Dra. Cléo Salustiano In this article
SummaryWhy the wisdom tooth gets inflamed and what the symptoms areWhat to do until your visit, what to avoid and when it is an emergencyFAQRead nextPericoronitis: Inflamed Wisdom Tooth, Symptoms and What to Do
Quick summary of this article+
Pericoronitis is inflammation of the gum that partly covers an erupting wisdom tooth, caused by food debris and bacteria trapped under that flap. The most common symptoms are pain at the back of the mouth, a swollen gum, bad taste, bad breath and difficulty opening the mouth. Until your visit, gentle brushing, warm salt-water rinses and soft foods help; do not put tablets on the gum, use alcohol, squeeze the area or take antibiotics on your own. The dentist cleans the area, treats the flare-up and assesses whether the wisdom tooth should be removed. Spreading swelling, fever or trouble swallowing or breathing call for an emergency room. In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) sees patients every day, from 8 a.m. to 10 p.m.
Pericoronitis is inflammation of the gum that partly covers a tooth that is still coming in, almost always a lower wisdom tooth (the lower third molar). This flap of gum creates a pocket where food debris and bacteria get trapped and are hard to clean. The usual result is pain at the back of the mouth, a red, swollen gum behind the last tooth, a bad taste, bad breath and sometimes difficulty opening the mouth or swallowing. Treatment starts at the dental office with careful cleaning of the area, and then the dentist assesses whether the wisdom tooth can stay or whether extraction is the more suitable option.
In clinical practice, many people say "my wisdom tooth is coming in and it hurts" and assume they just have to wait. Mild discomfort can happen while the tooth erupts, but a swollen gum, pus, fever or trouble opening the mouth are signs of inflammation or infection, not of normal eruption. Pericoronitis also tends to come back if the cause (the gum flap over the tooth and plaque buildup) is still there.
Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, explains why wisdom teeth become inflamed, how to recognize the symptoms, what is safe to do until your visit, what not to do and when to seek emergency care.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the general dentistry page to learn how the treatment is done here and book your assessment.
Why the wisdom tooth gets inflamed and what the symptoms are
Wisdom teeth are the last teeth to come in, usually in the late teens or early adulthood, and they often do not have enough room in the jaw. When the tooth only partly erupts, a band of gum (the operculum, or "flap") keeps covering part of the crown. Food and bacteria build up underneath, where a toothbrush barely reaches. The gum reacts with inflammation and, if it progresses, an infection with pus can develop. Another common factor is the upper tooth biting on that swollen gum with every bite, which injures it and makes the inflammation worse.
The most frequent symptoms are: pain at the back of the mouth that may spread to the ear, throat or head; a red, swollen, tender gum behind the last molar; bleeding or pus when the area is pressed; a bad taste and bad breath; pain when chewing or closing the mouth; and difficulty opening the mouth (trismus). In more intense cases there may be swollen lymph nodes under the jaw, facial swelling, fever and feeling unwell.
Not all pain around a wisdom tooth is pericoronitis. Decay in the wisdom tooth or the tooth next to it, a cracked tooth, jaw joint problems, gingivitis and even a sore throat can be mistaken for it. That is why an exam matters: the dentist examines the mouth, checks the position of the wisdom tooth and, when needed, requests an X-ray to see whether the tooth has room to come in, whether it is tilted or whether it is harming the tooth in front of it.
Treatment is usually done in stages. In the acute phase, the dentist gently cleans and irrigates the space under the gum, removes food debris and explains how to clean the area. If the upper tooth is biting the inflamed gum, an adjustment may be made. Medication, when needed, is prescribed by the professional after the exam, based on your health and the signs of infection. Once the flare-up settles, the dentist discusses whether the wisdom tooth can stay and be kept clean or whether extraction is the more suitable way to prevent new episodes. The article when to remove wisdom teeth covers this decision.
| What you feel | What it may be | What to do |
|---|---|---|
| Pressure or mild discomfort at the back, no swelling | Wisdom tooth erupting | Thorough hygiene; routine check-up |
| Red, sore gum behind the last tooth | Early pericoronitis | Book a visit; warm salt-water rinses |
| Bad taste, bad breath or pus near the wisdom tooth | Pericoronitis with infection | Visit as soon as possible |
| Pain when closing, with the upper tooth touching the gum | Gum being bitten by the opposing tooth | Visit for cleaning and adjustment |
| Facial swelling, fever, trouble swallowing or breathing | Spreading infection | Emergency room right away |
What to do until your visit, what to avoid and when it is an emergency
Until you are examined, a few simple steps can bring comfort safely: brush the area gently with a soft brush, without skipping the back of the mouth; rinse gently with warm water and a little salt after meals to help loosen food debris; choose soft foods and chew on the other side; drink plenty of water; and avoid smoking and alcohol, which irritate the gum. If you need a pain reliever, use it only as advised by a doctor, dentist or pharmacist and according to the package leaflet.
What not to do: do not place a tablet (such as aspirin) on the gum, as it can burn the tissue; do not apply alcohol, spirits, garlic or cleaning products; do not try to pierce or squeeze the gum to release pus; do not take leftover antibiotics or ones suggested by friends; and do not put a hot compress on your face when there is swelling. These measures can worsen the inflammation or hide important warning signs.
Go to an emergency room right away if there is swelling that grows quickly or spreads to the face, eye or neck, difficulty swallowing or breathing, fever, feeling very unwell or a mouth that barely opens. These are signs the infection may be spreading and need same-day care. For other kinds of pain that call for urgency, see toothache: when is it an emergency.
This content is for information only and does not replace an exam. Consult a dentist as soon as you notice an inflamed gum around a wisdom tooth, even if the pain improves, because pericoronitis tends to return. In Mooca, Dr. Cléo Salustiano sees patients every day, from 8 a.m. to 10 p.m., including Sundays and holidays, for general dentistry and dental emergencies in Mooca.
What is pericoronitis?
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It is inflammation of the gum around a tooth that has only partly erupted, almost always a lower wisdom tooth. The gum covering the tooth forms a pocket where food and bacteria build up, causing pain, swelling and sometimes infection.
Does a wisdom tooth hurt when it comes in? When is it normal?
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Mild, short-lived pressure or discomfort during eruption can happen. A very swollen gum, pus, bad taste, fever or difficulty opening the mouth are not part of normal eruption and point to pericoronitis or another problem that needs assessment.
Does pericoronitis go away on its own?
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Symptoms may ease for a few days, but the cause usually remains: the gum over the tooth keeps trapping plaque. That is why it tends to come back. It is best to be examined even if the pain has improved, to decide what to do with the wisdom tooth.
Do salt-water rinses help with pericoronitis?
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Gentle rinses with warm water and a little salt can help loosen food debris and bring comfort until your visit. They do not treat the cause and do not replace the cleaning done by the dentist or the assessment of whether other care is needed.
Does pericoronitis need antibiotics?
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Not always. In many cases, cleaning the area resolves the flare-up. When there are signs of a wider infection, the dentist may prescribe medication after the exam, taking your health into account. Do not take antibiotics on your own or use leftovers from other treatments.
Does every case of pericoronitis mean removing the wisdom tooth?
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Not necessarily. If the wisdom tooth has room to come in, is well positioned and can be kept clean, it can sometimes stay. When episodes keep returning, the tooth has no room or it harms the neighboring tooth, extraction is usually recommended. This decision is made after the exam and, when needed, an X-ray.
Where can I have an inflamed wisdom tooth checked in Mooca?
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In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) sees patients at Rua Hipódromo, 1141, near Bresser-Mooca station, Monday to Sunday, from 8 a.m. to 10 p.m., including holidays. Appointments via WhatsApp (11) 97409-7834, in Portuguese, English or Spanish.
