Case history
Case history #1
A 39-year-old man presents with left mandibular pain and edema. His last dental visit was more than 3 years ago for emergency extraction of an abscessed tooth in the lower-left. At that time, he was told that he had other areas of decay, as well as gum disease. One week ago, he noticed pain in the lower-left, along with a bad taste in his mouth and mild intraoral edema. He was seen 5 days ago in urgent care and was started on amoxicillin. Despite this, the pain and edema continue to increase. He reports having a fever, chills, and a mild sore throat, but has no difficulty swallowing or breathing. On exam, he has left mandibular erythema with fluctuant edema and limited mouth opening (i.e., 20 mm). He rates his pain level as being 7 out of 10.
Case history #2
A 22-year-old man presents with left facial pain and edema which started 3 days ago. He describes the edema as "doubling" overnight. He has noticed that the pain increases with attempted chewing or full mouth closure. He was told that he needed his wisdom teeth out 4 years ago but never followed through with treatment. Since then, he has experienced intermittent, localized intraoral irritation related to a carious, partially erupted, lower-left third molar until it fractured about one year ago. He reports having a fever, chills, severe sore throat, drooling, and an altered voice. On exam, he speaks with a "hot potato" voice. He has left mandibular erythema with nonfluctuant edema and limited mouth opening (i.e., 15 mm). He rates his pain level as being 9 out of 10.
Other presentations
Very young or older patients, as well as patients with compromised host defenses related to poorly controlled diabetes, renal or liver disease, malnutrition, HIV infection/AIDS, alcohol or intravenous drug misuse, recent splenectomy, or use of immunosuppressant medications, must be treated aggressively with early operative intervention to remove the source of infection and establish drainage, as odontogenic infections often spread much more rapidly in these populations.
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