Sir, a 47-year-old female presented with persistent pain and swelling of the right submandibular region of four weeks' duration. There was no history of dental pain or swelling intraorally. She did not complain of any problems eating, drinking, swallowing or breathing. Specifically, she did not complain of any mealtime symptoms of pain and swelling. Due to her symptoms, she visited her general dental practitioner twice thinking it to be a 'dental infection' and was prescribed oral antibiotics on both occasions. She was further advised removal of the lower right first molar tooth after finishing the course of antibiotics.

Medically, she suffered from gastro-oesophageal reflux disease (GORD) and hypothyroidism and was on regular levothyroxine and omeprazole. She was afebrile. On examination, she had a tender, fluctuant, localised 7-8 cm swelling of the right submandibular region. Intraorally, her mouth opening was satisfactory with no evidence of any obvious pathology. The floor of the mouth was not tender or raised. The lower right first molar tooth was grossly decayed but no evidence of acute infection was noticed.

An orthopantomograph revealed three radiopaque lesions below the right lower border of the mandible (Fig. 1). The largest of this opacities measured about 1.5 cm in diameter. A diagnosis of right submandibular abscess secondary to multiple sialoliths in the main body of the submandibular salivary gland was made which was further confirmed with an ultrasound scan. The patient underwent aspiration of abscess which revealed about 12 ml of pus and was subsequently booked for formal excision of the submandibular salivary gland. There are many situations where the teeth may not be the cause of facial/neck swellings. We recommend early referral of these patients to secondary care as drainage is necessary to facilitate further spread and prevent further morbidity to the patients.

Figure 1
figure 1

Orthopantomograph revealing three radiopaque lesions below the right lower border of the mandible