst is removed, the crown of the tooth about to erupt is visible.

Diagnostic features

History of the disease Pericoronitis sometimes looks like a completely different disease of the oral cavity - for example, its symptoms can be confused with periodontitis (inflammation of the peri-apical tissues of the oral cavity) or pulpitis (inflammation of the dental pulp). The pain in these diseases is very similar, and periodontitis is often accompanied by hyperemia and swelling of the gums. One disease can be distinguished from another by the following signs: with pulpitis there is no pain when opening the mouth and no noticeable swelling of the gums, and periodontitis develops only at the tops of the roots of fully erupted teeth. You also need to pay attention to the presence of a characteristic “hood” - a photo will help you assess how it looks with pericoronaritis.

When teeth start cutting

There is no exact answer as to what time a child’s teeth are cut – the timing varies from person to person. However, you can focus on the average, standard periods of eruption approved by WHO:

the lower incisors appear at 6–7 months;
upper – at 7–8 months;
upper lateral incisors – at 8–9 months;
the lower ones are closer to a year.

According to the standard, a one-year-old child must have eight baby teeth.

From one year to one and a half years, the child acquires larger teeth - upper and lower molars, and from fifteen to twenty months - upper canines, which are also called “ocular.” The fact is that the optic nerve runs next to them, so these teeth are often more difficult for the child than others. Irritation of the nerve causes sharp pain and sometimes watery eyes.

It can be difficult even for a doctor to understand that the first teeth are being cut. After all, this process is often accompanied by an increase in temperature, changes in stool and mood, and refusal to eat.

Prevention

In some cases, especially when it comes to inflammation of the gums during teething in children, preventive measures will help prevent the disease: careful regular oral hygiene, timely removal of tartar and soft deposits, visits to the dentist for diagnostic examinations at least once every six months.

If pericoronitis is caused by the anatomical features of the structure of the dental system and the lack of space for the lower “eights” on the dental arch, preventive measures will only smooth out the course of the inflammatory process (due to timely cleaning of the oral cavity from bacterial plaque and food particles that create favorable conditions for inflammation) and identify the problem in time (subject to regular dental examinations).

The color of the first teeth, which should alert you

It is the color of the enamel of the first teeth that can indicate certain pathological processes occurring in the baby’s body:

a blackish tint indicates excessive abuse of drugs and foods high in iron. Somewhat less often, such a shade may indicate a chronic process of inflammatory origin in the baby’s body.
brownish tint of teeth, with yellowness - a mother who is breastfeeding her baby is abusing antibiotics, or the child herself is being stuffed with drugs from this group beyond measure.
a yellowish tint of teeth, with a greenish coating , indicates blood diseases, and a reddish tint indicates a congenital disorder of metabolic processes, the production of a special pigment, porphyrin.

When a child's first teeth appear, they need to be looked after. Even the first, one tooth needs to be cleaned; you can use a clean bandage for mechanical cleaning or a special silicone attachment.

Gradually, you can get into the habit of using baby toothpaste and a brush with soft, natural bristles. They change it every month - until the child is 2 years old, parents brush the baby’s teeth, after which they accustom the child to the procedure. You should teach your child this hygiene procedure in the format of a game - a brush in the shape of a funny dinosaur and a toothpaste with a banana flavor will help with this.

Parents should regularly examine their baby’s oral cavity - this will help identify any dental problems at the very beginning and take timely measures to avoid serious complications.