What are the key clinical signs and symptoms that indicate a dental abscess in a primary care setting?

In a primary care setting, key clinical signs and symptoms that may indicate a dental abscess include:

• Pain, which can be exacerbated by temperature or biting NICE CKS.
• Swelling, which may present as diffuse swelling, or more specifically as mandibular, submandibular, or infraorbital swelling, or 'floor of mouth' swelling NICE CKS.
• Signs of systemic infection, such as fever (pyrexia), malaise, nausea, or rigors NICE CKS.
• Lymphadenopathy (swollen lymph nodes) NICE CKS.
• Cellulitis NICE CKS.

It is crucial to recognise signs and symptoms that indicate a severe or spreading infection, as these necessitate urgent hospital admission or specialist advice:

• Airway compromise, indicated by difficulty breathing or speaking, inability to swallow saliva, drooling, uvular deviation, trismus (difficulty opening the mouth), or inability to push the tongue forward NICE CKS.
• High temperature with cardio-respiratory compromise, such as a rapid pulse rate, low blood pressure, or high respiratory rate NICE CKS.
• Rapidly progressing infection NICE CKS.
• Significant swelling, particularly if it is mandibular, submandibular, infraorbital (or causing difficulty opening the eye), or involves the 'floor of mouth' NICE CKS.
• Spreading facial infection or orbital cellulitis NICE CKS.
• Neurological signs, including decreased level of consciousness, headache, or eye signs like diplopia (double vision), papilloedema, pupil dilation, or proptosis (bulging eyes) NICE CKS.
• Dehydration NICE CKS.
• Severe pain despite analgesia prescribed in primary care NICE CKS.