The predisposing factors of perlcoronitis of mandibuiar third moiars in a Jordanian population Anwar B, Bataineh, BDS, MScD, CSOS, MDScVMansour A, AI Qudah, MSc, FFDRCSI, FDSRCS(Eng)3 Objectives: The purpose of this study was to identify the most frequentiy encountered predisposing fac- tors in reiation to the etioiogy of pericoronitis in young aduits and to compare these findings with simiiar studies. Method and tnaterials: The patients included in this prospective study were those presenting for treatment of signs and symptoms of pericoronitis in the mandibuiar third moiar area during an 8-year pe- riod from 1994 to 2001, A standard checi< sheet of subjective and objective observations was compieted, and femaie patients were asked about menstruation or pregnancy. Each patient with a diagnosis of peri- coronitis was interviewed and observations were recorded. Patients were asked about the symptoms reiat- ing to the pericoronitis. Patients were divided into five 5-year age groups ranging from 16 fo 40 years. Results: During the 8-year period, 2,151 patients presented diagnosed cases of pericoronitis; 932 (43,3%) patients were maie and 1,219 (56,7%] were femaie. 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%]), foiiowed by Aprii (181 [8,4%j); for subacute pericoronitis, the highest was in February (128 [5,95%]] and Aprii (112 [5,2%]], foiiowed by October (97 [4,5%]), The most frequentiy seen predisposing factor was upper respiratory tract infection in 815 (37,9%) patients, foiiowed by stress in 473 (22%) patients. Conclusion: it was conciuded that the upper respiratory tract infection was the most fre- quently predisposing factor, which couid precipitate pericoronitis. (Quintessence Int 2003:34:227-231) Key words: pericoronitis, predisposing factor, third moiars ericoronifis is an infectious disease of the opercu- process, tberapeutic alternatives, potential complica- Plum overlying an etnapting or semi-impacted tooth. tions, expected results, and their responsibility in treat- It manifests Itself mainly in late adolescence and ment as well as consequences of no treatment.^ young adulthood, and nearly always occurs around Pericoronitis of mandibular tbird molars may be asso- the mandibular tbird molar,' ciated with respiratory tract infection, emotional and Acute pericoronitis is a painful, debihtating infec- physical stress, and excessive physical fatigue,* tion that is most commonly found in young adults with Pericoronitis is by far tbe most common acute erupting mandibular tbird molars, Propbylactic re- problem in third molars, but there are relatively few moval of third molars to prevent tbis disease has been reported studies on the predisposing factors in relation advocated.- Tbe damages of such an infection should to the etiology of pericoronitis. be weE recognized and respected, for it may spread an- The purpose of this study was to identify the most teriorly or posteriorly down facial planes and involve frequently encountered predisposing factors in rela- vestibular, buccal, submasseteric, submental, sub- tion to the etiology of pericoronitis In young adults mandibular, and pterygoid spaces,^'' Patients shouid be and to compare these findings with similar studies. informed and given explanation about tbe disease METHOD AND MATERIALS 'Associate Professor of Ool and Maxiilofacial Surgery, Faculty ot Dentistry, The patients included in this prospective study were Jordar University ot Science and Technology, irbid, Jordan, those presenting to the Oral and Maxillofaciai Surgery 'Assistant Professor ot Oral and Maxiiiofacial Surgery, Facuity ot Dentistry, Unit, Faculty of Dentistry, Jordan University of Science Jordan University of Science and Technoiogy, Irbid, Jcrdan, and Technology, for treatment of signs and symptoms Reprint requests: Dr Anwar B, Bataineh, Facuity of Dentistry, Jordan of pericoronitis in the mandihular third molar area University of Science and Technology, Irbid 22110, Jordan, E-mail during an 8-year period from 1994 to 2001, Quintessence International 227 Bataineii/Ai Qudaíi TABLE Frequency distribution of patients with TABLE 2 Frequency distribution ot patients with pericoronitis by age and gender (%) acute and subacute pericoronitis by month {%) Age tviaie Female Totai Type of Pericoronitis (%) 16-20 202 (9.39) 297 (13.81) 499 (23.20) ivlonth Acute Subacute Total 21-25 484 (22,50) 629 (29.24) 1113(51.74) January 86 (4.00) 66 (3.07) 152(7.07) 26-30 186(8.65) 179(8.32) 365(16.97) February 102 (4.74) 118(5.49) 220 (10.23) 31-35 37(1.72) 74 (3.44) 111 (5.16) Ma re il 137 (6.37) 120 (5.58) 257(11.95) 36-40 23 (1.07) 40 (1.86) 63 (2.93) April 181 (8.41) 109 (5.07) 290 (13.48) Total 932 (43.33) 1219(56.67) 2151 (100.00) May 57 (2.65) 55 (2.56) 112(5.21) June 51 (2.37) 54(2.51) 105(4.88) July 53 (2.46) 61 (2.84) 114(5.30) August 72 (3.35) 52 (2.42) 124(5.77) September 207 (9.62) 83 (3.86) 290(13.48) October 137 (6.37) 97(4.51) 234 (10.88) November 63 (2.93) 48 (2.23) 111 (5.16) December 77 (3.58) 65 (3.02) 142 (6.60) Totai 1223 (56.90) 928(43.10) 2151 (100.00)" A standard check sheet of subjective and objective were female (Table 1}. There was a 1:1.3 male-to-fe- observations was completed, including name, age, male ratio attending the clinic at the time of this study gender, type of pericoronitis (teetb affected and tbeir As noted In Table 1, tbe peak age of occurrence positions; state of eruption), date of presence, upper varied from 21 to 25 years and included 1,113 respiratory tract infection, concurrent illness, general (51.74%) patients. fatigue, emotional stress, and vaccination bistory. Tbe incidence of pericoronitis varied witb the sea- Female patients were asked about menstruation or son and was highest in tbe spring and autumn as pregnancy. A classification was predetermined as to sbown in Table 2. Acute pericoronitis was bigbest in acute and subacute pericoronitis. The following initial September (207 [9.6%]), followed by April (181 symptoms were recorded for acute pericoronitis: tris- [8.4%]); subacute pericoronitis was highest in March mus, pain, dysphagia, extraoral swelling, malaise, bali- (120 [5.58%]) and February (118 [5.49%]), followed tosis, discbarge, sore throat, and anorexia. The follow- by April (109 [5.07%]). ing initial symptoms were recorded for subacute All the patients showed unilateral involvement of pericoronitis: pain, dysphagia, intraorai swelling, hali- mandibular third molars by pericoronitis. The majorify tosis, discharge, sore throat, and stiffness. More than of tbe patients (1,223 [56.86%]) were diagnosed as bav- one symptom was stressed by many of tbe patients. ing acute pericoronitis and 928 (43.14%) were diag- Eacb patient with a diagnosis of pericoronitis was in- nosed as baving subacute pericoronitis (see Table 2). terviewed and observations were recorded. Patients Since more than one symptom was stressed by the pa- were asked about the symptoms relating to tbe peri- tients in both acute and subacute pericoronitis, there coronitis. Patients were divided into five 5-year age were 3,072 symptoms stressed in the acute pericoronitis groups ranging from 16 to 40 years in age. patients (Fig 1) and 3,204 in the subacute pericoronitis Uniform criteria for diagnosis of each patient were patients (Fig 2). Trismus was tbe most common symp- determined after group discussion among the authors tom in acute pericoronitis, foilowed by pain, dysphagia, of this study and the staff at the oral and maxillofacial and extraoral swelling [Fig 1). Pain was the most com- clinic, and they were then trained beforehand to par- mon symptom in subacute pericoronitis, followed hy ticipate in the study. The data obtained were statisti- intraorai swelling, halitosis, and jaw stiffness (Fig 2). cally analyzed and calculated for the incidence rate The most frequently seen predisposing factor was and frequencies of pericoronitis. upper respiratory tract infection in 815 (37.9%) pa- tients, followed by stress in 473 (22%) patients (Fig 3). RESULTS DISCUSSION During the 8-year period, 2,151 patients presented di- agnosed cases of mandibular wisdom teeth pericoroni- Pericoronitis is a very common condition tbat affects tis; 932 (43.30/0) patients were male and 1,219 (56.7%) both sexes equally and the incidence of which appears 228 Volume 34, Number 3, 2003 • Batainein/Ai Qudah Rg 1 Frequency distribution of initiai symptoms ol pa- tients in acute pericoronitis. Some patients experienced more ttian one symptom. Anorexia ^M |81 Sore throat H |B3 Discharge H ^^^|i77 s Halitosis H ^^^^|206 ptom r^alaise H ^^^^^203 m , Sy Extraorai H swelling ^1 Dysphagia H ^^^m^^^^^^^i562 Pain H ^^^^^^^^^^H 584 Tris mus H 1 1 1 1 1 1 1 r 0 100 200 300 400 500 600 700 No, of patients Fig 2 Frequency distribution ot initial symptoms in subacute peNccronitis. Some patients experienced rrorethan one symptom 200 400 600 800 1000 1200 No. of patients Fig 3 Distribution of patients by individuai predispos- ing factors of pericoronitis. S Gerieral g' fatigue o g- Concurrent •ü iliness °^ Upper respiratory tract infection Pregnancy 0 100 200 300 400 500 600 700 800 900 No of patients Quintessence International 229 Batainen/Al Qudah to be increasing, Pilronen and Ylipaavalniemi' found pericoronitis is increased if patients are weakened hy in a retrospective study of a Finnish population that respiratory tract infection,^ Kay^ and Bean and King^ females presented with pericoronitis twice as fre- were the first to suggest an association between peri- quently as males, Pericoronitis may affect patients of coronitis and respiratory tract infection. The incidence any age, hut it is most frequently seen between the of respiratory tract infection was significantly higher ages of 17 and 25 years, with a peak incidence in the during the two weeks hefore acute pericoronitis was 21- to 25-year-old age group, during the period when diagnosed compared with that in controls.