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PubMed1993

Microbiology of the pericoronal pouch in mandibular third molar pericoronitis.

The microorganisms associated with mandibular third molar pericoronitis were investigated using direct microscopy and anaerobic culture method. The pericoronal pouch was sampled with paper points in A) 8 patients without mandibular third molar pericoronitis and B) 6 patients with mandibular third molar pericoronitis. Under the microscope, the microflora was found to be a complex mixture comprising gram-positive and gram-negative cocci, rods and filaments (including fusiform and curved rods), motile rods and spirochetes. Significantly higher proportions of motile, gram-negative rods were found in group B than in group A. The predominant cultivable microflora of 9 samples: A (4) and B (5) comprised several species of facultative and obligate anaerobic bacteria, namely Peptostreptococcus, Streptococcus, Actinomyces, Eubacterium, Propionibacterium, Veillonella, Porphyromonas, Prevotella, Bacteriodes, Fusobacterium, Campylobacter, Staphylococcus, Stomatococcus, Lactobacillus, Neisseria, Capnocytophaga, Haemophilus, Selenomonas and Centipeda species. The microflora in pericoronitis appeared similar to that of diseased periodontal pockets.

Adolescent↗
PubMed1986

Inflammatory cells and bacteria in pericoronal exudates from acute pericoronitis.

The present work is one in a series of studies carried out to verify the relationship between bacteria and gingival tissues in pericoronitis. Exudates from 6 cases of acute pericoronitis were examined by light and electron microscopy, including ultrathin sections and negative staining. While bacterial phagocytosis was prevalent in all the exudates studied, spirochetes, which were the predominant microorganisms, were not observed being phagocytized by PMNs or macrophages. The presence of spirochetes in pericoronitis as compared with acute necrotizing ulcerative gingivitis is discussed.

Acute Disease↗
PubMed2003

The predisposing factors of pericoronitis of mandibular third molars in a Jordanian population.

OBJECTIVES: The purpose of this study was to identify the most frequently encountered predisposing factors in relation to the etiology of pericoronitis in young adults and to compare these findings with similar studies. METHOD AND MATERIALS: The patients included in this prospective study were those presenting for treatment of signs and symptoms of pericoronitis in the mandibular third molar area during an 8-year period from 1994 to 2001. A standard check sheet of subjective and objective observations was completed, and female patients were asked about menstruation or pregnancy. Each patient with a diagnosis of pericoronitis was interviewed and observations were recorded. Patients were asked about the symptoms relating to the pericoronitis. Patients were divided into five 5-year age groups ranging from 16 to 40 years. RESULTS: During the 8-year period, 2,151 patients presented diagnosed cases of pericoronitis; 932 (43.3%) patients were male and 1,219 (56.7%) were female. The peak age of occurrence of pericoronitis varied from 21 to 25 years (55.2% of the patients). The incidence of pericoronitis was highest in September (207 [9.6%]), followed by April (181 [8.4%]); for subacute pericoronitis, the highest was in February (128 [5.95%]) and April (112 [5.2%]), followed by October (97 [4.5%]). The most frequently seen predisposing factor was upper respiratory tract infection in 815 (37.9%) patients, followed by stress in 473 (22%) patients. CONCLUSION: It was concluded that the upper respiratory tract infection was the most frequently predisposing factor, which could precipitate pericoronitis.

Adolescent↗
PubMed1989

[The relation of pericoronitis to the position of the mandibular third molar].

Pericoronitis is the most commonly encountered pathologic condition involving the mandibular third molar. Because of the dangers associated with mandibular third molar pericoronitis, prophylactic extraction of third molar at high risk has been recommended. We studied 411 patients with mandibular third molar pericoronitis by clinical symptoms and radiographic measurement of mandibular third molar height, wideth and angulation. The results were as follows: 1. Mandibular third molar pericoronitis is frequently seen in third decade and there are no sexual difference significantely. 2. In inflammatory type of mandibular third molar pericoronitis, chronic pericoronitis occured more frequently than acute type. 3. In relation to angulation and height, mandibular third molar most likely to be afflicted with pericoronitis is vertical eruption at occlusal plane of the second molar. 4. In relation to angulation and width, it appears that the position of the mandibular third molar most likely to be afflicted with pericoronitis is in a vertically erupted tooth of which the space between the ramus and the distal side of the second molar is less than the mesiodistal diameter of crown. (Class II). 5. In relation to height and width, it appears that the position of the mandibular third molar most likely to be afflicted with pericoronitis is class II width (described above)at occlusal plane of the second molar.

Adolescent↗
PubMed1995

Respiratory tract infections and concomitant pericoronitis of the wisdom teeth.

OBJECTIVE: To discover if there is an association between respiratory tract infections and pericoronitis of erupting third molars in young adults. DESIGN: Data from male military conscripts' medical records were collected over five years and the incidence of respiratory tract infection before and after acute pericoronitis (191 cases) and before and after standard (722 cases) and operative (741) extractions compared with that in controls (n = 703) who had no infections in the third molar regions. SUBJECTS: 14,500 male military conscripts aged 20. SETTING: Garrisons in Valkeala and Kouvola, Finland. RESULTS: The incidence of respiratory tract infection was significantly higher during the two weeks before acute pericoronitis was diagnosed compared with that in controls. The highest incidence was observed in the three days before pericoronitis (odds ratio 6.8; 95% confidence interval 3.0 to 15.0). The incidence was also increased in the first week after pericoronitis (odds ratio 3.7; 1.6 to 8.4) and three days before (odds ratio 2.6; 0.9 to 7.5) and during the first week after extraction of third molars (odds ratio 2.6; 1.3 to 5.3). CONCLUSIONS: Respiratory tract infection may precipitate and occur concomitantly with acute pericoronitis. Third molar surgery for pericoronitis, on the other hand, may trigger respiratory tract infection.

Acute Disease↗
PubMed1996

Pericoronitis and tonsillitis: clinical and darkfield microscopy findings.

OBJECTIVE: Upper respiratory tract infections and tonsillitis and pharyngitis in particular increase the risk of lower third molar pericoronitis. The study was made to investigate clinical and microbiologic associations between pericoronitis and tonsillitis. STUDY DESIGN: The subjects were 20-year-old Finnish male conscripts. Thirty-eight patients had tonsillitis without and 33 patients had tonsillitis with a symptom-free erupting lower third molar; 27 patients had pericoronitis but healthy tonsils. All subjects were examined clinically. Bacterial samples were taken from healthy and diseased tonsils and from healthy and diseased third molar pericoronal pockets. The microbes were classified morphologically with the use of a darkfield microscope. RESULTS: Eighty-two percent of infected tonsils had deep crypts and 52% of them exudated pus compared with 36% (p < 0.001) and 0% (p < 0.001) in healthy tonsils, respectively. Infected lower third molars were less than half erupted and had on average 8.8 mm deep pericoronal pockets compared with pockets 5.5 mm deep recorded in symptom-free cases (p < 0.001). Spirochetes were more common in infected pockets than in symptom-free cases comprising 8.2% versus 3.0% of the total bacterial count (p = 0.044). Rods were more common in infected tonsils than healthy ones (8.9% versus 4.8%, p = 0.041). CONCLUSION: There were similarities in morphologic microbiota of pericoronitis and tonsillitis. However, clinical findings of tonsils did not appear to link with the findings of third molars.

Adult↗
PubMed1992

The mandibular third molar position as a predictive criteria for risk for pericoronitis: a retrospective study.

During the 6-month period from mid February 1988 to mid August 1988, 148 patients presented with 154 diagnosed cases of mandibular third molar pericoronitis. All patients were members of the recruit population stationed at the Recruit Training Command, Great Lakes, Illinois. Selected clinical parameters relating to the orientation and eruption status of these third molars were collected and analyzed. The goal was to obtain a predictive clinical profile of the impacted mandibular third molar (MTM) at greatest risk for pericoronitis in the young naval and Marine Corps personnel. The majority of pericoronitis cases, 120 of 148 or 81.0%, involved vertically oriented MTMs; of this total, 79.1% were erupted to the approximate height of the occlusal plane of the arch. The remaining 20.9% were at or below the height of contour of the adjacent tooth. Mesioangular impacted MTMs accounted for only 11.2% of pericoronitis cases. The remaining cases comprised distoangular and horizontally impacted MTMs (3.4% and 3.8%, respectively). Involvement by impinging maxillary dentition was observed in 39.7% of the vertically oriented MTMs, 56.2% of the mesioangular oriented MTMs, 40.0% of the distoangular MTMs, and 14.0% of the horizontally impacted MTMs. The mean value for occlusal coverage by a soft tissue operculum observed for all MTMs in this study was 49%. In the population studied, risk for pericoronitis appears to increase with greater vertical orientation and height of eruption. The absence of impinging maxillary dentition did not eliminate the risk of mandibular third molar pericoronitis. These data have implications for targeting treatment needs of naval and Marine Corps personnel who may be without dental support for extended periods of time.

Adult↗
PubMed2005

Role of TNF-alpha and its receptors in pericoronitis.

The classic stimulus for cellular cytokine production is bacterial lipopolysaccharide (endotoxin). It was therefore hypothesized that tumor necrosis factor-alpha (TNF-alpha) may be responsible for pericoronitis. TNF-alpha and its receptors were detected by immunohistochemical staining in third molar pericoronitis in ten patients and ten healthy control samples. The percentage of TNF-alpha positive cells was high in pericoronitis (p = 0.0317). TNF receptors TNF-R1 and TNF-R2 were found in macrophage- and fibroblast-like cells, vascular endothelial cells in post-capillary venules, and basal epithelial cells in pericoronitis, but were only weakly expressed in controls. Increased expression of interleukin-1beta and vascular cell adhesion molecule-1 was found as a biological indicator of TNF-alpha ligand-receptor interaction. Explanted tissues acquired destructive potential upon TNF-alpha stimulation, whereas TNF-alpha blockers controlled it in inflamed tissues. These findings suggest that, in pericoronitis, inflammatory and resident cells produce and respond to potent pro-inflammatory cytokine TNF-alpha, with pathogenic and potential therapeutic relevance.

Adult↗
PubMed1984

A scanning electron microscopic study on the microflora of chronic pericoronitis of lower third molars.

In nine cases of chronic pericoronitis of lower third molars, the affected teeth were carefully removed with the follicles in situ and prepared for scanning electron microscopic (SEM) study. The study disclosed great heterogeneity in the distribution and density of microorganisms on hard as well as soft tissues surrounding the pericoronal pouch. Common features were presence of discrete microenvironments with clusters of bacteria, a decrease in the number of organisms toward the bottom of the pericoronal pouch, and the high proportion of spirochetes, which tended to increase in an apical direction. The study showed leukocytic activity in all areas, and phagocytosis apparently took place on the tissue surfaces within the pericoronal space.

Adult↗
PubMed2005

Is malaria a predisposing factor for third molar pericoronitis in the tropics?

BACKGROUND: Malaria is an important disease in the tropics, and its role as a predisposing factor or co morbidity has been investigated in many diseases including HIV infection and tuberculosis. There are very few studies, which have investigated its role in oral and dental diseases. Our study aimed to demonstrate the possible role of malaria in predisposing to pericoronitis, an infection affecting impacted third molars predominantly. PATIENTS AND METHODS: Thirty-eight patients presenting with pericoronitis were tested for malaria parasites and results compared with that obtained from controls that were equally susceptible to pericoronitis but did not have the infection. RESULTS: 19.7% of the study group compared to 6.6% of control group had malaria parasite in their blood. This difference was statistically significant, P=0.018 (Fisher's exact). The odds ratio was 4.3 (95% CI=1.2-17.0). CONCLUSIONS: Malaria appears to be a predisposing factor to pericoronitis in this study. There is a need for further studies on the possible role of malaria in oral and dental diseases.

Adult↗
PubMed1985

Pericoronitis: a reappraisal of its clinical and microbiologic aspects.

Pericoronitis is an infectious disease of the operculum overlying an erupting or semi-impacted tooth. It manifests itself mainly in late adolescence and young adulthood and nearly always occurs around the lower third molar. The distinctive location, age, clinical picture, and link with predisposing factors warranted a reappraisal of pericoronitis and its etiology. Spirochetes and fusobacteria proved prevalent at all stages of the disease. The presence of these microbacteria may provide a clue as to the late appearance, particular location, and singular clinical picture of pericoronitis. The fact that spirochetes and fusobacteria are also found in acute necrotizing ulcerative gingivitis, and have been associated with alveolar osteitis, indicates a possible relationship between these disorders and pericoronitis.

Adolescent↗
PubMed1996

Clinical/biological outcomes of treatment for pericoronitis.

PURPOSE: This prospective clinical study was designed to determine the clinical and biologic outcomes of treatment for minor signs and symptoms of pericoronitis. PATIENTS AND METHODS: Patients (n = 20) with all third molars, presenting consecutively to an academic clinical center for treatment of minor signs and symptoms of pericoronitis, were enrolled in the study. At the initial visit, gingival crevicular fluid (GCF) samples to assess levels of the cytokines interleukin- 1b (IL-1b) IL-1b and prostaglandin E2 (PGE2) as a measure of the host inflammatory response, and plaque samples to identify microorganisms, were collected from the distal of all second molars and the mesial of first molars. Standardized vertical bite wing radiographs were taken to assess alveolar bone height on the distal of the second molars and the inclination and the degree of eruption of the third molar. Full-mouth periodontal probing was conducted to determine probing depths and relative clinical attachment levels (CAL). Pain levels were assessed with Gracely verbal descriptor scales for sensory intensity and unpleasantness and 10-cm visual analog scales. Symptomatic third molar sites were treated with local debridement and irrigation after baseline data collection. One week after entry, data were collected again. Subsequently, the patients were scheduled for removal of all third molars. Data collection was repeated 3 months postsurgery. As controls, data were collected from 12 subjects who had asymptomatic third molars removed previously. RESULTS: At entry, symptomatic mandibular third molars (n = 21) were mostly vertical (n = 18) and at or above the occlusal plane (n = 19). No maxillary teeth had symptoms. Microbial counts were elevated for specific anaerobic microorganisms. GCF IL-1b levels were elevated at the distal of second molars adjacent to symptomatic third molars, as compared with asymptomatic third molars and second molars in control patients. Alveolar bone levels and CAL on the distal of second molars were normal. At 1 week, patients' pain symptoms and IL-1b levels were reduced, but microbial counts remained high. Three months after surgery, patients had no pain symptoms, and alveolar bone levels and CAL were similar to entry levels. IL-1b levels were elevated at both the distal of second molars and the mesial of first molars for all patients; microbial counts decreased, although not to levels of control patients. No increase in microbial counts for Porphyromonas gingivalis or Bacteroides forsythus, or GCF PGE2 levels, risk factors for progressive periodontal disease, was detected in samples taken from the study patients. CONCLUSION: Pericoronitis expressed by minor signs/symptoms in these patients was associated with considerable discomfort. Symptomatic mandibular third molars were vertical and at or near the occlusal plane. Additionally, this condition was characterized by microbial flora and GCF inflammatory mediator levels that are more consistent with gingivitis than periodontitis. Removal of third molars eliminated symptoms, but the microbial burden and an affected patient's inflammatory response, as measured by IL-1b levels, remained elevated as compared with controls. Further study is needed to determine which of these factors can be used to identify patients at risk for pericoronitis before symptoms arise.

Adolescent↗
PubMed2003

Flow-cytometric analysis of T-lymphocyte subsets after different treatment methods in patients with pericoronitis.

PURPOSE: The aim of this study was to determine whether there was any change in T-lymphocyte subsets in patients with periocoronitis after the application of different treatment methods. PATIENTS AND METHODS: Twenty-six patients with acute pericoronitis were included in the study. In every phase of the treatment (pretreatment, postcurettage, and postextraction), the biopsy samples were taken from the gingival tissues at sites of pericoronitis. Then, CD4(+) and CD8(+) lymphocyte and CD4(+)/CD8(+) ratio values were determined using flow cytometry in the biopsy samples. At the same time, gingival index (Löe-Silness) and plaque index (Silness-Löe) scores were recorded to assess the periodontal status in patients. To determine the correlation between the clinical measurements and the laboratory results obtained before the treatment, after curettage, and after extraction, we conducted an analysis using a paired t-test. RESULTS: The normal values in peripheral blood of CD4(+) and CD8(+) lymphocytes are 25% to 29% and 19% to 48%, respectively. However, the CD4(+) and CD8(+) lymphocyte values in the patients with acute pericoronitis were found to be 22.12% +/- 6.15% and 7.69% +/- 4.12%, respectively. These values are lower than the normal values. The CD4(+) lymphocyte value increased to 31.06% +/- 7.09% postcurettage and to 32.24% +/- 3.11% postextraction. The CD8(+) lymphocyte value increased to 16.21% +/- 5.27% postcurettage and to 18.25% +/- 3.13% postextraction. The CD4/CD8 ratio increased postcurettage and postextraction. This increase was statistically significant (P <.001). Postcurettage, there was decrease in clinical indexes, which was statistically significant (P <.001). A significant correlation between CD4(+) lymphocyte and ginigival index values and also between CD8(+) lymphocyte and plaque index values was determined postcurettage (P <.05). CONCLUSION: CD4(+) and CD8(+) T-lymphocytes could play a significant role in pericoronitis pathobiology.

Adult↗
PubMed2000

Investigation of infectious organisms causing pericoronitis of the mandibular third molar.

PURPOSE: The purpose of the study was to identify the most frequently encountered pyogenic organisms involved in pericoronitis to permit more targeted antibiotic therapy. PATIENTS AND METHODS: Pericoronal pockets of mandibular third molars from 37 patients showing symptoms of acute, severe pericoronitis were sampled and subjected to microbiologic analysis, including primary evaluation by phase-contrast microscopy. To avoid overgrowth with faster-growing, less fastidious organisms, specimens were cultured on a wide variety of selective media (supporting growth of fastidious bacteria, protozoa, and fungi). RESULTS: Microscopic examination indicated spirochetes in 55% and fusiform bacteria in 84% of the samples. A total of 441 microorganisms were isolated and identified from the 37 cultured samples. Besides obligate anaerobic bacteria, including various Actinomyces and Prevotella species, a predominantly facultative anaerobic microflora was cultivated, that is, Streptococcus milleri group (78% of samples), Stomatococcus mucilaginosus (71%), and Rothia dentocariosa (57%). CONCLUSION: It was concluded that the Streptococci milleri group bacteria, well-known for their ability to cause suppurative infections, are most likely involved in the pathogenesis of acute severe pericoronitis of the lower third molar.

Acute Disease↗
PubMed2000

Early soft tissue pathosis associated with impacted third molars without pericoronal radiolucency.

OBJECTIVES: This study was performed to histologically evaluate soft tissue pathosis in pericoronal tissues of impacted third molars that did not exhibit pathologic pericoronal radiolucency. STUDY DESIGN: One hundred impacted third molars without evidence of abnormal pericoronal radiolucency (follicular space <2.0 mm) were removed for reasons other than participation in this study, and the pericoronal tissues were submitted for histopathologic examination. Specimens were fixed and processed routinely and were stained with hematoxylin and eosin before independent evaluation by each of 2 oral pathologists. A subset of both diseased and healthy tissues underwent additional evaluation for the presence of proliferating cell nuclear antigen (PCNA) for assessment of cellular activity. RESULTS: Of the specimens submitted, 34% showed squamous metaplasia suggestive of cystic change equivalent to that found in dentigerous cysts. Soft tissue pathosis was significantly higher in patients over 21 years of age (P =.001). Five of 8 diseased specimens demonstrated PCNA uptake, whereas none of 10 healthy specimens were PCNA positive. CONCLUSIONS: These findings suggest that radiographic appearance may not be a reliable indicator of the absence of disease within a dental follicle. We conclude that the incidence of soft tissue pathologic conditions is higher than generally assumed from radiographic examination alone.

Adolescent↗
PubMed2002

Pericoronal radiolucencies and the significance of early detection.

Pericoronal radiolucencies are common radiographic findings encountered in general dental practice. They usually represent a normal or enlarged dental follicle that requires no intervention; alternatively they may represent a pathological entity that requires appropriate management and histopathological interpretation. A pericoronal space of greater than 2.5mm on an intraoral radiograph and greater than 3mm on a rotational panoramic radiograph should be regarded as suspicious. Although many pathological processes may present radiographically as pericoronal radiolucencies associated with unerupted teeth, the most common is the dentigerous cyst. These lesions may enlarge considerably if allowed to develop unchecked, and have the potential for pathological transformation. In this report we present four cases of large pericoronal radiolucencies associated with unerupted teeth, and highlight the importance of early detection and management of such lesions.

Adult↗
PubMed1986

Correlation of acute pericoronitis and the position of the mandibular third molar.

Acute pericoronitis is a painful, debilitating infection that is most commonly found among young adults with erupting mandibular third molars. Prophylactic removal of third molars to prevent this disease has been advocated, but this procedure requires an accurate description of the third molar at highest risk for this infection. Clinical and radiographic measurements were compared in 25 diseased subjects and 109 normal subjects. Of 10 variables significantly related to the presence of acute pericoronitis, stepwise discriminant analysis selected 4 variables that produced a canonical correlation coefficient of 0.71. In clinical terms, these variables described the tooth at highest risk for acute pericoronitis as a fully erupted, vertical mandibular third molar that is in contact with the adjacent second molar, at or above the occlusal plane, and partially encapsulated by soft or hard tissues. Prophylactic treatment of these third molars is highly recommended.

Acute Disease↗
PubMed1991

British oral and maxillofacial surgeons' views on the aetiology and management of acute pericoronitis.

Acute pericoronitis is a common oral infection characterised by a predominance of anaerobic micro-organisms such as peptococci, peptostreptococci, bacteroides and fusobacteria, and also spirochaetes. Penicillins such as amoxycillin, and metronidazole are effective antimicrobials in the treatment of acute pericoronitis. This study presents the views of a group of British Oral and Maxillofacial Surgeons as to the causative microbial agents and the antimicrobial management of acute pericoronitis.

Acute Disease↗