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Susie is a healthy 4 year old who recently began attending pre-school. Her father received a call asking him to pick her up early one day. Susie had lost her appetite, was not playing with the other kids, and was quite cranky. He then brought her to your office for evaluation.
On exam, Susie shows little interest in interacting with either you or her father. Neither she nor Dad could add any additional historical details. They deny fever, cough, runny nose, ear pain, abdominal pain, urinary symptoms, and diarrhea. She has no new skin rashes, medications, or travel exposures. Her vital signs were completely normal. On physical exam no abnormalities are noted except the following finding on oral exam:
The correct diagnosis based on the photo is:
You correctly diagnose a fistulized periapical abscess. Dad tells you that Susie has never been to a dentist.
The most appropriate next step in management is:
Three weeks later Susie returns to your office with fever and facial swelling. You examine her mouth and see that the original problem tooth has been extracted, but gross decay remains in the molars in the mandible. You diagnose facial cellulitis which appears associated with one of the lower right molars.
Donald Greiner, DDS
The most appropriate choice for initial oral antibiotic therapy would be: