Dental Pain, Pericoronitis

Presentation

Patients, typically between the ages of 17 and 29, seek help because of painful swelling and signs of infection around a partially erupted or impacted third molar (wisdom tooth). There may be a bad taste caused by pus oozing from the area. The pain is usually quite intense and may radiate to the external neck, throat, ear, or oral floor. Occasionally there is trismus (the inability to open the jaws more than a few millimeters) or pain on biting. The site appears red and swollen, with a flap that may reveal a partial tooth eruption beneath it ( Fig. 47.1 ). There may be purulent drainage when the flap is pulled open. There should be no pain on percussion of the tooth.

Even with relatively minor enlargement of the operculum (flap), the third molar region of the mandible can be very painful. Cervical lymphadenopathy, fever, and malaise may be present in advanced cases. In severe cases there can be compromise of the airway.