Lymphadenopathy: Lymph node enlargement can occur at any time during the infective process The treatment of choice for a localized dentoalveolar abscess is symptomatic control (oral analgesics and moist heat) and drainage Drainage may be established by extraction of the offending tooth In cases which have progressed to facial cellulitis with lymphadenopathy, antibiotics should be given Amoxicillin or amoxicillin with clavulanate are first-line agents in children Use of clindamycin in penicillin allergic patients is decreasing in dental patients due to concerns with growth of Clostridium difficile Erythromycin and tetracycline are no longer recommended due to increasing resistance of some strains of bacteria If extensive or rapidly progressive swelling is noted, a hospital admission may be required for parenteral antibiotics Other factors to consider in determining the need for hospital admission include signs of systemic illness such as fever, altered mentation, lethargy and leukocytosis, the child’s ability to take fluids, and the likelihood of the parent’s compliance with follow-up dental care In addition to antibiotics, warm oral saline rinses can be used (if the child is able to cooperate) or warm moist heat applied to the area of swelling Analgesic therapy with acetaminophen or ibuprofen is usually sufficient though narcotics may be required in more severe cases Dental consultation should be obtained As with abscesses elsewhere in the body, the basic surgical principles of treatment are to establish drainage as a means of source control For dentoalveolar abscesses specifically, definitive treatment may include venting or extraction of the offending tooth, and possibly incising any fluctuant mass when needed Treatment of facial cellulitis is covered in Chapter 94 Infectious Disease Emergencies In the rare case of systemic infection, blood cultures should be obtained and broad-spectrum parenteral antibiotics given POSTEXTRACTION COMPLICATIONS Goals of Treatment Children may present to the ED in hours to days after dental procedures such as tooth extractions, with concerns related to bleeding, swelling, pain, or fever When these symptoms develop during hours in which their primary dentist is unavailable, the ED becomes a means of access for urgent consultation Emergency physicians should identify whether symptoms are related to the prior procedure and if so, treat any complications until the patient is able to be evaluated by a dentist