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Based on her history and examination, Mrs D is most likely suffering from a dental abscess. In such cases patients classically experience a swelling of the face. Only when asked if they suffer from toothache will patients admit that a tooth has been giving them problems. On examination, the suspicious tooth should be noticed.
All swellings should be examined by a doctor
Dental abscesses can be very painful, but in some cases the patient will not necessarily experience pain, only swelling. The patient might have spiking fevers. Abscesses should be treated as quickly as possible. The patient will be referred to a dentist to remove the affected tooth and drain the abscess. The dentist will prescribe antibiotics.
Read: Facial Swelling
Distinguishing between abscesses and other causes of facial swelling is not always straightforward. One has to exclude allergic reactions and also make sure the swelling is not affecting the airways of the patient. Ear, nose and throat causes need to be excluded. In the absence of dental problems, an ENT surgeon will examine the patient and exclude soft tissue growths (which develop over time, rather than overnight), and infections of the nose, sinus cavities and ears.
In the case of sudden onset swelling, a medical opinion is urgently needed – especially if the overlying skin is red, tender and the patient has fever, facial weakness or draining of fluid or pus from the mouth or nasal cavities. All swellings should be examined by a doctor.
NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.
Previously on What's Your Diagnosis?
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What's your diagnosis? - Case 2: eye pain
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What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms
What's your diagnosis? - Case 11: bruising with no apparent reason
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What's your diagnosis? - Case 13: severe sore throat
What's your diagnosis? - Case 14: abdominal pain and swelling
What's your diagnosis? - Case 15: the world is spinning
What's your diagnosis? - Case 16: numbness in forearm
What's your diagnosis? - Case 17: burning urine
What's your diagnosis? - Case 18: boy with persistent fever
What's your diagnosis? – Case 19: lady who can't lose weight
What's your diagnosis? – Case 20: chest pain next to breastbone
What's your diagnosis? – Case 21: burning sensation in vagina
What's your diagnosis? – Case 22: vomiting and headaches
What's your diagnosis? – Case 23: frequent urination
