Examination

When clinically assessing a patient a number of examinations need to be performed:

Initial examination

The initial examination must include an ABC assessment as, rarely, dental infection may be complicated by airway obstruction. The presence of any of the following may indicate actual or impending airway compromise and should prompt an urgent senior anaesthetic assessment:

• Stridor
• Difficulty in breathing
• Dysphagia
• Dysphonia (alteration in the character of the voice)

Learning bite

Dental infections may be complicated by airway compromise and need urgent anaesthetic intervention.

A general examination and set of observations including temperature, blood pressure, pulse, respiratory rate and oxygen saturation will identify signs of systemic disturbance.

Examination of the face

When examining the face look for:

• Visible facial swelling. If there is:
  • Where is it? Cheek swelling is typically found in either an upper or lower tooth abscess. Submandibular swelling occurs in infection of the molar
  • Is it firm or fluctuant? Fluctuant swelling indicates a collection of fluid usually pus
  • Does it extend into the neck? This may indicate spreading infection
• Trismus – an inability to open the mouth normally
• Palpable lymph nodes

Examination of the mouth

For an adequate examination, it is essential to use a bright light, tongue depressor and mirror:

• Look at the teeth, what condition are they in? Is dental caries present?
• Are the gums red, bleeding, inflamed or swollen?
• Look in the sublingual space for swelling and redness these are signs of sublingual infection and potential airway compromise
• Look at the pharynx is there evidence of swelling? this may indicate retropharyngeal spread of infection
• Feel in the mouth with a gloved finger for tenderness, swelling and/or fluctuance

Learning bite

Swelling of the pharynx or under the tongue are serious signs that indicate spread of infection into the deeper tissues.

During the course of the history and examination, the clinician may identify features that suggest a more serious problem.

If any of the features shown in the table are present consider seeking advice from a senior colleague, anaesthetist or maxillofacial specialist, as appropriate.