If you can see your wisdom teeth erupting, there’s probably only a portion of it that’s actually visible. You’ll most likely also see a gum flap. Wisdom tooth eruption involves the third molar “cutting” through the gums, creating an opening in the tissue. As it does, a gum flap can form over the back and chewing surface of your wisdom tooth. We call this flap of tissue an “operculum.”
Sometimes an operculum goes away with time. Other times, it can become infected because of food or plaque getting underneath it. Although all teeth will have some amount of gum tissue covering them at a certain point in eruption, wisdom teeth are the only ones that can consistently have an operculum well after they erupt.
The problem with having a gum flap over any tooth is that it makes it impossible to clean, which starts a cycle of dental disease and inflammation. Unless it’s treated quickly, it can spread into adjacent teeth and lead to additional oral health concerns.
An operculum is a flap or strip of gum tissue that covers part of an erupting tooth. It prevents you from being able to see the entire chewing surface. Sometimes only a small portion of the tooth is visible. Other times, a skinny strip of gum tissue covers the back and middle of the chewing surface while the surrounding area is visible.
Your operculum might lift up and down, or it could be fixed in place around the tooth. In either scenario, it hasn’t resorbed or pulled back as part of the normal eruption process like the gums do around other teeth.
Typically, we see the gums work their way back down a tooth as the tooth erupts. But with a wisdom tooth, your third molar may be partially impacted in the bone or against its neighboring tooth. Especially if it’s coming in at an angle or if there isn’t any room in your jaw for the tooth to fully erupt. When a partially erupted wisdom tooth happens, it allows the gum tissue to sit higher up on the tooth. What you’re left with is a large amount of tissue that continually covers your wisdom tooth because there’s nowhere else for it to go.
It’s the tight, angled position of wisdom teeth that makes them especially prone to having an operculum compared to other teeth that are erupting.
Pericoronitis is an infection that—in at least in 95% of cases—affects the lower wisdom teeth (third molars)when they have an operculum. You’re probably familiar with periodontal disease/periodontitis, which is gum disease around the roots of teeth. Pericoronitis is a similar type of infection that forms around the crown of the tooth when it’s covered by a gum flap or operculum.
Symptoms of pericoronitis include pain or mild discomfort, swelling, difficulty opening the mouth, and bad taste or bad breath. Acute pericoronitis symptoms usually last about three to four days. Severe pericoronitis symptoms include severe pain, lymph node and facial swelling, difficulty swallowing or speaking, and fever.
You have two different options when it comes to managing an infected or painful gum flaps. One is to remove your gum flap over the wisdom tooth (operculectomy), and the other is to have a wisdom tooth extraction altogether.
Removing the excess gum tissue or gum flap will allow the full chewing surface of your wisdom tooth to be exposed. And believe it or not, an operculumectomy is actually easier than you might realize. You could think of it as a gum contouring or gingivectomy procedure, where the dentist either gently cuts away the excess tissue or uses a laser to remove it quickly. In most cases, lasers are preferred because numbing may not be needed, and it significantly shortens the overall recovery time.
Why bother with wisdom tooth removal? Because even if you have the operculum removed, the position of certain wisdom teeth may still make them more likely to develop cavities or gum disease because of how difficult they are to clean around. But if you have plenty of room for your wisdom teeth and the only issue going on is a gum flap over them, having that piece of tissue removed may be all you need. Good oral hygiene is critical to prevent infection.
Laser operculum removal gently cauterizes the gum tissue, removing it without any scalpel or cutting mechanisms. With laser soft tissue surgery, it helps minimize any inflammation, redness, or bleeding after the surgical procedure. That’s why so many dentists use lasers for gum recontouring/gummy smile treatments. You won’t need any sutures afterward because of how the laser helps seal the tissues together when the operculum is removed. This and other types of laser surgery are minimally invasive, so any minor post-operative discomfort can usually be controlled with Motrin or ibuprofen.
If you’re having a conventional gum tissue removal surgery, your dentist will use local anesthetic to numb the operculum and area around your wisdom teeth. Then a sterile scalpel is used to cut away the gum flap, reshaping the edge of the gum tissue around your tooth. Sutures may or may not be needed, or a medicated dressing might be applied to act as a temporary bandage. This type of procedure usually requires a week or so for recovery.
95% of cases involving pericoronitis (infection of the operculum) are associated with wisdom teeth in the lower jaw. But there are still a few exceptions. Sometimes teeth may be partially impacted because of major orthodontic concerns, like premature tooth loss or injuries. When that’s the case, the tooth might not erupt completely and may need to have the gum flap removed so that an orthodontist can move the tooth into the desired position with braces.
We also frequently see operculum issues in children whose molars are erupting. As those back teeth come through the gums, it’s normal to see a flap of gum tissue either cover the back of the tooth or extend onto the chewing surface. But in almost every case, the tissue goes away once the tooth has fully erupted. If it doesn’t, your pediatric or family dentist will make a point to remove it. Otherwise, your child will be more prone to cavities and infection simply because that space can’t be cleaned with a toothbrush.
If you have pain around your wisdom teeth or notice a swollen gum flap, wisdom tooth surgery or an operculumectomy is probably in your near future. These situations don’t resolve on their own, so it’s important to be proactive and talk to your dentist about them. Plan on scheduling regular checkups every six months. That way, they can consistently monitor your wisdom tooth eruption. You and your dentist will decide together whether you need to see an oral and maxillofacial surgeon for an operculumectomy or if it’s better to go ahead and take your wisdom teeth out.
Have a gum flap over your wisdom tooth? It’s called an “operculum.” Normally an operculum will go away, but with wisdom teeth, they’re more likely to stick around or become infected (because you can’t clean underneath them.) If you’re not having your wisdom teeth removed, your dentist will need to surgically remove any gum flap during an “operculumectomy” so that it doesn’t get infected. To treat pericoronitis, your dentist or oral surgeon can do conventional surgery or something less invasive like a laser.
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