The inflammation form acute apical periodontitis can spread into the tissues surrounding the tooth provoking a marked acute response with swelling, pain and redness. The cause may also be from a previously treated or traumatised tooth. The tooth may be very tender to touch, feel elevated out of its socket and interfering with the normal bite. The tooth may become loose. There may be malaise and raised temperature. In warm weather lack of drinking due to discomfort can lead to dehydration. A good question to ask is “does the patient feel unwell” and if the swelling is increasing in size. Antibiotics should not be prescribed unless there are systemic effects, spreading infection to the eye or neck or if the patient is immunocompromised. In rare cases the infection may have spread to the surgical spaces around the tongue and oro-pharynx leading to risk of airway compromise. This can be indicated by the patient being unable to push their tongue out and/or swallow their own saliva and in such cases urgent admission to A&E is indicated.
In cases where urgent referral is not indicated the management would be to refer the patient to the relevant dental helpline and in the meantime to take appropriate analgesia and suitable fluids. Effective management is by physical intervention such as extraction, incision and drainage or opening the tooth to establish drainage none of which can be performed in General Medical Practice.