Buccal space infection; a most common yet diverse case that is frequently reported to clinics. Especially rural parts of Nepal and India where dental treatment is quite neglected, buccal space infection is frequently seen . This might be difficult to manage if the condition is worse. So In this case report we are writing how the case was presented with Signs, Symptoms, Clinical condition, Intra-oral condition and how to decide the method of treatment as well as medicines that should be prescribed.
A 53 year old woman had reported to the clinic with swelling in the left cheek region for 2 days. It was about 5cm length and 5 cm breadth. The swelling was extended from corner of mouth to angle of jaw horizontally and zygomatic region to few cm below the inferior border of mandible. She had pain which was
- Character: Throbbing
- Intensity: Moderate to severe
- Radiating to left temporal region
- Aggravated by chewing food
- Relieved by ice pack application
- Progression: Swelling increased significantly in two days (Progression is important to know the stages of infection)
Also She had night pain and painful mouth opening.
Intra-oral Examination of Buccal Space Infection:
The soft tissue was clinically apparently normal.
Mouth opening was limited (approx of 20 mm)
No signs of pus drainage and fistula. (This can differentiate cellulitis and abscess stage)
- The buccal vestibule adjacent to the lower left 1st molar was very painful but no swelling and pus collection was observed. (This rule out vestibular abscess or space infection)
- The swelling was soft in consistency but not fluctuating.
Hard Tissue Examinations:
- Caries: 16,37,46,48
- Root stump:17, 36
- Peripapical abscess: 36,37,46,47
- The tooth of concern as per OPG and clinical findings is to be 36 and 37.
- There is bone loss observed with periapical radiolucency . So the Cause of this infection is Periapical Origin as a result of pulpal necrosis of 36 and 37.
Treatment plan of buccal space infection:
Since the swelling has started since 2 days and there is no collection of pus, no fluctuating swelling on palpation and no signs of sinus or fistula , it can be managed by medication followed by extraction of tooth resulting in odontogenic infections. However if the condidtion had been severe the management of space infection would be additional and more specific.
So the treatment plan was prescribing Antibiotics for 5 days, and extraction of 36 and 37 under Local Anesthesia. The treatment plan could be changed as per the condition of the patient afterwards.
- Cap Amoxicillin 500 mg – PO- TDS- 5 days(against aerobic bacteria)
- Tab Metronidazole 400 mg – PO- TDS- 5 days(against anaerobic bacteria)
- Tab Ibuprofen 400 mg – PO- TDS- 3 days and then SOS
Space infection is one of the common as well as important problems that is reported to the clinic. It should be diagnosed precisely and managed according to the condition and stage of infection. There are many important things like stages of infection, microorganism associated with the infection and antibiotic therapy that should be known precisely before its treatment which is given in detail in this article within links. The clinical finding, intra-oral, Extra-oral , nature of pain and extent of swelling, finding of the causative tooth, proper diagnosis and decision regarding the management are some important factors that must be considered during treatment of buccal space infection.
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