What is the recommended course of action for a swollen face following tooth pain with no additional symptoms like fever or difficulty opening the mouth?

Immediate Dental Referral for Evaluation and Possible Surgical Intervention

Amanda requires urgent dental evaluation within 24-48 hours, as facial swelling following tooth pain strongly suggests a dental abscess that has spread beyond the tooth, and antibiotics alone without surgical drainage will not resolve the infection and may lead to progressive worsening. 1, 2

Critical Understanding: Why This Cannot Wait

• Dental abscesses do not resolve with antibiotics alone—the infection requires source control through drainage, debridement, or extraction of the affected tooth 3, 1
• Even without fever or trismus (difficulty opening mouth), facial swelling indicates the infection has spread beyond the confines of the tooth into surrounding soft tissues 2, 4
• If treated with antibiotics alone, the infection will not resolve and will become progressively worse, potentially leading to airway compromise or septicemia 1

Immediate Assessment Before Referral

Evaluate for red flag features that would require emergency department referral instead of routine dental referral 5:

• Difficulty swallowing or breathing (suggests deep space infection)
• Trismus (inability to open mouth >2 finger widths)
• Floor of mouth swelling (Ludwig's angina risk)
• Fever, malaise, or systemic symptoms (indicates spreading infection requiring immediate intervention) 6, 3
• Bilateral facial swelling or neck involvement (suggests fascial space involvement)

Management Algorithm

If NO Red Flags Present (Amanda's Current Presentation):

1. Urgent dental referral within 24-48 hours for definitive surgical management 5
2. Consider empiric antibiotics while awaiting dental evaluation:
   • Amoxicillin 500 mg orally three times daily 6, 3
   • Alternative: Clindamycin if penicillin allergic 6, 3
3. Emphasize to patient: Antibiotics are a bridge to definitive treatment, not the treatment itself 1

If ANY Red Flags Present:

• Immediate emergency department referral for potential airway management and surgical consultation 1, 4
• These patients require prompt assessment at a tertiary hospital for cases at risk of airway compromise 1

Common Pitfall to Avoid

The most dangerous error is prescribing antibiotics without arranging surgical intervention, as this creates false reassurance while the infection continues to spread 3, 1. The subsidence of tooth pain does not indicate resolution—it often means the tooth nerve has died, while the infection continues to spread into surrounding tissues 2, 7.

Why Dental Evaluation Cannot Be Deferred

• Panoramic dental radiography is needed to identify the source tooth and extent of bony involvement 7
• The dental team must determine if extraction, incision and drainage, or endodontic treatment is required 5
• Facial swelling after tooth pain represents end-stage dental disease with periapical abscess formation that has breached into surrounding tissues 1, 2