Oral Health Problems in children with Down Syndrome

The most peaceful and beautiful patients that one encounters is a child with Down syndrome. These children are gentle angels who if handled properly, do not create any problems in carrying out the dental treatment.

Down syndrome is one of the most common hormonal abnormalities that occur in 1.5 per 1000 children. It occurs due to an extra number of chromosomes 21 (Trisomy 21).

DENTAL  PROBLEMS: Dental problems encountered in these children:

DELAYED TOOTH ERUPTION: the milk teeth as well as permanent teeth may show a delayed appearance in the mouth. Some children may get their first teeth after their first birthday or even around the second one. Similarly the milk teeth may shed late leading to late emergence of permanent teeth.

 ABNORMAL TEETH SIZE AND ARRANGEMENT:  they may have small teeth  leading to a lot of gaps between them. At times the jaw maybe small in size leading to crowding in the jaw. They may have an open mouth posture leading to habits like mouth breathing that will further cause teeth malalignment .

                             

LARGE TONGUE: the children may have a large tongue which may show indented borders as the tongue rubs around the teeth. The tongue may have a fissured appearance.

POOR ORAL HYGIENE:

Children cannot maintain their oral hygiene adequately and even when they get the assistance, the care giver may not be able to provide the needed care due to lack of knowledge. Children in Partial or Self help group can be taught the techniques for tooth brushing by using special brushes fabricated based on their needs. Powered toothbrushes can be used to assist in maintaining oral hygiene as not much skill is required in using a powered (electric) tooth brush.

GUM DISEASE: Poor Oral hygiene and oral neglect leads to gum diseases in children. It is more commonly present oral finding in these children. Mouth breathing habit can lead to constant drying effect on the gums causing gum disease.

Gum overgrowth may occur if the child is taking certain medications like Dilantin for seizures; Cyclosphorine by immunocompromised children and Calcium Channel Blockers such as Nifedipine.

     

ORAL SENSITIVITIES:Many children with Down’s syndrome have a very sensitive mouth, with increased gag reflex making it further difficult to maintain good oral hygiene.

DENTAL CARIES (TOOTH DECAY): it is amazing that children with Down’s syndrome have less chances of getting tooth decay. At times though due to very poor oral hygiene, they may have decayed teeth but the chances are actually low.

The Low incidence of Dental decay is due

• Due to immune protection caused by the elevated salivary S. mutans specific IgA concentrations
• Delayed eruption of teeth  reduces time of exposure to caries causing environment
• Congenitally missing teeth & small size teeth
• Spaces between the teeth

DENTAL MANAGEMENT:

DENTAL MANAGEMENT:

Dental management will be influenced by the patient’s compliance and presence or absence of associated congenital abnormalities. Children have to be sent for medical consultations regarding Cardiac Disorders and Leukemia which are common in these children before starting any dental procedures. 

These children are generally affectionate and cooperative and present no special problems during management if the behavior is well managed using various behavior guidance techniques. Nitrous oxide analgesia or sedation can be used in mildly apprehensive patient who cannot be treated by simple behavior management techniques.

PREVENTIVE STRATEGIES:

• Adequate Oral hygiene measures like Tooth brushing provided by the care giver totally or assisted tooth brushing using various modifications of toothbrushes. (as suggested by the dentist)
• Focus on Diet containing foods that do not cause less chances of dental decay.
• Regular visit to dentist preferably a Pediatric Dentist who has an expertise in managing children with Special needs is highly recommended.

Author Information

Dr. Parajeeta Dikshit is an Assistant Professor and Head, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at Kantipur Dental College teaching hospital and research center Basundhara , Kathmandu and Consultant Pediatric Dentist at Smile Square Dental Care Center, Maharajgunj, Kathmandu. (email- pardix9@gmail.com)