Diagnosis: Pain and swelling in right mandible
Treatment: Inpatient admission
The Inpatient admission was not medically necessary.

The patient is a healthy male. He developed pain and swelling in the right mandible over three days. He saw his PCP (primary care provider) ten days prior to admission and was given amoxicillin. The patient then reported to the emergency room and was evaluated by oral surgery.

The oral surgery notes state that the patient's PTT (partial thromboplastin time) was slightly elevated, but there is no record that this was repeated, and it did not interfere with surgery. The patient was afebrile, and his swelling was limited to the facial aspect of the mandible with no airway impingement.

The patient was admitted and seen in the oral surgery clinic the following day, where he underwent the removal of #30 with an incision and drainage with IV sedation. Discharge orders were written.

Postoperatively, the patient complained of severe pain, which was controlled with one dose of IV Ketorolac. The patient was then discharged. The discharge note contradicts the pediatric note, as it states that postoperatively, the patient was febrile and his pain was not controlled with the Ketorolac. The pediatric note states that the patient was afebrile and his pain was controlled with one dose of Ketorolac.

The literature regarding the course of odontogenic maxillofacial infections requiring hospital care shows that hospital admission criteria are as follows: threat to airways or other vital structures, need for general anesthesia, septic fever, marked swelling, need for inpatient control of a concomitant systemic disease, and need for intravenous antimicrobial treatment. This patient had none of these. He was admitted for convenience.

The patient could have received his IV antibiotics at an Observation level of care. Additionally, provision of Ketorolac did not require acute inpatient admission. He did not require general anesthesia, did not have a septic fever, marked swelling that encroaches upon the airway and did not require an admission due to concomitant systemic disease.