Sir, an 11-year-old female patient was under the care of the paediatric intensive care unit (PICU) with severe diabetic ketoacidosis and septic shock with multiple organ failure. She required ventilation, multiple inotropes and continuous veno-venous haemofiltration and was on intravenous broad-spectrum antibiotics. The PICU team requested a dental opinion in order to rule out dental pathology as there was a history of attendance at a dental surgery with pain a week earlier. Extra-orally, the patient did not appear to have a significant facial swelling. Intraoral examination revealed multiple unrestorable carious decidious teeth. There was a buccal swelling associated with the cavitated primary upper left canine and primary upper left first molar. A decision was made to extract both these teeth under local anaesthesia in addition to her continuing sedation and muscle relaxation.

A few days following the dental extractions, the general health of the patient improved and she was discharged from PICU, and then sent home having made a full recovery.

Although it cannot be confirmed with certainty that the dental abscess was the source of the systemic infection, nonetheless, the child's health improved significantly after the removal of the carious teeth, and no other source of infection was ever clinically suspected or proven.

The patient's mother explained that her daughter had seen her general dental practitioner approximately a week earlier and extraction of the carious teeth had been advised. However, the patient was not willing to have this carried out under local anaesthesia. This case highlights the need to treat carious deciduous teeth, especially if the child has an underlying medical problem.1,2