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Pericoronitis No Antibiotics — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsPericoronitis No AntibioticsORE Part 1

An immunocompetent adult presents with acute pericoronitis around a partially erupted mandibular third molar. There is local pain and inflamed opercular tissue, but no facial swelling, trismus, lymphadenopathy, fever or malaise. What is the most appropriate initial management?

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Correct answer: B — Provide local debridement, irrigation, analgesia and mouth-rinsing advice without antibiotics

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

A is correct. In uncomplicated acute pericoronitis, management is directed at controlling the local cause: remove trapped debris where possible, irrigate beneath the operculum, advise salt-water or 0.2% chlorhexidine rinsing, optimise oral hygiene and provide analgesia. SDCEP specifically advises against antibiotics unless there is spreading infection, systemic infection, or an immunocompromised patient requires them. Therefore amoxicillin, co-amoxiclav and metronidazole (B, C and E) are inappropriate in this presentation and would conflict with antimicrobial-stewardship principles. Immediate extraction (D) is not the routine initial response to a first uncomplicated acute episode; extraction may be considered later for severe or recurrent pericoronitis, or where the tooth is unlikely to become functional.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Acute Dental Problems: Acute pericoronitis (including erupting teeth in children), current web guidance. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/acute-pericoronitis-including-erupting-teeth-in-children/