Please evaluate the subjective and objective information provided to you in the case below. The first part of the discussion board is to identify all pertinent positive and negative information. 

Pertinent Positives: The child has a temperature of 100F. Pt with history of seasonal allergies. Pt has not seen a dentist yet and she is 5 years old. Mother also admits to inadequate home dental care. Child is obese with a BMI of 22.54. Pt has a swollen lymph node and lower jaw swelling on L side with a visible area of irritation/infection on the upper gum. Pt with general malaise, sleeping more than usual, and not wanting to eat. Eyes are itchy, red, and watery.

Pertinent Negatives: No prenatal history of HSV. No evidence of rash noted anywhere else on body. Denies throat pain and examination was within defined limits. Temperature is low-grade. Symptom onset was gradual, with her eyes and mouth concerns starting 4 days apart. Pt without rhinorrhea or cough. Eyes do not have any abnormal or purulent discharge. Child is not exposed to smoke in the home.

Would there be any other information you would want to obtain? 

I would like to know about whether or not the child attends school and if anyone has been reported sick at school. I would like to know if we have information about what specifically the child is allergic to and if she has been additionally exposed recently. For example, is it pollen season? Has she been playing outside in the grass? Also, has she been taking her Claritin daily? I would like to know about the child’s diet and whether or not she has any known history of dental caries or tooth pain. I would want to make sure the child does not have any changes in vision. I would also like to know if the child has been swimming recently or using any new products on her face.

Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings. 

  1. Dental abscess with unrelated allergic conjunctivitis
  2. Hand, foot, and mouth disease
  3. Herpes simplex virus

Second part is to create a plan utilizing clinical practice guidelines for the priority diagnoses. Be sure to include health promotion and education.

The diagnosis I am leaning toward is a dental abscess with unrelated allergic conjunctivitis. I came to this conclusion because of her poor dental care history, low grade temp, and the swelling of her jaw. I believe that her dental infection has led to a systemic response causing a low-grade temp and general malaise. For this, I would swab the gingival sore and send to pathology to ensure that it is not HSV and then place an urgent referral to a pediatric dentist for evaluation of the cause of her swelling pain. The child may continue to take the Tylenol PRN for pain and fever. Here the dentist will likely prescribe antibiotics, perform a thorough dental exam and cleaning, and treat any other findings at a later date when the abscess has healed. For the itchy, watery, red eyes, I would have the child use vasoconstrictor-antihistamine eye drops, such as Pataday, and take her Claritin daily. I would also educate the patient on good hand hygiene and to avoid rubbing her eyes (Garzon et al, 2025). If the swab result was positive for HSV, I would prescribe Acyclovir 200mg/5ml 8ml q8hrs x10days and an immediate referral ophthalmology (Garzon et al., 2025). Lastly, we would discuss the child’s BMI, healthy lifestyle modifications, and dental hygiene and health promotion expectations for her age. For elementary school children, tooth decay is the most prevalent chronic infectious disease. In addition to pain and suffering, children with periodontal disease and tooth decay often face food and sleep difficulties, diminished learning capacity, lost school days, and acute and chronic infections. Dental infections have an impact on child development, growth, nutrition, and overall quality of life (Shirahmadi et al., 2024).

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