Cheek swelling, medically termed edema, is a common physical symptom indicating an underlying process ranging from localized irritation to systemic disease. This enlargement occurs when fluid accumulates in the soft tissues of the face, involving the skin, muscles, glands, and sometimes the structures around the jawbone. The noticeable puffiness can develop suddenly or gradually, with or without accompanying pain, redness, or heat. Understanding the anatomical structures involved helps narrow down potential causes.
Causes Originating in the Mouth and Teeth
Infections stemming from the oral cavity are a frequent cause of cheek swelling. A dental abscess, a localized collection of pus caused by bacterial infection, often triggers swelling that extends into the adjacent cheek tissue. This may be a periapical abscess, forming at the root tip due to decay, or a periodontal abscess, located in the gum tissue. Both types typically present with intense, throbbing pain, sensitivity to temperature, and may cause fever.
Impacted wisdom teeth frequently cause localized inflammation that spreads to the cheek. When these teeth only partially emerge, a flap of gum tissue can form over them, trapping food particles and bacteria in a condition called pericoronitis. This creates a breeding ground for infection, resulting in pain, difficulty opening the mouth, and noticeable swelling in the cheek and jaw area.
Untreated gum disease, specifically advanced periodontitis, is another source of inflammation that can progress to facial swelling. Periodontitis involves the infection and destruction of the soft tissue and bone supporting the teeth, and the resulting inflammation can extend outward into the cheek. A severe infection can also lead to osteomyelitis, an infection of the jawbone itself, causing persistent pain and significant, firm swelling of the cheek and jaw.
Causes Related to Systemic Infection and Illness
Infections not confined to the teeth or gums can also manifest as cheek swelling, often signaling systemic involvement. One such condition is mumps, a viral infection that primarily targets the parotid glands, the largest salivary glands located near the ears. The resulting inflammation, known as parotitis, causes the characteristic “chipmunk cheek” appearance, where one or both cheeks swell painfully and the angle of the jawbone may become obscured.
Cellulitis is a serious bacterial infection of the skin and underlying soft tissues of the face. This infection typically presents with a rapidly spreading area of redness, warmth, and tenderness on the cheek, often accompanied by fever and general illness. Cellulitis requires prompt medical attention because the bacteria can quickly spread to the bloodstream, potentially leading to life-threatening complications.
Problems with the salivary glands, collectively termed sialadenitis, can also cause cheek enlargement. This inflammation or infection, most commonly affecting the parotid gland, is often triggered by a blockage, such as a salivary stone, or by bacterial or viral agents. The swelling is usually painful and firm, sometimes causing reduced saliva flow. Sinus infections (sinusitis) can also refer pain and swelling to the cheek area, particularly if the maxillary sinuses are involved.
Causes Stemming from Physical Trauma or Allergy
Acute cheek swelling can result immediately from physical injury or rapidly from an immune response to an allergen. Physical trauma, such as a direct blow to the face, causes swelling through the accumulation of blood (hematoma) and the leakage of inflammatory fluid into the soft tissues. The onset of swelling is immediate or develops within hours and is frequently accompanied by bruising, pain, and sometimes an underlying fracture of the facial bones or jaw.
Allergic reactions can trigger a rapid, sometimes life-threatening, form of swelling known as angioedema. This condition involves the sudden, localized swelling of the deep layers of the skin and mucous membranes, frequently affecting the face, lips, and cheeks. Allergic angioedema is the body’s hypersensitive immune response to triggers like foods, medications, or insect stings, causing the release of chemical mediators. Its rapid onset and potential for airway involvement make it a serious concern.
A non-allergic form of angioedema can also be caused by specific medications, such as ACE inhibitors, which are used for high blood pressure. In all forms, the swelling is due to the temporary leakage of fluid from small blood vessels into the tissue spaces. The swelling typically resolves on its own within a few days, but the initial presentation requires careful monitoring.
Identifying Symptoms Requiring Immediate Medical Attention
A swollen cheek can quickly escalate from a manageable issue to a medical emergency, and certain symptoms warrant immediate attention. Seek emergency care if the swelling is accompanied by difficulty breathing, throat tightness, or an inability to swallow, as this suggests a compromise of the airway. Swelling that spreads rapidly to the neck, eye, or floor of the mouth is also a red flag, indicating a potentially aggressive infection or severe allergic reaction.
A high fever, chills, or a general feeling of severe illness alongside the swelling may signal a systemic infection, such as cellulitis or a deep abscess, which could lead to sepsis. Unbearable or unrelieved pain that is not managed by over-the-counter medication should prompt an urgent medical evaluation. Any sudden loss of consciousness, confusion, or visual changes in conjunction with the facial swelling also necessitates an immediate trip to the emergency room for assessment.