Pericoronitis has a habit of returning to the same tooth. One flare settles, a few weeks or months pass, and the gum over the half-erupted wisdom tooth swells again. Calming an episode is mostly about keeping food and bacteria out from under the gum flap, and stopping the cycle depends on what happens to that flap or the tooth in the long run.
Why the same tooth keeps flaring
A wisdom tooth that is only partly through usually has a fold of gum lying over its back or biting surface. The gap under the fold traps plaque and food every time you eat, and a brush cannot get in. Each time bacteria build up faster than your body can clear them, the gum becomes inflamed again. A cold, a run-down week or a sandwich crust wedged in the wrong place can be enough to start it.
If the tooth has enough room and is still moving into position, the flap may shrink as the tooth rises. If the tooth is tilted or blocked, the flap tends to stay. Our article on whether wisdom teeth cause crowding looks at how these teeth behave as they come through.
A daily routine that keeps the flap clean
When symptoms are mild, with no swelling in the face and no fever, careful cleaning is the main treatment. After each meal, swish warm salt water (about a teaspoon in a cup) around the back of the mouth for 30 seconds or so to flush out what has collected. Brush the tooth and the gum over it gently with a soft brush; a small-headed or single-tuft brush can reach behind the last molar more easily than a standard one.
For pain, paracetamol or ibuprofen used as the packet directs can help if they suit you. Choose soft food and chew on the other side for a few days so the swollen flap is not bitten repeatedly. If the soreness is not improving after a few days, or is getting worse, it is time to see a dentist.
What the dentist does to settle it
At the visit, the dentist or OHT cleans and irrigates under the gum flap, which often eases the pain within a day or two. An antiseptic mouthwash such as chlorhexidine may be suggested for a short time while the gum heals. An X-ray is often taken to see the angle of the tooth and how much space it has.
Antibiotics are kept for infection that is spreading, causing fever or significant swelling. A 2021 review by Schmidt and colleagues in the International Journal of Environmental Research and Public Health concluded that local treatment should come first and antibiotics should be reserved for severe cases, because routine prescribing for pericoronitis adds to antibiotic overuse.
When it is no longer a home-care problem
Some signs mean the infection may be spreading into deeper tissues. Get seen the same day if swelling is growing in your cheek or under your jaw, you have a temperature, or you can only open your mouth a little. Trouble swallowing or breathing, or swelling under the tongue or down the neck, needs a hospital emergency department or a 000 call straight away. A spreading infection can behave much like a dental abscess.
Keep, trim or remove: the long-term options
Once the infection has settled, the decision is about the future. The main choices are:
- Watch and keep clean. Reasonable after a single mild episode when the tooth looks likely to come through fully.
- Remove the gum flap. Trimming the flap (an operculectomy) is sometimes suggested, although gum can grow back over a tooth that stays partly buried.
- Remove the wisdom tooth. This takes away the trap for good. The UK National Institute for Health and Care Excellence (NICE) regards second or later episodes of pericoronitis as an appropriate reason to consider removal, but not a first episode unless it is particularly severe.
Where a lower wisdom tooth sits very close to the nerve, a coronectomy, which removes the crown and leaves the roots in place, may be an option for suitable cases at Lumi; complex cases may be referred to an oral surgeon. For people who are anxious about surgery, IV sedation is available at Lumi, along with happy gas. Our wisdom teeth removal guide walks through what extraction involves.
Questions we are often asked
How long does a flare usually last?
Mild episodes often improve within a few days to a week once the area is kept clean. A more severe infection, or one that needs treatment under the flap, can take longer.
Should I keep brushing the sore area?
Yes, gently. Avoiding the area lets more plaque build up under the flap, which keeps the inflammation going.
Will taking antibiotics stop it coming back?
No. Antibiotics can help a spreading infection, but they do not change the gum flap or the position of the tooth, so episodes can return.
If a wisdom tooth keeps flaring, it is worth having it looked at between episodes rather than during the next one. The team at Lumi Dental in Melrose Park can examine the tooth, explain the options and help you plan, with booking available through our current deals page.
