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)…

Presentation The patient may have had an extraction or other dental surgery performed earlier in the day and now has excessive bleeding at the site and is unable to visit the dentist. The patient may also be using aspirin, warfarin, or direct-acting oral anticoagulants (DOACs) such as apixaban, dabigatran, or rivaroxaban. In addition, patients may be taking aspirin in combination with one of the newer dual…

Presentation After a direct blow to the mouth, the patient, usually a child 7 to 9 years old, may have a permanent tooth that has been completely knocked out of its socket (avulsion) ( Fig. 43.1 ). The tooth is intact down to its root, from which hangs the delicate periodontal ligament that used to be attached to alveolar bone. Alternatively, the tooth may have only…

Presentation Patients present with a painful lesion in their mouth, often worried about having herpes. Lesions may interfere with eating, speaking, or swallowing. Minor oral trauma from dental appliances, dentures, and orthodontic hardware may be causative, or patients may inadvertently produce traumatic ulcers through biting of their oral mucosa. Simple aphthosis (apthous ulcers), episodic lesions that are few in number, healing within 1 to 2 weeks,…

Presentation After a viral infection or with chronic allergies, the patient may complain of a dull facial pain, which is usually unilateral, gradually increases over a couple of days, is exacerbated by sudden motion of the head or bending over with the head dependent, may radiate to the upper molar teeth (through the maxillary antrum), and may increase with eye movement (through the ethmoid sinuses). Often…

Presentation In allergic rhinitis , patients typically complain of rhinorrhea (“runny nose”), nasal congestion, sneezing, nasal itching, and “itchy eyes.” There may be a problem with sleep disturbance (from nasal congestion), malaise, fatigue, irritability, and neurocognitive deficits. Typically patients with allergic rhinitis have clear discharge, swollen turbinates, and bluish or pale mucosa. There may be “allergic shiners”—infraorbital darkening thought to be caused by chronic venous pooling—or…

Presentation The patient with bacterial pharyngitis complains of a rapid onset of throat pain worsened by swallowing. There is usually sudden onset of the following: fever; pharyngeal erythema; edematous uvula; palatine petechiae ( Fig. 39.1 ); purulent, patchy yellow, gray, or white exudate; tender anterior cervical adenopathy; headache; and absence of a cough. Children who are younger than 3 years of age more often have coryza…

Presentation The patient experiences ear pain after barotrauma, such as a blow or slap on the ear, an exploding firecracker, a fall while water skiing or during a deep-water dive, or after direct trauma inflicted with a sharp object, such as an open paper clip, cerumen curette, or sharp plant part. Hemorrhage is often noticed within the external canal, and the patient will experience the acute…