A Swollen Face at Two O'Clock on Erev Shabbat

Quick answer: A dental abscess on erev Shabbat needs draining, not just antibiotics, because you are about to be twenty-five hours from help. Drainage relieves the pressure immediately and dramatically reduces the chance of it escalating overnight.

The call

1:50pm on a Friday in November. Shabbat coming in around 4:30. Naftali, 38, from RBS Alef, phoned with a cheek that had swollen through the morning and a tooth that had been niggling all week.

The clinic was winding down. We told him to come immediately. This is the appointment you make room for, because the alternative is an abscess with nowhere to go for a day and a night.

What we found

Lower left first molar, non-vital, with a firm swelling extending from the gum into the cheek. His mouth opened to about 35mm — reduced but workable. No fever. No swelling under the jaw, no difficulty swallowing, no change to his voice, and the floor of his mouth was soft and normal.

That examination is the whole triage. A localised abscess is a dental problem. A spreading one is a medical emergency, and the distinction is made on specific signs:

Go to hospital, not the dentist, if there is: - Swelling under the jaw or in the floor of the mouth, or a raised tongue - Difficulty swallowing, drooling, or a change in voice - Difficulty breathing - Swelling closing the eye - Fever with feeling generally unwell - Mouth opening reduced below about 20mm

He had none of these. This was a localised, drainable abscess.

What we did

Anaesthetised the area — which takes care in infected tissue, since local anaesthetic works less predictably in an acidic environment, so we used a nerve block placed away from the infection.

Then two routes of drainage. We opened the tooth through the crown, and pus drained through the canals immediately, which is the most effective decompression there is. Then a small incision into the swelling in the sulcus released the rest.

The relief was immediate. Pressure inside a confined space is what makes an abscess so painful, and letting it out does more in thirty seconds than any drug.

We cleaned the canals as thoroughly as time allowed, dressed and sealed the tooth, prescribed an antibiotic — justified here because of the facial swelling — and gave him written instructions and a phone number for Shabbat.

The outcome

He phoned Motzei Shabbat to say the swelling had halved by Friday night. We completed the root canal the following week and crowned the tooth six weeks later.

The safety-netting is the part worth emphasising. He went into Shabbat knowing exactly which signs meant going to hospital rather than waiting, and knowing that in that situation nobody would be weighing up whether to travel.

What to do if this happens to you

1. Phone early on Friday, not late. A morning call is an appointment; a 3pm call is a scramble.
2. Do not settle for a prescription alone if there is swelling. Ask whether it can be drained.
3. Warm salt-water rinses, every couple of hours. Do not put heat on the outside of the face.
4. Take the antibiotics on time, including overnight if the schedule requires it.
5. Know the red flags listed above, and act on them without hesitation.
6. Do not squeeze the swelling.

Swelling before Shabbat? Phone Ramat Beit Shemesh Urgent Dental Care as early as you can on Friday: 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.