Exodontia.Info
Operculectomy
If the flap / hood of gum (operculum) overlying a
(wisdom) tooth becomes infected / inflamed,
this elicits an
operculitis, which is a form of
pericoronitis.

Operculectomy is the removal of the flap of gum overlying
a tooth

Often, wisdom teeth are only partly erupted into the
mouth.  There is often a flap of gum (
operculum) overlying
the tooth.  It is difficult to keep the area clean because of
this flap.  The flap can also be traumatised by the upper
wisdom tooth biting onto it.  If this is the case, the upper
wisdom tooth may need to be removed as well.

Once the
operculum has been removed, it should be
easier to clean the area, lessening the risk of decay in the
wisdom tooth (and the adjacent tooth) and of infection in
and around the crown of the tooth.

The removal of the
operculum can be achieved by a
number of means (‘cold steel’,
glacial acetic acid, radio-
surgical
means, laser or cautery).
Problems with the procedure:

  • It may not help at all.

  • It possible that the operculum may grow back and the
    operculectomy may need to be repeated.

  • The Lingual Nerve (supplies sensation to the tongue)
    may be effected.  This can result in a numb tongue as
    well as loss of taste on that side of the tongue; the
    numbness can last up several months.

  • If the wisdom teeth flare-ups have been quite episodic,
    then it may be hard to know if the operculectomy has
    in itself, been successful.

  • The op site may become infected afterwards.  This
    can happen in fit and healthy people with "clean
    mouths" and even if the patient is on antibiotics.  Very
    occasionally, the infection may be such that the patient
    may need to be admitted to hospital for drainage of
    the abscess under a general anaesthetic.


An
operculectomy is sometimes considered if the upper,
opposing wisdom tooth is traumatising the
operculum.  The
SIGN Guidelines suggest pain associated with the lower
wisdom tooth is commonly exacerbated by the upper
wisdom tooth biting on the gum flap (
operculum), causing
pain and discomfort.

Alternatively, if the upper
wisdom tooth is easy to remove
and is non-functional, then immediate removal of that tooth
will often dramatically relieve the pain from the area.  This
is particularly useful where there is likely to be delay in the
removal of the lower wisdom tooth and can be regarded as
an interim measure (after referral but prior to surgery).
Last Updated 22nd November 2018
Useful Articles:

Int J Laser Dent 2014.  Case Report.  Minimally Invasive Management of
Pericoronal Abscess using a 810 nm Diode Laser

Int J Current Research 2016.  Comparison of Healing Process of Operculectomy
with Laser & Surgical Knife - A Clinical Study


Useful Website:

DocDoc
Photo of Pericoronits / Operculitis effecting Lower Jaw
Wisdom Teeth
This list of warnings might seem excessive to some however the legal ruling in
the case of
Chester vs Afshar (2004) would suggest that it is quite prudent /
necessary to list them.  Others might say that there isn't enough information but
where do you stop?  

The following list of warnings regarding
operculectomy is neither exhaustive nor
is it predictive.  The most pertinent warnings have been included here
.


Operculectomy Specific Warnings:

Failure of Procedure.  Even though an operculectomy may have been successfully
carried out, there may still be problems of infection / inflammation around the
crown of the tooth..  That is, the
operculectomy may not have worked.

Repeated Operation due to Regrowth of Operculum.  The operculum can always
grow back.  If this is the case and the
operculum is symptomatic, the operculum
can be removed again.  It is always possible that at this stage, the patient may just
want to have the wisdom tooth removed.

Numbness of tongue ± loss of taste.  The Lingual Nerve may be damaged during
the procedure resulting in numbness (the “numbness” can range from “blunted
sensation” to a burning sensation) affecting the tongue ± loss of taste to that side
of the tongue.  The numbness of the tongue ± loss of taste can last from weeks to
months though it does have a low incidence.

Need to remove the upper wisdom tooth.  The upper wisdom tooth may be biting
on the
operculum, traumatising it and exacerbating the painful symptoms.  The
patient may benefit from having this tooth removed as well.

Initial Appearance.  Initially, the operculectomy site may look somewhat
disconcerting.  It can appear raw, charred, deep, swollen and may bleed easily.  
The op site heals quite quickly (becoming noticeable after the 1st week or so).  For
the 1st week of healing, it is worth using an
antiseptic mouthwash (such as
Corsodyl or Peroxyl mouthwashes), a local anæsthetic mouthwash if painful (such
as
Difflam or Bongela) and hyaluronic acid gel / mouthwash (such as Gengigel).


General Surgical Warnings:

Pain.  As it is a surgical procedure, there will be soreness after the
operculectomy.  This can last for several days.  Painkillers such as
ibuprofen,
paracetamol, Solpadeine or Nurofen Plus are very effective.  Obviously, the
painkiller you use is dependent on your medical history & the ease of the operation.

Swelling.  There will be swelling afterwards.  This can last up to a week and peaks
at around 2 - 3 days.  Use of an icepack or a bag of frozen peas pressed against
the cheek adjacent to the operation site will help to decrease the swelling.  
Avoidance in the first few hours post-operatively of alcohol, exercise or hot foods /
drinks will decrease the degree of swelling that will develop.

Bruising & Bleeding into Cheeks.  Some people are prone to bruise.  Older
people, people on aspirin or steroids will also bruise that much more easily.  The
bruising can look quite florid; this will eventually resolve but can take several weeks
(in the worst cases).

Swelling that does not resolve within a few days may be due to bleeding into the
cheek.  The cheek swelling will feel quite firm.  Coupled with this, there may be
limitation to mouth opening and bruising.  Both the swelling, bruising and mouth
opening will resolve with time.

Stitches.  Where the operculum has been removed, it is often cauterised using
electro-cautery, lasers, radio-frequency cautery or chemical cautery.  These may
need to be augmented with stitches.  The stitches dissolve and ‘fall out’ within 10 –
14 days.

Limited Mouth Opening.  Often the chewing muscles and the jaw joints are sore
after the procedure so that mouth opening can be limited for the next few days.  If
you are unlucky enough to develop an infection afterwards in the operation site, this
can make the limited mouth opening worse and last for longer.  There may also be
scarring around the operation site - this scar can contribute to limited mouth
opening.

Post-op Infection.  You may develop an infection in the operation site after the
procedure.  This though is rare.  There may be swelling, limited mouth opening,
pain, bad breath and an unpleasant taste in the mouth. If this happens, you need to
contact your surgeon or dentist of A&E as soon as possible.

Occasionally, there may be a collection of pus from the infection that may need
draining.  This may be done under a general anæsthetic - if so, the wisdom tooth
associated with the
operculum may be removed at the same time.