Oral Health And Down Syndrome

Oral HealthandDown SyndromeJessica De Bord, DDS, MS, MAAssistant Professor of Clinical DentistryOstrow School of Dentistry of USCDivision of Dental Public Health and Pediatric DentistryChildren’s Hospital Los AngelesDivision of DentistryUniversity Center for Excellence in Developmental DisabilitiesAugust 25, 2011

What is unique in peoplewith Down syndrome?

Teeth Short roots Missing teeth Microdontia Small teeth Can result in spacingbetween the teeth Peg lateral incisors Small lateral incisorsHennequin et al Developmental Medicine and Child Neurology 1999; 41: 275 - 283Desai et al Oral Surgery Oral Medicine Oral Pathology Oral Radiology 1997; 84: 279 - 285

Oral Health Fissured tongue Macroglossia Large tongue Hypotonia Low muscle tone Low muscle tone and largetongues lead to an openmouth postureHennequin et al Developmental Medicine and Child Neurology 1999; 41: 275 - 283Desai et al Oral Surgery Oral Medicine Oral Pathology Oral Radiology 1997; 84: 279 - 285

Malocclusion Small midface Small upper jaw Crossbites Top teeth are inside thebottom teeth Can happen in the front,back, or both Open bite Top and bottom teeth donot touch Crowded teeth Impacted caninesPhoto Courtesy of the American Academy ofPediatric DentistryZigmond et al Journal of Intellectual Disability Research 2006; 50: 492 - 500Hennequin et al Developmental Medicine and Child Neurology 1999; 41: 275 - 283Desai et al Oral Surgery Oral Medicine Oral Pathology Oral Radiology 1997; 84: 279 - 285

Orthodontics May be best to deferbraces or orthodontictreatment to allow forspeech developmentwhich can be delayed byorthodontic appliances

Eruption of Baby TeethADA.org

Eruption of Permanent TeethADA.org

Delayed Eruption The 1st tooth in childrenwith Down syndrometypically erupts at 12 to 14months Can be up to 24 months A child with Downsyndrome may be 4 or 5years old before all thebaby teeth come in The order the teeth comein may be different thanchildren without DownsyndromeDesai et al Oral Surgery Oral Medicine Oral Pathology Oral Radiology 1997; 84: 279 - 285

Delayed Eruption Permanent front teeth and6 year molars may noterupt until 8 - 9 years ofageDesai et al Oral Surgery Oral Medicine Oral Pathology Oral Radiology 1997; 84: 279 - 285

Bruxism Bruxism Tooth grinding Common in children Typically resolves on itsown Typically does notdamage the teeth In children withdevelopmental disabilities May be severe May continue beyondchildhood Mouthguards are avoidedbecause they may breakand be choking hazards

Periodontal Disease Increased periodontaldisease “Gum disease” Even when compared topeople of the same agewith other intellectualdisabilities and peoplewithout intellectualdisabilities Disease not proportional tooral hygiene Due to impaired immunityCichon et al Annals of Periodontology 1998; 3: 370 - 380Ulseth et al Special Care Dentistry 1991; 11: 71 - 73Zigmond et al Journal of Intellectual Disability Research 2006; 50: 492 - 500

Risk of Cavities Data mixed Some studies say fewercavities Other studies say nosignificant difference Many of the studies arefrom when people withDown syndrome wereinstitutionalized and do notaccount for modern, noninstitutionalized dietsUlseth et al Special Care Dentistry 1991; 11: 71 - 73

How can cavities beprevented ?Photo Courtesy of the American Academy of Pediatric Dentistry

Preventing Cavities Begin brushing withFluoride tooth paste whenthe first teeth erupt The first dental visit shouldbe within 6 months of firsttooth eruption, no laterthan 12 months of age Avoid carbohydratecontaining liquids from abottle or sippy cup,especially for longdurations of time Avoid carbohydratecontaining between mealsnacks and drinks

Toothbrushing Before tooth eruption Wipe mouth with amoistened cloth First tooth - 2 years Soft toothbrush and asmear of F- toothpasteonce per day Do not rinseSmear 2 - 6 years Pea-sized amount of Ftoothpaste twice daily Spit, do not rinse 6 years F- toothpaste twice dailyPea-sized amountRamos-Gomezet al California Dental Association Journal 2010; 36: 746 - 760

Prevention Tips ACT Fluoride Rinse Can dip a toothbrush inACT and brush the teethfor children with sensoryissues who cannot toleratetoothpaste

Prevention Tips Flosser Handle helps to flossanother person Helps to protect fingerswhen flossing someoneelse

Prevention Tips Electric toothbrush Can be helpful Some people withdevelopmental disabilitiesfind it difficult to toleratethe vibration Start with an inexpensiveelectric toothbrush toensure it is toleratedbefore purchasing anexpensive one

Visiting the Dentist

Antibiotics for Dental Visits People with certain heartconditions have to takeantibiotics prior to going tothe dentist Ask your cardiologist ifantibiotics are needed fordental visits Make sure to let youdentist know about allhealth conditionsespecially heart conditions

Knee - to - KneePhoto Courtesy of the University of Washington Department of Pediatric Dentistry

Sensory Issues or Aversions Light Sound of handpiece Sound of suction Water or air syringe Tastes and textures ofgloves, gauze, dentalmaterials Movement of chair Before the exam considerlaying the chair flat firstrather than moving thechair with the patient in itRaposa Dental Clinics of North America 2009; 53: 359-373

Treatment Options Many people with Downsyndrome can cooperatefor dental care in thetraditional office setting In office sedation may notbe appropriate for somepeople with Downsyndrome due to Small airway Low muscle tone causingairway collapse Large tongue General anesthesia maybe needed to completedental treatment

Resources Ask other people withDown syndrome and theirfamilies forrecommendations

Resources American Academy ofPediatric Dentistry www.aapd.org/finddentist Pediatric dentists receivean extra 2 – 3 years oftraining beyond dentalschool in caring forchildren, including thosewith special needs

Resources Special Care DentistryAssociation www.scdaonline.org Click on “Online ReferralSystem”

Resources Your local dental schoolwill typically have residentsor faculty who areexperienced in caring forpeople with Downsyndrome

Resources Some hospitals havedental departments andthese dentists are typicallytrained in caring forpeople with Downsyndrome

References Desai et al. Down syndrome: a review of the literature. Oral Surgery Oral Medicine Oral PathologyOral Radiology. 1997; 84: 279 - 285. Cichon et al. Early - onset periodontitis associated with Down’s syndrome: a clinical interventionstudy. Annals of Periodontology. 1998; 3: 370 - 380. Glassman P, and Miller C. Social supports and prevention strategies as adjuncts and alternatives tosedation and anesthesia for people with special health care needs. Special Care in Dentistry. 2009;29: 31-38. Hennequin et al. Significance of oral health in persons with Down syndrome; a literature review.Developmental Medicine and Child Neurology. 1999; 41: 275 - 283. Ramos-Gomez et al. Pediatric Dental Care: Prevention and Management Protocols Based onCaries Risk Assessment. California Dental Association Journal. 2010; 36: 746 - 760 Ulseth et al. Dental caries and periodontitis in persons with Down syndrome. Special Care Dentistry.1991; 11: 71 - 73. Zigmond et al. The outcome of a preventive dental care programme on the prevalence oflocalized aggressive periodontitis in Down’s syndrome individuals. Journal of Intellectual DisabilityResearch. 2006; 50: 492 - 500.

Jessica De Bordjdebord@usc.edu213.740.2680

with Down syndrome typically erupts at 12 to 14 months Can be up to 24 months A child with Down syndrome may be 4 or 5 years old before all the baby teeth come in The order the teeth come in may be different than children without Down syndrome Desai et al Oral Surgery Oral