Presentation The patient may have been sprayed with tear gas (e.g., Mace) during a riot being dispersed by the police or may have accidentally sprayed oneself. The patient might complain of burning of the eyes, nose, mouth, and skin, as well as tearing and inability to open the eyes because of the severe stinging. There may be sneezing, coughing, runny nose, and perhaps a metallic taste…

Presentation The patient was trapped in an enclosed space with toxic gases or fumes (e.g., produced by a fire, a leak, evaporation of a solvent, a chemical reaction, or fermentation of silage) and comes to the emergency department or acute care center complaining of coughing, wheezing, shortness of breath, irritated or runny eyes or nose, or skin irritation. More severe symptoms include confusion and narcosis, dizziness,…

Presentation Patients, typically younger than age 40, present with a day or more of steady aching with intermittent stabbing chest pain. The pain may follow an episode of minor trauma, a period of frequent coughing, or unusual physical activity or overuse. The symptoms may be localized to the left or right of the sternum and may worsen when the patient takes a deep breath, changes position,…

Presentation The patient’s symptoms generally begin with 1 to 5 days of fever, malaise, and myalgias that are often indistinguishable from other acute upper respiratory tract infections (URIs). With acute bronchitis, the acute phase is followed by a second phase characterized by persistent cough, often accompanied by phlegm production or wheezing. This second phase usually lasts 1 to 3 weeks but may last as long as…

Presentation The patient presents with a foreign-body sensation or a fullness or lump in the throat, possibly associated with a slightly muffled voice and gagging. Often patients have seen their swollen uvula after looking in a mirror. On examination of the throat, the uvula is boggy, swollen, pale, and somewhat translucent and gelatinous appearing (uvular hydrops). If greatly enlarged, the uvula might rest on the tongue…

Presentation Patients present with the inability to close the jaw, usually after yawning, laughing, taking a large bite of food, suffering a traumatic jaw injury, or having a dystonic drug reaction. Such patients have difficulty enunciating clearly. Although they usually have only mild to moderate discomfort, they may have severe pain anterior to the ear. A depression can be seen or felt in the preauricular area,…

Presentation Patients usually complain of poorly localized facial pain or headache that does not appear to conform to a strict anatomic distribution. The pain is generally dull and unilateral, centered in the temple above and behind the eye, and in and around the ear. The pain may be associated with mastication and passive movement of the mandible, instability of the temporomandibular joint (TMJ), crepitus, or clicking…

Presentation Although most common in men of age 30 to 60 years, patients of any demographic may develop salivary duct stones. Most salivary stones occur in the Wharton duct from the submandibular gland. The patient typically presents after rapid swelling that suddenly appears beneath the jaw while eating. The swelling may be painful but is not inflamed and usually subsides within hours. This swelling may be…

Presentation Patients present with inflammation and soreness of the skin and contiguous labial mucous membranes at the angles of the mouth ( Fig. 56.1 ). On examination, there is erythema, fissuring, and maceration of the oral commissures. In severe cases, bleeding can occur when the mouth is opened, and shallow ulcers or a crust may form. You’re Reading a Preview Become a Clinical Tree membership for…

Presentation Patients with orthodontic appliances may present after traumatic injury or discomfort in the absence of distinct trauma. There may be bleeding, lacerations, or patient anxiety. Other problems include impacted food, candy, or chewing gum causing gingival infection. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Presentation Patients present with swelling, burning, or soreness at the vermilion border of the lips followed by the appearance of clusters of small painful vesicles on an erythematous base ( Fig. 54.1 ). The vesicles can rupture to produce red, irregular ulcerations with swollen borders and crusting, which eventually heal without leaving a scar. These lesions can also occur on the hard palate or gingiva. Episodes…

Presentation A parent may present with an infant with white patches in the mouth, or an older patient—classically with either poor oral hygiene, diabetes, a hematologic malignancy, an immunodeficiency, or on antibiotic, cytotoxic, or steroid therapy—may complain of a sore mouth and sensitivity to foods that are spicy or acidic. On physical examination, painless white patches are found in the mouth and on the tongue. The…

Presentation Because of the rich vascularity of the soft tissues of the mouth, impact injuries often lead to dramatic hemorrhages that bring patients with relatively trivial lacerations to the emergency department (ED) and other health care facilities. Blunt trauma to the face can cause secondary lacerations of the lips, frenulum, buccal mucosa, gingiva, and tongue. Active bleeding has often stopped by the time a patient with…

Presentation With mild gingivitis, the patient’s gums bleed easily and become red and swollen with increased sensitivity. As symptoms worsen, the gums begin to recede and take on a beefy red, inflamed color. Further progression leads to the most severe periodontal infection, trench mouth, or acute necrotizing ulcerative gingivitis (ANUG). The patient complains of generalized severe pain of the gums, often with a foul taste or…

Presentation After a direct blow to the mouth, a portion of a patient’s tooth (most often one of the maxillary incisors) may be broken off, or a tooth may be loosened to a variable degree. Ellis class I dental fractures ( Fig. 50.1 ) involve only the enamel and are problematic only if a sharp edge remains, which can be filed down with an emery board.…

Presentation The patient presents with a sharp, throbbing pain in a tooth. This pain is often worse when the patient is in a recumbent position. This individual may or may not be aware of a cavity in the affected tooth. Initially, the pain is decreased by heat application and increased by cold application, but as the condition progresses, heat application worsens the pain, whereas application of…

Presentation Patients present with severe, dull, throbbing pain 2 to 4 days after a tooth extraction, usually a wisdom tooth in the lower jaw. The pain is often excruciating and continuous; may radiate to the ear, temple, or neck; and is not relieved by oral analgesics. There may be associated foul taste and odor (halitosis). There may also be localized swelling and lymph node involvement. The…

Presentation Patients, typically between the ages of 17 and 29, seek help because of painful swelling and signs of infection around a partially erupted or impacted third molar (wisdom tooth). There may be a bad taste caused by pus oozing from the area. The pain is usually quite intense and may radiate to the external neck, throat, ear, or oral floor. Occasionally there is trismus (the…

Presentation The patient complains of severe, constant facial or dental pain, often associated with facial swelling, regional lymphadenopathy, and cellulitis, and may exhibit signs of systemic toxicity. The pain may be gnawing, throbbing, or sharp and shooting. Dental caries may or may not be apparent. Percussion of the offending tooth causes increased pain ( Fig. 46.1 ). The severe toothache may be exacerbated by thermal changes,…

Presentation Patients present with a painful sensation of the tongue or mouth. The pain is variably described as a burning, tingling, hot, scalded, or numb sensation, the magnitude of which is similar to a toothache. The sensation occurs most commonly on the anterior two-thirds and tip of the tongue but may include the upper alveolar region, palate, lips, and lower alveolar region. Burning mouth syndrome (BMS)…