Serious infection after dental treatment

Working in an inner city emergency department, away from your suburban general practice, you enjoy the different spectrum of disease presentation that comes with groups such as tourists and business travellers.

One morning you attended a 39-year-old man who had been given a middle level triage score of 3 (to be seen within 30 minutes). The triage nurse had noted the presenting problems as: Dental surgery two weeks ago; now possible infection; right periorbital pressure, worse with coughing, and fevers. The observations showed the patient was afebrile, with a pulse of 90 beats per minute and blood pressure, 140/90 mmHg. The patient had rated his pain as severe, 9 out of 10. It was also noted that the patient had no past health problems and was currently on amoxycillin. The nurses had given him, with permission, two tablets of paracetamol 500 mg plus codeine 30 mg to relieve the extreme pain. The medications had started to take effect when you saw the patient 30 minutes later.