Pericoronitis without systemic involvement — ORE Part 1 MCQ

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ModerateOral SurgeryPericoronitis without systemic involvementORE Part 1

A 22-year-old patient has pain and swelling around a partially erupted lower third molar. There is local operculum inflammation and limited plaque control, but no fever, no facial swelling and no trismus. The patient can swallow normally. What is the most likely diagnosis?

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Correct answer: A — Localised pericoronitis

The diagnosis is localised pericoronitis. The stem provides critical negative findings: absence of fever, facial swelling, trismus, and dysphagia. These exclude Ludwig's angina, a life-threatening cellulitis presenting with bilateral swelling, fever, and airway compromise. Alveolar osteitis occurs post-extraction, not in erupting teeth. Acute apical abscess affects the periapical region of non-vital teeth, not the operculum of a partially erupted tooth. Necrotising periodontitis presents with ulceration and necrosis, not simple opercular inflammation. Pericoronitis is defined as inflammation of the soft tissues around the crown of an erupting or partially erupted tooth, most commonly the mandibular third molar. UK guidance (SDCEP, NHS Forth Valley) recommends local management: irrigation, debridement, and antiseptic rinses, with antibiotics reserved for severe or systemically involved cases. The absence of systemic involvement is the key discriminator confirming localised disease.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Acute pericoronitis (including Erupting Teeth in Children). Available at https://madp.sdcep.org.uk/content/conditions-library/acute_pericoronitis.html. Accessed 2026.