removal of the plaque stagnation areas through tooth extraction or gingival resection, which can be done with diode lasers atraumatically. Often acute symptoms of pericoronitis are treated before the underlying cause is addressed. Acute pericoronitis When possible, immediate definitive treatment of acute pericoronitis is recommended because surgical treatment has been shown to resolve the spread of the infection and pain, with a quicker return of function. Also immediate treatment avoids overuse of antibiotics (preventing antibiotic resistance). However, surgery is sometimes delayed in an area of acute infection, with the help of pain relief and antibiotics, for the following reasons: Reduces the risk of causing an infected surgical site with delayed healing (e.g. osteomyelitis or cellulitis). Avoids reduced efficiency of local anesthetics caused by the acidic environment of infected tissues. Resolves the limited mouth opening, making oral surgery easier. Patients may better cope with the dental treatment when free from pain. Allows for adequate planning with correctly allocated procedure time. Firstly, the area underneath the operculum is gently irrigated to remove debris and inflammatory exudate. Often warm saline is used but other solutions may contain hydrogen peroxide, chlorhexidine or other antiseptics. Irrigation may be assisted in conjunction with Debridement (removal of plaque, calculus and food debris) with periodontal instruments. Irrigation may be enough to relieve any associated pericoronal abscess; otherwise a small incision can be made to allow drainage. Smoothing an opposing tooth which bites into the affected operculum can eliminate this source of trauma. Home care may involve regular use of warm salt water mouthwashes/mouth baths. A randomized clinical trial found green tea mouth rinse effective in controlling pain and trismus in acute cases of pericoronitis. Following treatment, if there are systemic signs and symptoms, such as facial or neck swelling, cervical lymphadenitis, fever or malaise, a course of oral antibiotics is often prescribed,. Common antibiotics used are from the β-lactam antibiotic group, clindamycin and metronidazole. If there is dysphagia or dyspnoea (difficulty swallowing or breathing), then this usually means there is a severe infection and an emergency admission to hospital is appropriate so that intravenous medications and fluids can be administered and the threat to the airway monitored. Sometimes semi-emergency surgery may be arranged to drain a swelling that is threatening the airway. Definitive treatment If the tooth will not continue to erupt completely, definitive treatment involves either sustained oral hygiene improvements or removal of the offending tooth or