A Seven Year Old with a Swollen Face

2/12/2008

A seven year old girl came to the office with an extremely swollen left side of her face that started the evening before. She had a low grade fever for 24 hours and complained of a toothache just prior to the appearance of the swelling.

On examination, her entire left cheek and eye were swollen. The left upper gum had a small but distinct area of bulging and redness adjacent to the affected tooth where she complained of pain.

I consulted with her dentist about the course of action. It was clear that this little girl had a dental abscess which involved the soft tissues of the face as well. These are bacterial infections that result from a deep infection in the pulp of the tooth. Since the tooth is a closed space, these infections are notorious for building up swelling under the pressure of a bacterial process. Typically the tooth must be extracted as part of the treatment however the dentist appropriately chose to treat with an oral antibiotic before extraction. The reason for this is that severe swelling in the area does not allow for adequate anesthesia of the area. The dentist saw the child the day after being diagnosed and allowed a small amount of pus to be released from the gum around the involved tooth. I chose the antibiotic Duricef for ten days. The child also took a course of probiotics during and after the antibiotic treatment. The facial swelling resolved over a 48-72 hour period.

Two weeks after presentation, the tooth was successfully extracted.

      

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