A Seminary Student Who Could Barely Open Her Mouth

Quick answer: Pericoronitis is infection of the gum flap over a partly erupted wisdom tooth. It causes a swollen, tender gum at the very back, a stiff jaw and a bad taste. Cleaning under the flap gives fast relief; the long-term fix is usually removing the tooth.

The call

Chavi, 19, in seminary in Beit Shemesh, in her first year in Israel and a long way from her parents in Toronto. She phoned on a Monday with three days of pain at the back of her lower right jaw, difficulty opening her mouth, and — the thing that had frightened her — a bad taste she could not get rid of.

She had exams that week and no idea whether this counted as an emergency.

What we found

The lower right wisdom tooth was half erupted, with a flap of gum, the operculum, lying over the back half of it. That flap was red, swollen, and had a clear indentation where the upper wisdom tooth had been biting into it. Pus expressed from beneath it when we pressed gently. Her mouth opened to about 28mm, down from a normal 45 or so. She had a tender lymph node under the jaw, and a low-grade temperature.

Pericoronitis is a mechanical problem before it is an infectious one. A partly erupted wisdom tooth creates a pocket beneath the gum flap that cannot be cleaned by any brush. Food and plaque collect there. The upper tooth traumatises the swollen flap every time she closes, which swells it further, which means more trauma. The cycle escalates over days.

It is extremely common in this age group, and stress, poor sleep and exam-week eating habits all make an episode more likely — which is why seminary and yeshiva students in Beit Shemesh present with it constantly in the middle of a busy zman.

What we did

Immediate. Irrigated thoroughly under the flap with chlorhexidine using a blunt-ended syringe, removing debris and pus. This is what actually relieves it. Then we relieved the trauma by smoothing the opposing upper wisdom tooth slightly so it no longer bit into the flap.

Medication. Antibiotics, justified by the trismus, the lymph node and the temperature. Ibuprofen for pain and swelling.

Home care. Warm salt-water rinses every two hours, and a curved-tip syringe to irrigate under the flap herself twice a day.

She was noticeably better within 24 hours and comfortable within four days. She sat her exams.

The definitive part. We took a panoramic x-ray. The tooth was tilted forward against the second molar, with no realistic path to erupting fully. Once the acute episode had settled, we planned removal — and, because the upper wisdom tooth was doing the traumatising, that one too. Removing an infected tooth during an acute episode is more difficult and less comfortable; waiting two to three weeks is standard practice.

We also spoke to her parents in Toronto, with her permission, which is a routine part of treating students here.

The outcome

Both wisdom teeth were removed five weeks later, uneventfully. No further episodes.

What to do if this happens to you

1. Rinse with warm salt water every two hours. It genuinely helps.
2. Get it irrigated professionally. Home rinsing does not reach under the flap.
3. Take ibuprofen if you can — it addresses swelling as well as pain.
4. Keep eating soft food and keep the area as clean as you can manage.
5. Go to hospital if you cannot open your mouth more than two fingers, cannot swallow, or the swelling spreads under the jaw.
6. Plan the extraction once it settles. Episodes recur, and each one is worse than the last.

Student in Beit Shemesh with wisdom tooth pain? Ramat Beit Shemesh Urgent Dental Care sees students the same day and liaises with parents abroad. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.