Pericoronitis

Antibiotics are rarely indicated in pericoronitis unless there is pyrexia, spreading infection, and/or trismus.
Treat pericoronitis using local measures in the first instance to achieve debridement and irrigation of stagnation areas. Antibiotics are only required in the case of spreading infection (cellulitis, lymph node involvement, trismus) or systemic involvement (fever and malaise).
- Local Measures
  - Irrigate and debride the stagnation area.
  - Relieve occlusion by filing down the opposing tooth or extracting as appropriate.
  - Patients can be advised to use warm salt water and/or chlorhexidine rinses and/or targeted irrigation of site. Caution: very rare risk of anaphylaxis with chlorhexidine.
Pericoronitis is usually caused by oral gram positive or anaerobic organisms. Metronidazole or amoxicillin are usually effective in treating such infections. The duration of treatment depends on the severity of the infection and the clinical response.
Where there is significant trismus, floor of the mouth swelling or difficulty breathing, transfer patient to hospital as an emergency.
If patient does not respond to the prescribed antibiotic check the diagnosis and consider referral to a specialist.
Pericoronitis is rare in children < 6 years, consider alternative diagnosis/specialist input.
For recurrent pericoronitis consider extraction of the impacted tooth.

PERICORONITIS ANTIBIOTIC TREATMENT TABLE
Drug	Dose	Duration	Notes
1st choice option
Metronidazole	Children aged 6 years: 100mg every 12 hours Children aged 7-9 years: 100mg every 8 hours 10-17 years: 200mg every 8 hours For children with severe infection (or at extremes of body weight for their age) consider 7.5mg/kg (max. 400mg) every 8 hours Adults:** 400mg every 8 hours	3-5 Days*	Advise patients to avoid alcohol. Anticoagulant effect of warfarin enhanced by Metronidazole. Liquid preparations available: 200mg/5ml
OR
Amoxicillin	Children aged 6-11 years: 500mg every 8 hours For children with severe infection (or at extremes of body weight for their age) consider 30mg/kg (max. 1g ) every 8 hours Adults and children ≥12 years:** 500mg every 8 hours (max. 1g every 8 hours for severe infection)	3-5 Days*	Avoid in penicillin allergy. Liquid preparations available (sugar-free): 125mg/5ml 250mg/5ml
* Duration dependent on severity, response to treatment and impact of source control/local measures. **Pericoronitis is rare in children < 6 years, consider alternative diagnosis/specialist input.

Penicillin allergy – tips on prescribing in penicillin allergy
Renal impairment dosing table
Safety in Pregnancy and Lactation
Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed November 2023