Management of Infected 3rd Molars

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Management of Infected 3rd Molars

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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

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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

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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

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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.

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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.

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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