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Management of Infected 3 rd Molars

Management of Infected 3 rd Molars. 1. Pericoronitis. Microorganisms and their toxins are sheltered from host defenses by obstructive soft tissue. The response is a local one. If there is any pus, it is minimal. Hallmarks of Pericoronitis. Localized pain Localized erythema

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Management of Infected 3 rd Molars

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  1. Management of Infected 3rd Molars

  2. 1. Pericoronitis • Microorganisms and their toxins are sheltered from host defenses by obstructive soft tissue. • The response is a local one. • If there is any pus, it is minimal

  3. Hallmarks of Pericoronitis • Localized pain • Localized erythema • Partially impacted 3rd molar • May have localized intraoral edema • May have limited trismus • May have limited amount of pus • May have history of similar signs and symptoms

  4. Treatment of Choice • Preoperative loading dose of antibiotics • Remove offending 3rd molar – sedation if needed • Debride and irrigate socket • Do not close wound • Continue postoperative antibiotics for 7-10 days • Postoperative analgesics PRN • Monitor closely in the week following extraction

  5. Rationale • The tooth is the cause of the initiation and perpetuation of the problem. • Tooth removal and socket debridement immediately decreases bacterial colonization at the site of infection. • There is no evidence that surgical procedures promote the spread of infection.

  6. Rationale • Delaying removal delays resolution. • Delaying removal increases the risk of worsening – what if the antibiotics are not effective? • Removal immediately decreases microbial counts, antibiotics do so and assist the host to do so more slowly.

  7. Second Choice of Treatment • Prescribe antibiotics to be started immediately • Give patient clear instructions on monitoring progress of infection • Schedule removal after resolution of acute episode

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