Burton Sana’s father called the Dental Surgeon late in the evening a fortnight back. The following conversation ensued between the two: “Burton has for the past three days developed swelling of the face. It is marked on the left side. When he presses that side with his index and middle fingers he recoils with pain.
I believe it is mumps. I want to bring him over to you to establish whether it is mumps or not”. Next day early in the morning both father and son showed up.
The Dental Surgeon probed Burton’s mouth. It was an examination that turned out to be ‘symmetrically fascinating’ Burton had just turned eleven. All the milk teeth, even referred to as deciduous teeth, had already shed. Burton had second permanent molars which were covered with gums partially or completely. The lower left second molar had cut through the gums. Its occlusal surface could be noticed.
The gums were acutely inflamed. The second molars elsewhere in the mouth had a ‘plateau’ of strip of gingiva which gave a clear indication that the molars above the gums and one below the gums would in a matter of three to six months emerge in the mouth with their crowns and grinding surfaces.
The Dental Surgeon noticed that there was tenderness to pressure. There was however no denseness of the overlying skin of the face around the lower jaw. The characteristic feature of mumps happens to be the uplifting of the lobe of the ear and stiffness of the jaw.
Burton’s ear lobes presented no evidence of being lifted by the inflammation of the parotid gland. To the Dental Surgeon it seemed to be a clear cut case of lyumph gland enlargement which was secondary to the inflammation that had been the result of the crown of the molar cleaving through the gums.
The Dental Surgeon said, “In view of the swelling which is quite diffuse and the pain, I would recommend a dose of 1000mg. of ampiclox daily.
This will have to be supplemented with Vitamin B complex and Panadol tablets to complete the regimen. Since Burton was running a fever of 101o F. it was necessary to continue the dose for at least five days. Attention to oral hygiene would have to be paid.
In this context warm saline solution could be used as a mouthwash. The temperature of the saline solution could be raised without causing any discomfort in the mouth. The heat effect of the saline solution would also help dilate the capillaries in and around the gums. This would facilitate the process of eruption of tooth out of the gums.
Burton’s condition remained static. The swelling did not subside even after two days of the antibiotic administered. Burton’s father decided to seek a second opinion. He consulted a paediatrician. The child specialist in the city’s major hospital was well versed with vaccine advocacy programme in the sub-sahara region. He was an authority on vaccine preventable diseases.
After having perused the signs and symptoms of Buton, the peadiatrician posed a question to Burton’s dad, “Was your son vaccinated against measles, mumps and rubella?
The father was not sure. He sought the answer by ringing his wife on his cellular phone. His wife confirmed the fact that Burton had been administered MMR vaccine
The paediatrician said, “MMR is not part of the National Vaccination Programme. While MMR vaccine is available, it is not affordable for all. Parents would do well to have their children vaccinated with MMR. In the past, I believe he has immunity developed against mumps, measles and rubella.
Any doctor who will check Burton will notice the bilateral swelling of his face particularly on his left side. The Dental Surgeon who checked Burton correctly detected the cause of the swelling. It was general due to the tooth cutting through the flap of gums. I would ask you to carry on with the instructions of the Dental Surgeon.
However, instead of ampiclox give your child a paediatric dose of clavulin. It is more child friendly. Burton’s facial swelling disappeared as the second lower molar fully surfaced in a couple of days. The pain on palpation of the face externally disappeared. Burton is currently on vacation. He has no malaise or fever.
When he appeared in the Dental Surgery a few days ago the Dental Surgeon said, “Take a strip of chewing gun with xylitol as one of its constituents in your mouth. Munch it without going for a new strip for about one hour. It will help to tone your gums”.
Burton’s symmetry of the face was restored. It is not common to behold the arrival of all permanent first molars in the mouth at the same time.
Similarly the submerged second molars would upright themselves with time. It would be an amazing sight, miraculous indeed, to perceive all molars - two in the upper jaw, two in the lower, each announcing their arrival concurrently. That would also earn mention in any international dental journal.
Dr K.S Gupta is a private Clinical Dental Practitioner who can be contacted at: kgupta firstname.lastname@example.org.