Patient with swelling

Question 1

First thing to do when a patient presented with swelling?

Answer 1

history of the swelling

Assess degree of swelling:
- difficulty breathing?
- difficulty moving tongue
- swelling close to the eye?
- worsened in last hour?
- sudden and unexplained?

Question 2

What is the next thing to check, after the swelling has been assessed? What do you do?

Answer 2

Is it rapidly increasing or likely to obstruct airway? Or close eye?

If yes, emergency care NHS24, if not, next step

Question 3

What is the next step after assessing the swelling isn’t rapidly increasing or likely to obstruct airway or eye?

Answer 3

is patient systemically unwell? If yes, then emergency care NHS24

Question 4

What to check after patient systemically unwell?

Answer 4

Is it slowly increasing in size, hot or firm to touch? If yes then patient may require antibiotics and urgent dental care.

Question 5

If patient is not systemically unwell and the swelling is not closing eye or obstructing throat, and not slowly increasing in size, what should be done?

Answer 5

check if they are in pain, if no then non urgent dental care, if yes:

Assess atypical Jaw pain, or other signs of MI

And also assess if they have exceeded recommended dose of pain relief medication.

Question 6

If there are signs of MI or overdose, what done? What if no sign?

Answer 6

Emergency care

Or

Move to pain pathway

Question 7

Symptoms of acute apical abscess?

Answer 7

Localised pain
Pain on chewing / TTP
Localised swelling with rapid onset
Possible mobility

Question 8

Tx of acute apical abscess?

Answer 8

Immediate
- pulp extirpation / XLA
- +- drainage of fluctuant swellings with incision
- prescription of antibiotics if systemically unwell or elevated temperature
- consider relieving occlusion if heavy contact

Long term
- review
- definitive tx - RCT or XLA

Question 9

Symptoms / signs of perio-endo abscess?

Answer 9

Generalised periodontitis
Deep pocketing to root apex
Swelling

Question 10

Tx of perio-endo abscess?

Answer 10

Immediate
- pulpal extirpation
- prescription of antibiotics if systemically unwell
- excision and drainage of swellings
- give .2% chlorhexadine until acute symtoms subside

Long term
- RCT / XLA
- debridement of the deep periodontal pocket