Diagnosing oral and dental pain in people with developmental disability

Orofacial pain is complex and has many causes, only some of which are dental. For advice on diagnosis and management of acute orofacial pain, see Orofacial pain. In people with developmental disability, diagnosis can be compromised due to challenges in communicating the location and nature of pain (eg triggering, exacerbating and relieving factors, impact on quality of life).

In people with communication difficulties, orofacial pain can manifest in altered behaviour, sleep and diet patterns (eg reduced tolerance of tooth brushing, reluctance to eat or have hot or cold foods), new mouthing behaviours, pica or new or increased bruxism (teeth grinding). For tools and strategies to facilitate pain assessment in people with a communication disability, see Pain assessment tools and Establishing successful communication with people with developmental disability.

Local signs of oral and dental disease can include:

• swelling in the orofacial region
• oral bleeding or discharge
• loose teeth
• halitosis.

Systemic signs of infection such as fever and malaise might indicate systemic spread of bacteraemia.

Tooth eruption, especially eruption of wisdom teeth, can result in orofacial pain and local pericoronitis infection. Primary teeth eruption and exfoliation pattern and Secondary teeth eruption pattern give an indication of the average ages at which tooth eruption occurs in children and adolescents.

For further assessment of oral and dental disease, refer to a dental practitioner for comprehensive oral examination. In some cases, this might require positive behaviour support planning, anxiolysis (minimal sedation) or general anaesthesia; see Planning oral and dental treatment in people with developmental disability.