Page 11 - EADS Scientific Magazine .... 1st Edition

Prior occurrence:

• Pain from her lower right wisdom for 5 days

• Swelling of the gum around tooth
• Difficulty of biting for couple of days

• Last day she noticed pain in the floor of the mouth
• Pain during tongue movement

Extra oral examination:

➢ Palpable tender lymphnodes in the upper deep cervical chain and
submandibular triangle.

➢ Opening is limited to 15mm interincisal distance (trismus).
➢ Swelling: below and around the lower border of mandible extending

towards the neck. ( hot- tender- very firm- dusky – red color centrally –

not pointed to skin – halitosis)
➢ Temperature: 37.8°c (normal 36.8°c) which means that this patient is

pyretic.

Intra oral examination: Trismus hampers examina- Infection appears to be

tion, Lower right third molar is partially erupted, spreading relatively fast
Swollen operculum, On gentle probing pus exudes because the swelling has

from below operculum, Caries: no caries in second appeared overnight and
and third molar, Floor of the mouth: is very tender there are already systemic

and firm on the right side signs.
Final diagnosis Trismus is an important

The combination of sign, indicating that the

inflammation (swell- infection or inflamma-
ing, pain, redness and tion has spread to involve

heat) together with local the muscles of mastica-

lymphadenitis and pus tion. The patient is pyret-
seen intraorally indicate ic and feels unwell. These

an infection. Pericoro- features indicate that the
nitis is present and this infection is exerting a

appears to be the primary systemic effect.
source of the infection