skip to main content

Abscess Anxious Patient — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateOral SurgeryAbscess Anxious PatientORE Part 1

A competent adult with severe dental anxiety presents with an acute dentoalveolar abscess. There is a localised intraoral buccal swelling, but no fever, malaise, facial or neck swelling, trismus, or airway symptoms. They refuse all operative treatment, including local anaesthesia. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Provide analgesia, safety-net urgently, and arrange anxiety-supported definitive care

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

A is correct. In a localised acute apical/dentoalveolar abscess without systemic or spreading infection, SDCEP advises optimal analgesia and urgent dental care; antibiotics are not indicated routinely. Although drainage or extraction is definitive treatment, this competent patient refuses treatment, so it cannot be undertaken without consent. Explain the risks of deterioration, give clear safety-net advice to seek urgent help if fever, malaise, facial/neck swelling, trismus, dysphagia or breathing difficulty develops, document the refusal, and arrange an anxiety-supported route to definitive treatment. B is inappropriate antibiotic-only management in the absence of an indication. C breaches valid consent. D fails to manage pain or provide essential review and safety-netting. E may ultimately be needed in selected cases, but general anaesthesia is not the automatic first response to anxiety.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Acute Dental Problems: Acute apical abscess, current online guidance. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/acute-apical-abscess/