Dental conditions: pain in the mouth

What are dental conditions?

Dental caries, erosive dental wear and periodontal conditions are the three most common dental problems.

• Dental caries (tooth decay) results from the degeneration of hard tooth tissue due to the action of acids that form in dental plaque. Acidity increases when bacteria convert carbohydrates into acids.
• Erosive dental wear occurs when acids act directly on the teeth without bacterial involvement, causing the teeth to wear.
• The periodontium is formed by the tissues that attach the dental element to the jaw. It is possible to distinguish between two types of periodontal condition: inflammation of the gums (gingivitis) and inflammation of the root and the jawbone around the root (periodontitis).

What are the complaints associated with dental conditions?

Caries results in visible white or brown spots in the dental enamel, and in cavities. Other complaints are pain (when eating) and, in the case of gingivitis, gums that bleed easily.

People with intellectual disabilities sometimes find it impossible to communicate pain. The people around them may then notice only a change in behaviour.

How common are dental conditions in the general population?

A study in 2011 found a history of dental problems in 41% of 5-year-olds, 27% of 11-year-olds, 61% of 17-year-olds and 84% of 23-year-olds. ⁵⁴²

Of insured adults, 98% had a history of caries. It has been estimated that 24% of 12-year-olds have erosive dental wear. ²⁶⁵

The inflammation of gum tissue is common, being found to a greater or lesser degree in approximately 94% of adults.  ⁵⁴³  This is generally gingivitis, the precursor of periodontitis. The one-year prevalence of severe periodontitis is thought to be approximately 10% in the Netherlands. ⁵⁴⁴

How common are dental conditions in people with intellectual disabilities?

No statistics have been found in the literature for the Netherlands.
An American study of 4732 adults found that 32.2% of people with intellectual disabilities had untreated caries, that 80.3% had periodontitis and that 10.9% had no teeth or a number of teeth missing. ⁵⁴⁵

The European POMONA questionnaire survey of a random sample of 1269 adults with intellectual disabilities found that 21% had pain in the mouth at least some of the time. The teeth were involved in three quarters of the cases, and other parts of the mouth in a quarter. People visited the dentist an average of 1.45 times a year. ²⁶⁶

An Australian study of 267 adults found that 16.9% had dental wear and that 76.3% had a history of caries.  ²⁶⁷  Wear, caries, missing teeth and fillings were linked to diet (carbohydrates), the frequency of dental visits, whether people were helped with oral hygiene (there was a lower probability of problems when they did receive assistance), and how much support people received in day-to-day life.
Another Australian questionnaire survey of 659 people with intellectual disabilities (in which questionnaires were answered by carers and parents) found that 56% of the study sample had dental and oral problems. ²⁶⁸

A Swedish study followed 124 adults with intellectual disabilities for a period of 8.5 years ²⁶⁹  and found an average of 0.5 new cases of caries a year. People with less severe intellectual disabilities, people living independently, people with Down syndrome and people who were unable to cooperate with dental checkups were most likely to have dental conditions. Periodontitis was the main cause of dental disease.

An Italian study of 219 adults with intellectual disabilities living in an institution found that 100% had periodontal conditions. ²⁷⁰

People with Down syndrome have gum conditions more often but they have caries less often than their peers without Down syndrome. ^{546   547}