Swelling of jaw/cheek- mumps, abscess or something else?

[Whatisthisarghhh]

DD, 6, woke up in a lot of pain on Sunday night saying she had a sore tooth and her head hurt. Had emergency dentist appointment on Monday- dentist was quite dismissive, said she couldn't see any sign of infection and was going to let us to but I reiterated how much pain she was in and she had another look. Said DD had a very small amount of decay (on a baby tooth she has previously had some filling paste on). Dentist put a small amount of paste on and home we went. She woke up on Monday night again in pain. Tuesday came home from school on Tuesday and one side of her cheek/jaw area had swollen considerably. Went to GP who asked if dentiat had dkne an x-ray to confirm no infection (she hadnt) and GP said maybe mumps but to go back to dentist if still swollen in the morning. DH took DD to dentist today who said maybe abscess, she has given antibiotics and said to come back in 48 hours if still there. She didn't do an x-ray.
GP has called back to check on DD and said if no improvement once I'm antibiotics to let her know.
All in all, great NHS care. But just wondering if anyone has had similar experience? GP was very honest and said she just wasnt sure what it was.
DD has a very low grade temperature on and off. Jaw is red and tender. She is cranky but well in herself. Don't know if I can face another sleepless night with her! She does have a bit of cake/biscuits/ sweets bit never any fizzy drinks and only drinks milk and water. We still brush her teeth. Any thoughts?

You can get isolated mumps of the submandibular gland but it is usually parotid

Be careful if it is spreading under her jaw, if it continues or she starts to feel unwell Id consider A&E.

@DishRanAwayWithTheSpoon

You can get isolated mumps of the submandibular gland but it is usually parotid

Be careful if it is spreading under her jaw, if it continues or she starts to feel unwell Id consider A&E.

No please don’t take a child who most likely has mumps to an emergency department.

@CherryPavlova I work for maxfacs department, we deal with facial swellings.

It is potentially mumps but equally could be a dental abscess that is spreading under her chin, which is potentially quite serious. If it does turn out to be mumps no one is going to tell you it was innapropriate to bring a 6 with a significant facial swelling into a&e.

You cannot say it is mumps based on that presentation alone and given she has had toothache, a recent recent filling and no dental xray you cannot rule out a dental cause either. If it continues spreading under her chin then yes I would consider a&e, she doesnt need to go just yet but should it worsen overnight, then I would consider it.

[quote DishRanAwayWithTheSpoon]@CherryPavlova I work for maxfacs department, we deal with facial swellings.

It is potentially mumps but equally could be a dental abscess that is spreading under her chin, which is potentially quite serious. If it does turn out to be mumps no one is going to tell you it was innapropriate to bring a 6 with a significant facial swelling into a&e.

You cannot say it is mumps based on that presentation alone and given she has had toothache, a recent recent filling and no dental xray you cannot rule out a dental cause either. If it continues spreading under her chin then yes I would consider a&e, she doesnt need to go just yet but should it worsen overnight, then I would consider it.[/quote]
You work in max fax as what?

I specifically said you cannot diagnose from a picture. She has good medical care from her GP, as is right and proper. How many cases of mumps in children have you seen? I saw one case in about 2004 but have seen many more in my early career. It was rife when I worked in Ethiopia and pretty frequent in 1980s UK. I’m not diagnosing anything. I’m suggesting what it looks like. A diagnosis needs a full clinical examination via GP. That is right and proper.

A dental abscess without extensive caries and in the absence of gum swelling, would be less likely than mumps. Again it needs clinical assessment for diagnosis.

You need to redo your IPC mandatory training.

As an old & experienced Community dentist ( children & adult special care), I'm in full agreement with @DishRanAwayWithTheSpoon.

That swelling appears to be left buccal space + submandibular rather than parotid. It's difficult to be certain from the angle this photo is taken at. I've seen maybe 4 cases ( children & young adults) of unilateral + bilateral mumps in my career ( all UK) and 2 of those had had their MMR .
Obviously a thorough examination is needed, a photograph or video consult are not appropriate for diagnosis in this particular case.

I really think you should arrange for another dentist to review your child urgently. There is no way your current dentist can rule out a dental abscess just on visual exam of a recently filled tooth. Originally your child thought she had toothache, I'd say that is a major clue.
And to echo @DishRanAwayWithTheSpoon, your dentist may have inadvertently blocked the drainage route with the new filling/ dressing.

Your dentist must be certain it's a bacterial infection at least, to have prescribed an antibiotic; presumably they don't think it's mumps because antibiotics are not routinely prescribed for mumps and if your dentist did suspect mumps, they should be liaising with your child's GP as a matter of urgency.

With facial cellulitis, you should be monitoring body temperature, difficulty in swallowing/ breathing, restriction in mouth opening / trismus, spreading swelling to the midline neck/ floor of mouth/ sublingual; therefore, the advice to go to A & E was not incorrect.

Extensive caries can't always be seen clinically, and to the untrained eye, a tooth could look clinically sound.
Localised gum swelling hasn't always been present with some of the gross facial swellings of dental origin I've seen as both a Max-fac SHO and Community dentist. Anyway, it is nearly always possible to take a diagnostic radiograph of some sort, whether intra-Oral or extra-oral, even in 3 year olds.

How is she op?

She's doing OK thanks. Swelling still there but more under jaw/chin. She seems well in herself and is eating and drinking. Dentist has said to come back in 48 hours if swelling still there but have now said if it is suspected mumps she can't come in, which is understandable. I just wish that they would have done an x-ray in the first place! But appreciate things are difficult in all NHS services at the moment.
Thanks to the HCPs who have commented. My photo probably wasn't particularly helpful and I understand everyone looks things from their own specialty's perspective!