Spreading Odontogenic Infection — ORE Part 1 MCQ

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EasyOral SurgerySpreading Odontogenic InfectionORE Part 1

A patient attends an emergency dental clinic with facial swelling arising from a lower left second molar with periapical pathology. They have a temperature of 38.8°C, trismus with a 10 mm interincisal opening, and difficulty swallowing. What is the most appropriate management?

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Correct answer: E — Arrange immediate emergency hospital referral

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

A is correct. Facial swelling with dysphagia, marked trismus and pyrexia represents a severe spreading odontogenic infection with potential airway compromise. NHS England identifies difficulty swallowing and significant trismus associated with dental infection as features warranting consideration of emergency referral to hospital; severe spreading oro-facial infection requires urgent specialist assessment. Hospital management permits airway assessment, imaging where needed, surgical drainage/source control and intravenous treatment if indicated. B and E inappropriately delay definitive care with oral antibiotics alone. C may ultimately form part of source control, but extraction under local anaesthesia in primary care is unsafe in this systemically unwell patient with restricted access and swallowing difficulty. D is not appropriate as isolated primary-care extraoral drainage and does not address airway risk or the need for specialist management.

Reference: NHS England, Clinical guidance: unscheduled, urgent and non-urgent dental care, section 3.3 Urgent unscheduled care, 2024. https://www.england.nhs.uk/long-read/clinical-guidance-unscheduled-urgent-and-non-urgent-dental-care/