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Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment?

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I went to check an oral surgeon considering that my lower wisdom tooth had been sore, but not in deep pain, for two weeks. It turned out that the surgeon said it to be pericoronitis, which completely came out of the blue, since I thought it was simply teething, and there wasn't any redness or significant swelling. That made me nervous, and I am taking a second opinion tomorrow. I am currently on penicillin, and I don't want to do a surgery now since I am an international student in the US from India, and I can't bear to go through something like this without my parents at hand. I am going back home in two months for my winter break. Would it be okay to wait till then? I just want to buy as much time as possible.
Posted Sun, 3 Nov 2013 in Dental Health
 
 
Answered by Dr. Anjana Rao Kavoor 1 hour later
Brief Answer:
Surgery only if severe infection

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

Pericoronitis is a dental disorder in which the gum tissue around the molar teeth becomes swollen and infected. This disorder usually occurs as a result of impacted or partially erupted wisdom teeth, the third and final set of molars that most people get in their late teens or early twenties.

Pericoronitis can develop when wisdom teeth only partially erupt (break through the gum). This allows an opening for bacteria to enter around the tooth and cause an infection. In cases of pericoronitis, food or plaque (a bacterial film that remains on teeth after eating) may get caught underneath a flap of gum around the tooth. If it remains there, it can irritate the gum and lead to pericoronitis. If the pericoronitis is severe, the swelling and infection may extend beyond the jaw to the cheeks and neck.

If the pericoronitis is limited to the tooth (for example, if the pain and swelling has not spread), treat it by rinsing your mouth with warm salt water. You should also make sure that the gum flap has no food trapped under it.

If your tooth, jaw and cheek are swollen and painful, treatment of the infection with antibiotics (usually penicillin group of antibiotics, unless you are allergic) is advised. You can also take pain relievers such as aspirin paracetamol or ibuprofen.

If the pain and inflammation are severe, or if the pericoronitis recurs, oral surgery to have the gum flap or wisdom tooth removed may be necessary. You can wait for a while before surgery if your symptoms are not severe and subside with medication.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment? 13 minutes later
Indeed, thank you! Ever since I am having the antibiotic, the soreness has gone down even more, and the tonsils, which were swollen to some extent, have also subsided. There is some soreness at times in my left ear especially when it gets cool, the same side to which the supposed infected tooth is there, but nothing else apart from that. I am advised to go through the entire prescription, which I am doing diligently. Do you advise me to have probiotics? I have had a few instances of loose-motion but nothing severe; I think it's a mild side-effect or something.
 
 
Answered by Dr. Anjana Rao Kavoor 10 minutes later
Brief Answer:
Probiotics is optional

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

I am glad to hear that the soreness has subsided and you are doing well. At the moment I would suggest you to take proper care of your dental hygiene and do salt water gargle regularly.

Probiotics may be considered as an optional for your condition. As per reseaarch on probiotics and oral health done in 2010, following conclusion has been drawn:

The interest in oral probiotics has been growing during the last decades. Most of the studies have been conducted with probiotic strains originally suggested for gut health; however, it is important to realize that each of the suggested health benefits should be studied for each bacterial strain individually. Thus, a probiotic bacterium in the mouth is not necessarily an oral probiotic. Furthermore, it is quite possible that the same species are not optimal for all oral health purposes; e.g., different properties might be desired in respect to dental and gingival health.

At least some of the probiotic bacteria used in various probiotic products may colonize the oral cavity during the time they are in use; thus, the effects of probiotic bacteria in the oral cavity are important to understand. Probiotic bacteria seem to affect both oral microbiota and immune responses. On the other hand, the extent to which bacteria in food or in food ingredients can influence relatively stable oral microbiota is difficult to predict. Thus, both research to unravel the mechanisms of possible probiotic action and long-term clinical trials are needed if probiotics are to provide a new scientifically proven means of preventing or treating oral diseases.

Several health-promoting effects of probiotic bacteria are well documented, and there is no reason to restrict the use of probiotic products because their effects on oral health are not yet well understood; however, their recommendation for dental health purposes is not yet justified.




Your mild loose motion might be a side effect. It is strongly recommended you eat healthy food and drink adequate amounts of water and fluids.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment? 10 minutes later
Thank you once again, you're words are really assuring! I am having a general sense tiredness, maybe because of the antibiotic fighting off the infections, and I am taking utmost care to rehydrate myself. I have given up on sugars for quite a while and intend to do so. Also, when I referred to my initial oral surgeon that I would wait out the two months before I do any surgery, he said the infection is most likely to come back.(Also I do realize, as most of my friends here tell me, that dentists here can be too honest, given the massive prices for dental stuff in the US..) What do you suggest I do to at least try and delay that? I have been taking a lot of raw vegetables and semi-liquid foods since the past week, and I have been flossing and brushing thrice daily; I have cut down on using too much mouthwash.
 
 
Answered by Dr. Anjana Rao Kavoor 17 minutes later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
You are welcome and thanks again for your update.

As you might have heard from your dentist, Pericoronitis can recur in many patients and at the same time 2 months is relatively a short period and you are taking proper measures to maintain dental hygiene. With these is place, there is little reason to worry.

If you develop pain, fever, discomfort and the swelling that extends beyond the jaw to the cheeks and neck, then you must report to your doctor immediately. Other than this there is no reason to worry. Please make sure that you take treatment from a dentist when in India, even if you do not have any pain or swelling.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment? 34 minutes later
Your advice has been invaluable! However, try as I might, I encountered another problem, albeit a little humorous if you can see it that way, just now; I had changed my mouthwash from Listerine to a Crest Pro-Health two days ago, since it is non-alcoholic. After having used it twice yesterday and twice today, as is the norm I follow, my front part of the tongue has kind of got burnt, and my inner lip also has some burning sensation. In effect, I probably can't taste much, neither can I do my hot salt water rinsing that I usually would have done, as my mouth just can't tolerate it. Is it anything majorly concerning about this, and will the skin grow back on its own? I mean, this isn't something I expected anyways.
 
 
Answered by Dr. Anjana Rao Kavoor 1 hour later
Brief Answer:
Crest Pro-Health can cause few side effects

Detailed Answer:
Hi XXXX,
You are welcome and thanks again for your update.

Humorous it may seem but I think there is a lot of controversy in using Crest Pro-Health mouthwash. It can cause burns in tongue/ inner lips as you have mentioned and also loss of taste sensation.

Reports also say that it contains Cetylpyridinium chloride, or CPC, is an antiseptic ammonium compound found in small amounts and can stain teeth in some people using it.

Please be careful of the skin peeling and stop using it if symptoms persist and/ or worsen.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment? 9 minutes later
Yes indeed, I have stopped it today itself. I guess I am not too late for that, but indeed, there was some blue stuff when I used to spit it out after mouthwashing. Is there any danger of infection? It seems like there is also some minor sting in the left side of my inner cheek, but nothing as significant as the tongue and the inner lip. I guess I have to wait for a few days, hopefully it heals back on its own. I reverting back to colgate as my toothpaste, and saltwater rinsing as when the burning sensation leaves. I am getting this consulted tomorrow too.
 
 
Answered by Dr. Anjana Rao Kavoor 1 hour later
Brief Answer:
Right step taken by you

Detailed Answer:
Hi XXXX,
You are welcome and thanks again for your update.

I think you are doing the right thing by taking enough precautions for your problem. Please consult your doctor tomorrow and have a review clinical examination and explain all your problems including the side effects to him.

Take care.
Wishing you good health.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment? 14 hours later
Yes indeed, I have had some ulcers now in the inner lip and below the tongue, and also some part in my left inner cheek, and it doesn't look nice, although it doesn't hurt much. Do you think I pose a risk of infection, and given that I have an apparent infected wisdom tooth, would that make matters worse or are they unrelated? And how much time should I give for the ulcers to heal?
Apparently, when I went for the second opinion, I expected something serious to be said about my wisdom tooth. It turned out that the infection of my wisdom tooth had been greatly reduced (the dentist said the gums although swollen, were not hurting anymore, and the infection, if any, must have been previously minor; two months theoretically was sufficient time to plan for the surgery); the ulcers were actually fungal infections candidiatis, caused by the combination of crest mouthwash and the penicillin that I was having. I was advised to immediately discontinue taking the antibiotic; the dentist said if another such wisdom tooth infection occurs, he would prescribe another antibiotic, a different, less potent one. But two months should be okay, he said. That's the difference between oral surgeons and dentists; I should have first referred to the latter to save all this trouble. This is ridiculously frustrating...
 
 
Answered by Dr. Anjana Rao Kavoor 3 hours later
Brief Answer:
You can wait two months

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

Well, first of all we can relax, as I have said earlier, two months is relatively a short period of time and the wisdom tooth infection has been controlled and this is confirmed through the second opinion. I understand your frustration at being told to go in for a surgery right away.

I suggest you do plain salt water gargle if you continue to have troublesome ulcers. In case you have to stop using crest mouthwash due to persistence of ulcers, you may continue to rinse your mouth after meals and at night. Use water or 0.9% sodium chloride solution (saline or salt water). You can make a fresh sodium chloride solution for each rinse by dissolving half a teaspoon of salt in 250 ml of fresh water. Use cool or warm water - whatever your prefer.

There are many newer antibiotics which will work well for your condition should it happen again. With the amount of care you are taking, I do not see any infection happening again, at least not in the next two months.

Concerning the ulcer healing, you may allow somewhere between 3 to 5 days before things should get normal for you.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment? 30 minutes later
I can't thank you enough for the immensely helpful suggestions that you've given. The saltwater rinsing is now quite irritating, but I was told by the dentist it would keep both the fungi and the bacteria in check, despite the irritation. I was also told to get to him next week to monitor the condition of the wisdom tooth and keep a track on its status. I now realize how important the distinction is between dentists and oral surgeons. The dentist also cleared up the doubt as to why my ear occasionally starts getting heavy; either due to the infection, or due to the movement of the tooth. I wonder how the oral surgeon would have operated on me with all the ulcers around in the mouth, it's absolutely stunning..!
Once again, I humbly thank you for your help, and I shall certainly write back if there is anything I would like to share of any importance.
 
 
Answered by Dr. Anjana Rao Kavoor 22 minutes later
Brief Answer:
Welcome

Detailed Answer:
Hi XXXX,
You are most welcome and I am glad to have been able to answer your queries.

As your dentist has rightly said, the salt water gargle will help the most, at the moment.

I would be glad to hear updates concerning your condition and answer further query should you have any.

Thanks,
Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Lower wisdom tooth was sore. Diagnosed as pericoronitis. On pencillin. Suggest the treatment? 2 hours later
Thank you very much! Just as a follow up, I was given a Penicillin 500 mg 4x a day, which is quite a big dosage, considering it was only a localized, minor infection. (I'm pretty sure the oral surgeon wanted to make sure there absolutely no infection, so he gave a big dosage). Should I have to worry about antibiotic resistance? I mean I know I don't feel anything, and the infection is controlled. I shall clear this one last doubt tomorrow with the dentist, and I shall have one final dosage of the antibiotic before I call it off; I can't tolerate these fungi in my mouth, such an irritating presence, so I anyways have to take care of it first.
 
 
Answered by Dr. Anjana Rao Kavoor 14 hours later
Brief Answer:
No antibiotic resistance

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

There is no need to worry for antibiotic resistance. I am sure that you take antibiotics only when necessary. It happens in people who take self medication and abuse antibiotics.

I agree that taking care of the fungi is important. Please discuss the matter with the dentist.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
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