We present the case of a three year old girl who came to the primary care clinic for three days presenting with toothache and discrete dental phlegmon, without fever.

The examination revealed a caries in the lower right second molar, with discrete inflammation and mandibular pain. It was decided to start antibiotic treatment with high-dose amoxicillin and anti-inflammatory drugs, and the patient was referred to the dentist3.
The patient was seen at the dentist's office four days later. The phlegmon and regional adenopathy persisted, but there was no pain. It was decided to continue with treatment and monitoring.
After a week of treatment, the phlegmon was more defined and painful, and the patient was referred to maxillofacial surgery. That same afternoon he presented with fever and was referred to the Emergency Department, where it was decided to treat with amoxicillin plus clavulanic acid and to see a dentist.
Twenty days later, at the primary care clinic, he presented with a red, painful and suppurative abscess on the right submaxillary border. She was again referred to the emergency department for drainage. There it was drained and samples were taken for culture and pathological anatomy of the ulcerated cervical lesion. Treatment was started with azithromycin and ciprofloxacin.

The result of the pathological anatomy describes granulation tissue with acute and chronic inflammation and central necrosis, with no microorganisms observed (with Grocot, Gram and Ziehl-Neelsen techniques) and no traces of lymph node are identified.
The evolution of the ulcer was torpid, with treatment every two days at the health centre. One month after drainage, exodontia was performed, with definitive improvement after two months of evolution. The large scar on the face begins to involute.