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Paediatric dentistry

Strep A streptococcal infection

British Dental Journal volume 234, page 96 (2023)Cite this article

A ten-year-old patient presented to our paediatric dental emergency clinic complaining of pain and swelling on the left side of the face, TMJ and teeth for over a week. The pain was described as 'hot and sharp', exacerbated by eating, talking, and overusing the jaw, and affected eating and sleeping. On examination, the patient had attention deficit hyperactivity disorder and learning difficulties but did not have a high temperature nor difficulty in breathing. It is worthwhile noting that vaccinations were not up to date as the parents had refused vaccinations historically. Upon examination, there was unilateral left buccal swelling in the parotid area with submandibular lymphadenitis. The buccal swelling was soft, palpable and tender to touch. There was limited mouth opening due to pain, but a full range of movements, including protrusive and lateral excursive movements, was tolerable. The findings from both intra-oral and radiographic examinations were unremarkable.

When considering differential diagnoses, TMJ dysfunction and mumps were considered. The former was unlikely however, given the unilateral presentation of pain and unaffected TMJ functions. Initial management was conservative, including bed rest and analgesia. The patient was advised to follow up with his general medical practitioner (GMP) on the day, in view of no intra-oral pathology and to exclude any systemic medical causes. The patient was followed up via telephone review a few days later when the mother suggested ongoing swelling, but that the patient was well enough to go to school. At the time, the mother still had not contacted the GMP so we strongly advised her to do so. The mother was contacted again a few days later. The patient had been seen by the GMP who had diagnosed scarlet fever caused by Group A Streptococcal (GAS) infection and given antibiotics, which had resolved the symptoms. The patient's sister suffered from scarlet fever as well and required hospital admission.

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References

  1. UK Health Security Agency. Group A streptococcal infections: First update on seasonal activity in England, 2022 to 2023. Updated 12 January 2023. Available at: https://www.gov.uk/government/publications/group-a-streptococcal-infections-activity-during-the-2022-to-2023-season/group-a-streptococcal-infections-first-update-on-seasonal-activity-in-england-2022-to-2023 (accessed January 2023).

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Authors and Affiliations

  1. St Thomas´ Hospital, London, UK

    N. Liu

  2. Paediatric Dentistry, London, UK

    D. Siddik

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  1. N. Liu
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  2. D. Siddik
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Correspondence to N. Liu or D. Siddik.

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Liu, N., Siddik, D. Strep A streptococcal infection. Br Dent J 234, 96 (2023). https://doi.org/10.1038/s41415-023-5468-7

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  • DOI: https://doi.org/10.1038/s41415-023-5468-7

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