Presentation of acute odontogenic infections to tertiary hospitals with intellectual disabilities; Is it the lack of awareness, motivation or insufficiencies in health system - A retrospective study

Abstract

Dental caries and periodontal disease are the most common dental diseases that affect all groups of population resulting in poor oral health. Patients with intellectual disability (ID) have been greatly affected. In patients with ID, as the expression of pain is diminished or overlapped with challenging behaviours, they often get misdiagnosed. Most often these patients present to the primary clinician with acute symptoms of pulpitis or facial swelling with or without an exacerbation of un-cooperative behaviour that leads to a referrals to a tertiary hospital.

In chapter 1, this thesis draws basic understanding of two major oral diseases affecting the oral system – dental caries and periodontal disease. In order to understand how these two diseases affect patients with ID as a whole and the reasons behind referrals to tertiary hospitals, this thesis initially draws light on one single intellectual disability – Cerebral Palsy and on children and adolescents; this is discussed as a systematic review in Chapter 2.

Further in chapter 3, this thesis discusses about patients with ID and on ways to provide dental treatment in a holistic way. It also discusses the challenges, treatment modalities and options around dental management of ID patients. In chapter 4, referral pathways are discussed to seek dental treatment under specialist care in three locations in Sydney.

In the final chapter 5, this thesis discusses the research project: to understand the reasons behind referrals as categorised as acute condition either with a facial swelling or a dental abscess or simply change in behaviour that is assumed to be related to dental discomfort. This research is a retrospective study, where the data were collected from existing 91 dental records that were randomly picked. The data were analysed and discussed in chapter 5. This is followed by discussion with concluding remarks to overcome this prevailing problem of referrals with acute odontogenic infection in ID population.