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Noticed Swollen Face And White Circles Inside Cheeks. What Could This Be?

Posted on Wed, 1 Jan 2014

Question: My Husband is in a great deal of pain, AND HIS FACE IS VERY SWOLLEN ON THE LEFT SIDE. I have looked in his mouth and all I could see was a little white circle on the inside cheek, but nothing around the tooth or gums. He has had a tetnus shot within the last ten years. He is not running a fever. What could this be? Should I take him to emergency?

Answered by Dr. Anshumala Singh (52 minutes later)

Brief Answer: Could be an abscess Detailed Answer: Hello and welcome. Thanks for sharing your concern. According to the history posted here it appears that there could be an infection in the tooth.Sudden unilateral swelling arises more commonly due to tooth decay and trauma. Therefore please provide me following details to answer better in this regard. 1.Where on the face is the swelling present,that is in the upper jaw near eyes or in the lower jaw? 2.Does he have any fillings done in any of his teeth? 3.Does he feels pain while opening the mouth or chewing? 4.When did notice the swelling, any associated tooth ache? 5.Is he taking any medication,other than the present swelling, please mention.? Awaiting your response. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anshumala Singh (20 minutes later)

1) Middle of the cheekbone, left side 2) yes filings in most teeth 3) Swelling and pain began last Friday 4) When he opens his mouth and chews the pain is no different 4) No Meds He has been to the dentist and they found no signs of an absess, and took an xray and could not find anything related to any teeth. His jaw also hurts. Pain is an 8 on a scale of 1 to 10. He also has a severe headache. Thanks

Answered by Dr. Anshumala Singh (3 hours later)

Brief Answer: Appears to be periapical abscess. Detailed Answer: Hello and thanks for reply. After going through the history posted here,it is very much clear that there is infection in his teeth in the upper jaw.The swelling and pain appears due to that. The reason for suspecting an abscess is presence of filled teeth. Sometimes the filled teeth appears very normal in x ray but there is periapical(near the roots) infection present which leads to pain and abscess. Remember x ray cannot give 3D view.It requires clinical exploration too. In my view, presently the patient requires to visit to an Endodontist(specialist in root canal treatment). Upon consultation he might start with antibiotics like Augumentin 625 mg,once daily for three days. He can also take pain killers like Combiflam every six hourly.It is best to see an Endodontist,so that they can detect which tooth is causing the infection and simultaneously, it can be treated. Upon detection once the tooth is opened, the pus will drain and patient will feel very much relieved. Remember pain originating due to dental origin requires no medication but treatment.Please do not apply warmth on the swelling.Do not cover your face with cloth or hand. Hope I have answered your query .please let me know for further doubts. Hope it helps. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Anshumala Singh (1 hour later)

Dear Doctor: I should have informed you that both of us all college educated however nevertheless unemployed. Do you feel reasonably certain that this id tooth related? The pain started last Friday, first in the lower left back tooth but then moved to the upper left tooth directly above the original tooth. Now the pain is in his cheek (which is swollen) and has now however spread to the right cheek. After careful examination of lower and upper gums in that area there is no sign of infection in or around tooth and gum, only in the cheek. We do not want to incur more expense than we have to. Can you prescribe medication for him during this interim while we search for a Dentist that will take payments monthly? He will need an anti-biotic and pain medication. He is allergic to Vicodin and Codeine. When he had a root canal in a different tooth a couple of years ago, they prescribed Oxycodone and that seem to help a great deal with the pain. I know you are probably thinking I sound like a nurse, however in all honesty I am the daughter of a nurse whom taught me a great deal. He has a small white circle in the inside cheek on the left side. He says he has not bitten his cheek in the last few months. I am scared of losing him as tooth/infection is not something one should take lightly. I just want to get him started on the meds, as I know he will need to be on antibiotics for two-three days before they can do any procedure other than draining. Please advise, thank you. Please feel free to call me for further description of the situation. I am dealing with a very headstrong independent person. I was a caregiver to my Father for 10+ years, and I found myself to be a patient advocate to a very stubborn headstrong individual , so it’s this is nothing new to me. However 51 and 81 are significantly different. Sincerely, XXXXX

Answered by Dr. Anshumala Singh (14 hours later)

Brief Answer: A 3 day course of antibiotic and analgesics Detailed Answer: Hello and thanks for reply. As I have mentioned earlier in my answers to your query that the tooth infection is the sole common cause for swelling in cheek with the kind of history you have given. Therefore I would like to say that please follow the previous prescription given to you by your dentist,when he had gone for root canal treatment. A course of antibiotic and analgesic for three days can be taken before starting any dental procedure.Too much delay can lead to space infections too.Therefore please be careful. It is not advisable for me to prescribe any drug to the patient without seeing his or her clinical condition.Therefore please excuse me, regarding this. The only indication I can give is ,you can very well continue with the previous prescription if there were no side effects. Also remember antibiotic and analgesics will take care of infection for short duration only.Therefore please see your dentist Hope it helps. Let me know for further doubts. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Anshumala Singh (2 hours later)

My husband saw a dentist today and they are baffled. They checked every tooth and even tapped pretty hard on them and it did not affect the pain whatsoever. His cheek is more swollen today. They put him on Augmentin just as you had suggested and gave him something for pain. They have now referred him to a specialist whom they say has a microscope to get a better look. Our problem is we are now out of money, after two trips to two different dentists and the medication. About five minutes ago I had a small epiphany, my husband had his first case of shingles a year ago March. It started on his forehead and ran down his face into his eye. It followed the nerve. It was very outwardly notiecable and started in the form of a red blistery rash and spread that way. Is it possible, or have you ever heard of someone getting Shingles inside their cheek without a noticible blister or breakout? The pain does follow a nerve on his face and it's even more swollen today. I am desparate for answers, as his older brother had tongue cancer out of the blue last year. We have a prescription for zoverax that we keep on hand in case of a shingles outbreak, so I suggested he start taking it as a precausionary for the next ten days to see if it helps. I was hoping you could tell me if you have ever heard of a Shingles outbreak that didn't rupture the skin. Thank you, XXXXX

Answered by Dr. Anshumala Singh (2 hours later)

Brief Answer: Antiviral to be started Detailed Answer: Hello and thanks for reply. you have done a wise thing by starting the antiviral drug. Yes definitely shingles can arise in such forms where patient feels intense pain without any blisters. Please remember a complete history helps in better diagnosis. you must be aware that the shingles affects the trigeminal nerve and its distribution on face.Thus causing pain. I feel that your husband will be benefitted with anti inflammatory agents like ADVIL/MOTRIN and nerve repairing agents like Gabapentin. Gabapentin is not over the counter. You need a prescription. Hope it helps. Let me know for further query. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anshumala Singh (13 hours later)

Dear Doc: My husbands face has gone down significantly, and the pain is dissipating to a degree. We have Neurontin on hand so I will start him on that immediately. Any suggestions on the dose? I am so glad I gave that consideration last night. It just never dawned on me that it could occur underneath the skin. I am calling my Doctor right now to get him to call in a prescription for a shingles vaccine for me, as I have a compromised immune systems from having Toxic Shock. My Mother was an RN and I could hear her voice telling me to go get it. I will keep you posted on his progress. If you could please tell me the dosage for the Neurontin, I will get him started. Thank you so much! XXXXX

Answered by Dr. Anshumala Singh (4 hours later)

Brief Answer: 300 mg single dosage is usually effective. Detailed Answer: Hello and thanks for reply. Neurontin therapy is to be started under care of a physician. We generally use 300 mg single dose per day in most patient. The dose can be increased to 600 mg in two divided dosage of 300 mg each if needed. This therapy is followed in ascending order after checking the correct required dosage for each different case. A maximum of 1500 mg in divided dosage can be given to patient in extreme pain. but please consult your physician regarding this. Hope it helps. Thanks. Take care.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Anshumala Singh (6 hours later)

Thank you for everything! Looks like were on the road to recovery. XXXXX

Answered by Dr. Anshumala Singh (23 minutes later)

Brief Answer: wish you good health Detailed Answer: Hello and thanks for reply. Wish you very good health. Thanks. Take care

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar