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Managementul pericoronaritei

Pericoronarita este inflamatia tesuturilor moi asociata cu eruptia partiala a coroanei dentare si
in majoritatea cazurilor tine de molarii 3 mandibulari. Simptomele si semnele comune sunt
durerea, gustul neplacut, inflamatia si exsudatul purulent aparut sub tesuturile pericoronare si
agravarea din cauza traumei produse de dintele opus. Acesta este unul dintre criteriile
convenite de NIH (Institutul National de Sanatate a Americii) pentru nlaturarea molarilor de
minte i este cel mai frecvent motiv pentru extractia molarilor de minte n Marea Britanie,
dei prezena lor nu nseamn neaprat c dintele necesit ndeprtarea.
Daca cauza nu este inlaturata pericironarita poate recidiva necesitind tratament repetat. In
cazuri grave se poate dezvolta abcesul pericoronar acut care poate ramiine localizat ori poate
antrena unul sau mai multe spatii adiacente si poate fi asociat cu semne si simptoame atit
sistemice cit si locale.
Pericoronarita este o stare care tine de ajutorul medical primar si secundar si scopurile
acestora constau in oferirea ajutorului si profilaxia recedivelor.

Management
1.Factorii de risc:
1.1 prezenta dintelui/dintilor neerupti/erupti partial;
1.2 buzunare periodontale patologice adiacente la dintele neerupt/erupt partial;
1.3 dintele/dintii opusi in relatie (in contact) cu tesuturile pericoronare inconjuratoare a
dintelui/dintilor neerupti/ erupti partial;
1.4 antecedente ale cazurilor de pericoronarita;
1.5 igiena orala nesatisfacatoare;
1.6 infectiile cailor respiratorii.
2.Criterii de diagnostic
2.1 prezenta dintelui/dintilor neerupti/erupti partial;
2.2 semne/simptome de baza ale inflamatiei asociate tesuturilor pericoronare:
2.2.1 durere locala/discomfort;
2.2.2 edem;
2.2.3 eritem;
2.3 semne/simptome asociate:
2.3.1 exsudat purulent de sub tesuturile pericoronare;
2.3.2 deschiderea limitata a gurii;
2.3.3 senzatii gustative schimbate;
2.3.4 halena;
2.3.5 limfadenopatie cervicala;
2.3.6 prezenta afectiunilor asociate- abces pericoronar/cervical:
2.3.7 semne si simptome de sistem;
2.3.8 trauma cauzata de dintele/dintii opusi.
3. Tratament
Urmtoarele ar trebui s fie luate n consideratie n faza acut:
3.1 irigarea spatiului pericoronar;
3.2 utilizarea agenilor locali pentru a cauteriza esuturilor moi;
3.3 inlaturarea dintelui/dintilor opusi daca este prezenta ocluzia traumatica;
3.4 folositrea anesteziei locale;

3.5 utilizarea locala a antibioticelor in cazul afectarii locale severe sau a identificarii
simptomelor sistemice;
3.6 a da sfaturi cu privire la igiena orala;
3.7 utilizarea apei de gura- clorhexidina 0,12%.
Urmtoarele trebuie s fie luate n consideratie dup faza acut:
3.8 tratament chirurgical a tesuturilor moi;
3.9 extractia dintelui cauza.
Nota explicativa
3.1 irigarea spatiului pericoronar inlatura mecanic orice resturi care pot fi colectare in acest
spatiu. Solutia de irigare trebuie sa fie sterila. Din solutiile de irigare fac parte: apa pentru
injecii, ser fiziologic, clorhexidina si solutii anestezice locale.
3.2 Daca sunt folositi agentii pentru cauterizare, trebuie sa fie aplicati cu precautie si grija
pentru a evita lezarea tesuturilor adiacente.
3.3 Pericoronarita este o stare inflamatorie i NSAID trebuie sa fie considerat analgezicul de
electie cu exceptia cazurilor in care este contraindicat.
3.4 Utilizarea i alegerea antibioticelor este o intrebare controversata. Flora bacterian este un
amestec complex de microorganisme gram-pozitive i gram-negative i ar fi benevenita
utilizarea antibioticelor cu spectru larg de actiune sau a combinatiilor de antibiotice in
dependenta de situatia clinica.
MANAGEMENT OF PERICORONITIS
INTRODUCTION
Pericoronitis is inammation of the soft tissues associated with the crown of a partially
erupted tooth
and is seen most commonly in relation to the mandibular third molar. The common symptoms
and
signs are pain, bad taste, inammation of, and pus expressible from beneath, the pericoronal
tissues and
aggravation by trauma from an opposing tooth. It is one of the agreed criteria by the NIH
(National
Institute of Health, of America) for removal of third molars and is the commonest cited reason
for
removal of wisdom teeth in the UK though its presence does not necessarily mean that the
associated
tooth requires removal.
Unless the cause is removed pericoronitis may present as a recurrent condition requiring
multiple
episodes of treatment. In severe episodes an acute pericoronal abscess may develop which
may remain
localised or spread to involve one or more of the adjacent deep surgical spaces and may be
associated
with systemic as well as local signs and symptoms.
Pericoronitis is a condition that presents to both Primary and Secondary care sectors and these
guidelines are intended to assist in the management of the condition and the prevention of
recurrent
episodes.
MANAGEMENT
1. Risk Factors
1.1 Presence of unerupted/partially erupted tooth/teeth in communication with the oral cavity.

Vertical and distoangular mandibular third molars most commonly affected.


1.2 Pathological periodontal pocketing adjacent to unerupted/partially erupted teeth.
1.3 Opposing tooth/teeth in relation to pericoronal tissues surrounding unerupted/partially
erupted
tooth/teeth.
1.4 Previous history of pericoronitis.
1.5 Poor oral hygiene.
1.6 Respiratory tract infections.
2. Diagnostic Criteria
2.1 Presence of unerupted/partially erupted tooth/teeth in communication with the oral cavity.
2.2 Cardinal signs/symptoms of inammation associated with the pericoronal tissues:
2.2.1 Local pain/discomfort.
2.2.2 Swelling.
2.2.3 Erythema.
2.3 Associated signs/symptoms (variable expression):
2.3.1 Pus expressible from beneath the pericoronal tissues.
12.3.2 Restricted mouth opening.
2.3.3 Abnormal taste.
2.3.4 Halitosis.
2.3.5 Cervical lymphadenopathy.
2.3.6 Presence of associated disease - pericoronal/cervical abscess.
2.3.7 Systemic signs and symptoms.
2.3.8 Evidence of trauma by opposing tooth/teeth.
3. TREATMENT
The following should be considered in the acute phase:
3.1 Irrigation of pericoronal space.
3.2 Use of local agents to cauterise the soft tissues.
3.3 Removal of opposing tooth/teeth if traumatic occlusion with pericoronal tissues present.
3.4 Use of appropriate analgesia.
3.5 Use of appropriate antibiotics in the presence of severe local disease or if systemic
symptoms
identied.
3.6 Give advice regarding oral hygiene.
3.7 Use of 0.12% chlorhexidine mouthwash.
The following should be considered following resolution of the acute phase:
3.8 Local soft tissue surgery.
3.9 Removal of associated tooth/teeth
EXLPANATORY NOTES
3.1 Irrigation of the pericoronal space mechanically removes any debris that may have
collected
within the space. The irrigant should be sterile. Irrigants used include; water for injection,
normal saline, chlorhexidine and local anaesthetic solutions.
3.2 Caustic agents to cauterise the local tissues, if used, should be applied with caution and
appropriate care to avoid injury to adjacent tissues.
3.3 Pericoronitis is an inammatory condition and the NSAIDs should be considered the
analgesic of choice unless contra-indicated.
3.4 The use and choice of antibiotics is controversial. The bacterial ora is a complex mixture
of
gram-positive and gram-negative organisms and consideration should therefore be given to
the use of broad spectrum or combinations of antibiotics dependant upon the clinical

situation.