Most Common reason for removal of Impacted Mandibular third molars:

# Most common reason for the removal of impacted mandibular third molars is:
 A. Referred pain
 B. Recurrent pericoronitis
 C. Chronic periodontal disease
 D. Orthodontic treatment


The correct answer is B. Recurrent Pericoronitis

Pericoronitis is an inflammatory lesion occurring around the impacted or partially erupted tooth. An incomplete eruption of the tooth provides a large stagnation area for food debris under the gingival flap. This becomes infected easily and results in inflammation of the pericoronal flap. It exhibits chronic inflammation for a long period. If the debris and bacteria are deeply entrapped, an abscess may form which is called a pericoronal abscess. It is a mixed infection and various bacteria of the dental plaque (particularly anaerobes) play a significant role in the development of pericoronitis.

Clinical Features: The mandibular third molar is the commonly involved tooth. Pain and swelling of the pericoronal tissue around the affected tooth, difficulty in chewing, and difficulty in opening the mouth are the usual complaints. The patient may be mildly ill with fever, malaise, and regional lymphadenopathy.

Management: Entrapped food debris must be removed. When the upper tooth is involved, it should be grounded or extracted if it is malposed. Radiograph helps in assessing the position of the involved tooth. If impacted, the tooth must be removed. And if it is in a favorable position, surgical removal of the pericoronal flap is advocated after acute symptoms subside. The administration of antibiotics helps to relieve the symptoms and prevents the spread of infection to the adjacent tissue spaces.

Ref: Shafer's Textbook of Oral Pathology, 7E, Page: 400

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