Management of Acute Dental Problems

Brief description of condition

Blockage of salivary duct due to obstruction or infection.

Key signs and symptoms

• Pain located in a major salivary gland
• Swelling
• History of xerostomia (dry mouth)
• Dehydration
• Fever

Initial management

Determine if the patient has a salivary gland obstruction or infection, which may represent or be associated with systemic infection, or whether the patient might have mumps.

If there is infection:

Acute gland pain or acute episode of chronic persistent gland pain, (does not fluctuate with meal times), erythema, severe symptoms, systemically unwell, bilateral or unilateral parotid swelling with fever (this also may be associated with mumps):

• Recommend optimal analgesia.
• Advise the patient to seek urgent medical care.

If mumps is suspected:

A young patient (e.g. less than 21 years) experiencing swelling at the side of the face under the ear(s) swelling, systematically unwell and has a raised temperature.

• Recommend optimal analgesia.
• Advise the patient to avoid spread of infection by staying at home.
• Refer for urgent medical care as soon as possible within 24 hours (mumps is a notifiable disease).

If there is obstruction without infection (major salivary glands):

Intermittent pain and swelling, typically within an hour of meal times, then subsiding without erythema or fever.

• Recommend optimal analgesia.
• Advise the patient to drink plenty of fluids if experiencing dry mouth.
• Advise the patient to seek urgent dental care.

If there is obstruction without infection (minor salivary glands):

Usually a small localised swelling as a result of trauma (mucocele) that often discharges spontaneously.

• Advise the patient to seek non-urgent dental care.

In all of the above cases, if the patient is systemically unwell or there is a history of diabetes, advise the patient to seek urgent medical care.

Subsequent Care

Refer to an oral and maxillofacial surgeon if symptoms persist.

If additional symptoms emerge (e.g. enlarging mass, facial weakness) refer the patient for urgent care from an oral and maxillofacial surgeon.

Consider referral for further investigation to identify the underlying cause of dry mouth.

Consider surgical removal of persistent mucoceles or referral to an oral surgeon or an oral and maxillofacial surgeon