Life-Threatening Infection — ORE Part 1 MCQ

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EasyOral SurgeryLife-Threatening InfectionORE Part 1

A 30-year-old patient presents with facial swelling from pericoronitis associated with a lower right third molar. He has severe trismus (maximum opening 15 mm), difficulty swallowing, a temperature of 39.2°C and appears systemically unwell. What is the single most important next step?

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Correct answer: A — Arrange immediate emergency transfer to hospital

**A is correct.** Dysphagia, marked trismus, facial swelling, pyrexia and systemic illness indicate a severe odontogenic infection with potential airway compromise and sepsis. The immediate priority is emergency hospital transfer for airway assessment, OMFS management, imaging and definitive treatment where required. NHS England specifically identifies difficulty swallowing and significant trismus associated with dental infection as reasons to refer to emergency hospital care. Oral antibiotics with next-day review are inadequate in this high-risk presentation. Extraction or incision and drainage may be components of definitive source control, but should not be attempted in primary care before emergency assessment when airway risk is present. Intravenous antibiotics alone do not secure the airway or provide drainage/source control and require an appropriate monitored hospital pathway.

Reference: NHS England. Clinical guidance: unscheduled urgent and non-urgent dental care, section 7.2 Patient assessment, 2025. https://www.england.nhs.uk/long-read/clinical-guidance-unscheduled-urgent-and-non-urgent-dental-care/