(tapping with a tongue depressor or instrument) and may exhibit excessive mobility Oral analgesia should be provided to address pain If symptoms can be improved and the patient is able to tolerate oral intake, a referral for outpatient dental care is appropriate If significant swelling is present with systemic signs of illness, then admission for palliative management may be necessary Dentoalveolar Infection and Abscess Odontogenic infections often results from dental caries, periodontal disease, or dental injuries Dental caries develop following bacterial colonization of the tooth surface, that is, plaque Certain bacteria, commonly Streptococcus mutans and Streptococcus sobrinus, invade the tooth surface and can eventually infect the pulp tissue An inflammatory response to the presence of bacteria in the dental pulp results in increased intrapulpal pressure and the clinical symptom of pain Pus may egress out of the root of the infected tooth, causing localized swelling Dental infection can also spread and become quite extensive Infection travels along planes of least resistance, which is predetermined by anatomic barriers, that is, muscle, bone, and fascia Pus perforates bone where it is thinnest and weakest: in the mandible on the lingual aspect of molars and buccal aspect of anterior teeth; in the maxilla on the buccal surface throughout The infection may spread into the subperiosteal area and then to the surrounding soft tissues If it does not drain intraorally, the infection can progress rapidly along the fascial planes of the face or neck Resultant facial cellulitis can have severe systemic consequences, including cavernous sinus thrombosis, preseptal or orbital cellulitis, intracranial spread and meningitis, or even sepsis The following are clinical manifestations of a dental infection in a child: Pain: The child may present with pain or it may be elicited with percussion Mobility: The tooth may have greater than normal degree of movement in the socket when palpated Swelling: The soft tissues surrounding the tooth may be edematous and erythematous Temperature elevation: The child may be febrile Sinus tracts: A pustule-like lesion may be noted on the gingiva (rarely on the face) when the infection has been longstanding Extrusion: The tooth may become extruded because of the presence of fluid in the periradicular (around the root) space