Symptoms What to look for/be aware of Investigation & treatment and/or referral pathway Further reading


  • Tooth decay.
  • Dental trauma following accidents, seizures and falls.
  • Tooth wear - grinding associated with bruxism.
  • Gum disease - bleeding gums and loose teeth Mouth ulcers.
  • Hypersalivation - increased salivation.
  • Medication related osteonecrosis of the jaw (particularly in relation to bisphosphonate / anti- resorptive medications).
  • Risks associated with treatment which requires sedation or general anaesthesia.
  • Bruxism is a recognized sleep disorder, which should be assessed through full polysomnography as this process causes arousals which disturb sleep leading to low mood.
  • Refer children and adults to the local Community Dental Service or contact local Dental Hospital Department of Paediatric Dentistry or Special Care.
  • Dentistry.
  • High fluoride toothpaste.
  • Corsodyl gel.
  • Fissure sealants.
  • Dental checks may be necessary under sedation.