Establishing a history is crucial. Look out for other medical issues the patient may present with or underlying conditions such as diabetes, immunosuppression or analgesia overdoses. One of the most common reasons for a paracetamol overdose is dental pain, therefore the patient may be admitted under the medical team to treat this and then get transferred to your ward.
Before you examine the patient intra-orally, ask yourself “Does the patient look well?” It is essential A&E take a set of observations before referring the patient. If the patient has a fever and/or tachycardia it is likely they are systemically unwell and you should request a baseline set of bloods (FBCs, U&Es, CRP).
With regards to the rest of your examination you should be looking for the following things:
1) Location and size of swelling
2) Extensive caries/significantly broken teeth/heavily restored dentition
3) Palpable lymph nodes
4) FOM firm and/or raised? Patient may be drooling if this is the case
5) Presence of purulent discharge intra/extra-orally
6) Does the swelling look cellulitic?
7) Trismus – ideally measure, however if you don’t have a ruler to hand, measure based on how many finger widths you can place between the maxillary and mandibular incisors (normal mouth opening is 35mm).
8) For suspected submandibular swellings, can you feel the lower border of the mandible?
9) Voice changes, difficulty in protruding the tongue. Can indicate more severe infections involving the retropharyngeal/parapharyngeal spaces.