People with Down syndrome require specialized dental treatment with careful planning and a meticulous oral hygiene regimen in addition to sensitivity to their feelings. This blog will discuss common medical and dental conditions as well as how to treat and address patients with Down syndrome.
What is Down syndrome?
Down syndrome is a genetic disorder caused when abnormal cell division results in extra genetic material from a chromosome. It is considered the most common chromosomal disorder. The cause of Down syndrome is unknown.
The U.S. Centers for Disease Control and Prevention reports that nearly one in 700 babies in the United States is born with Down syndrome.
Today the average lifespan of a person with Down syndrome is approximately 60 years.
Common Medical Conditions
People with Down syndrome are predisposed to certain medical conditions including congenital heart defects, thyroid disease, sleep apnea, and Alzheimer’s disease. There is also evidence of an increased risk of autism, childhood leukemia and seizures. Respiratory problems, craniofacial abnormalities, and immune deficiencies are common. Gastrointestinal tract abnormalities most commonly consist of gastroesophageal reflux, celiac disease and conditions that may lead to choking, gagging, feeding difficulties and inadequate nutrition. Orthopedic issues may be experienced by approximately 20% of individuals. Hearing loss can affect 40% to 75% of individuals with Down syndrome. Other common concerns include sinusitis and obstructive sleep apnea.
Down syndrome causes a distinct facial appearance. Common but not universal features include round face and almond-shaped eyes. Such features are not medical conditions.
Although children and adults with Down syndrome may share some common features, they look more like their immediate family members than like each other.
Intellectual disability and developmental delays are common in people with Down syndrome. The most common mental health concerns among individuals include general anxiety; repetitive and obsessive-compulsive behaviors; depression; autism spectrum conditions; and neuropsychological problems associated with progressive loss of cognitive skills.
Dental Health Challenges
People who have Down syndrome are often at increased risk for oral health challenges. Prosthodontists are trained to handle the unique and complex dental needs for these patients.
Misalignment of teeth is characteristic. Mouth breathing is common, as is drooling, which can cause redness and swollen patches in the corners of the mouth. The tongue may be enlarged. Deep fissures in the tongue can trap food, causing halitosis (bad breath).
Oral complications may result from systemic conditions, such as leukemia and celiac disease.
Congenitally missing teeth, delayed tooth formation and eruption can occur. Primary teeth can be two or three years behind a normal eruption pattern. Other problems include impacted teeth and peg shaped teeth, poor formation of tooth enamel, and dental issues that cause increased tooth mobility and early tooth loss.
Caring for Down syndrome Patients in the Prosthodontic Practice
The prosthodontist treats the whole patient. During the first visit, the doctor performs a comprehensive evaluation prior to providing any dental hygiene treatment with a thorough risk assessment. This evaluation includes a review of the patient’s medical and dental history, medication list, and analysis of mental capabilities, communication, mobility and self-care skills.
Poor oral hygiene and malocclusion can contribute to periodontal disease. Oral hygiene instruction is needed, along with ongoing support from caregivers, to help improve the Down syndrome patient’s oral health. Use of mouth rinses and disclosing agents can help to motivate the patient to brush thoroughly. Ongoing management with professional oral hygiene cleanings can help the patient maintain a healthy mouth.
Communication is an important part of every dental appointment. The entire dental team creates a friendly, caring and supportive environment. Appointments are short when possible.
Preventive care is important for individuals with Down syndrome, and includes home-care instruction. One study found that patients and caregivers who learned effective daily home-care strategies were able to control and even eliminate gingival and periodontal issues. Oral hygiene was most effective when these individuals were regularly helped by another person.
Addressing and Discussing a Person Who Has Down syndrome
The information below applies to dental and medical staff as well as the public at large. This information comes from the Global Down Syndrome Foundation website.
Labels can be hurtful and dehumanizing. In the past, people with Down syndrome were labeled “handicapped and mentally retarded” by society and the medical profession.
Inclusion specialist, Patti McVay emphasizes, “The best name to call someone is the name he or she was born with.” Many organizations, including the federal government and the National Institutes of Health, have gone back to scrub their old records of the word “mentally retarded” and have replaced it with intellectually and developmentally disabled. Other organizations are using cognitive disability, intellectual disability, or developmental disability. Still others use the word “challenged” instead of “disability”. There are subtle differences in the definitions based on each organization, but any of these terms are accepted as appropriate by the community being defined. The Global Down syndrome Foundation prefers to use the term, differently-abled.
People who are differently-abled and their families have a lot to offer society. Down syndrome is not a disease but rather a genetic condition. For this reason, some families take offense to the following terms being used in conjunction with Down syndrome:
Disease – Down syndrome is not a disease
Cure – While the overwhelming majority of those with Down syndrome and their family members would want to improve the health outcomes of individuals with Down syndrome, including cognition, many families are offended by the word “cure” because the word is imbued with negative connotations.
Suffer from or afflicted by – people with Down syndrome may have medical issues or intellectual and developmental delays that are clearly associated with the condition, however, many families feel their loved one with Down syndrome does not suffer from Down syndrome but rather from medical issues surrounding the syndrome or from incorrect medical treatment or timing.
Within the differently-abled community, there has been a movement to educate society about language that helps give more dignity to the individual and provides a language that is not imbued with stereotypes and preconceived ideas about the individual.
People with Down syndrome who are legal adults should be treated as adults and addressed as adults. These individuals should not be called “children.” And of course, baby-talk is embarrassing and annoying.
Quality dental care for patients with Down syndrome can make a major difference for their quality of life. The prosthodontists at Pi Dental Center provide focused care to meet the advanced treatment needs that contributes to better home-care and improved quality of life. If you are looking for a dental center that can provide the advanced dental care for you or your loved one, give us a call at (215) 646-6334.
Sources and Additional Reading
- Health Supervision for Children with Down syndromeor GLOBAL Medical Care Guidelines for Adults with Down syndrome
- S. Centers for Disease Control and Prevention. Data and statistics on Down syndrome. Available at: https://www.cdc.gov/ncbddd/birthdefects/downsyndrome/data.html. Accessed May 11, 2021.
- National Down syndrome Society. Down syndrome fact sheet. Available at: https://www.ndss.org/about-down-syndrome/down-syndrome-facts/. Accessed May 11, 2021.
- National Down syndrome Society. What is Down syndrome. Available at: https://www.ndss.org/about-down-syndrome/down-syndrome/. Accessed May 11, 2021.
- Mundakel GT. Down syndrome. Available at: https://emedicine.medscape.com/article/943216-print. Accessed May 11, 2021.
- Vraneković J, Božović IB, Grubić Z, et al. Down syndrome: Parental origin, recombination, and maternal age. Genet Test Mol Boimark. 2012;16:70–73.
- Sherman SL, Lamb NE, Feingold E. Relationship of recombination patterns and maternal age among non-disjoined chromosomes 21. Biochem Soc Trans. 2006;34:578–580.
- Ghosh S, Feingold E, Dey SK. Etiology of Down syndrome: Evidence for consistent association among altered meiotic recombination, nondisjunction and maternal age across populations. Am J Med Genet A. 2009;149A:1415–1420.
- Hunter JE, Allen EG, Shin M, et al. The association of low socioeconomic status and the risk of having a child with Down syndrome: A report from the National Down syndrome Project. Genet Med. 2013;15:698–705.
- S. Centers for Disease Control and Prevention. Facts about Down syndrome. Available at: htpps://www.cdc.gov/ncbddd/birthdefects/downsyndrome.html. Accessed May 11, 2021.
- Baum RA, Nash PL, Foster JE, et al. Primary care of children and adolescents with down syndrome: An update. Curr Probl Pediatr Adolesc Health Care. 2008;38:241–261.
- Sobey CG, Judkins CP, Sundararajan V, et al. Risk of major cardiovascular events in people with Down syndrome. PLOS One. 2015;10:e0137093.
- Jensen KM, Bulova PD. Managing the care of adults with Down’s syndrome. BMJ. 2014;349:g5596.
- McDowell KM, Craven DI. Pulmonary complications of Down syndrome during childhood. J Pediatr. 2011;158:319–325.
- Mazurek D, Wyka J. Down syndrome — Genetic and nutritional aspects of accompanying disorders. Rocz Panstw Zakl Hig. 2015:66:189–194.
- Liyanage S, Barnes J. The eye and Down’s syndrome. Br J Hosp Med. 2008;69:632–634.
- Miyazaki EA. The orthoptics of Down syndrome. Am Orthopt J. 2014;64:12–16.
- Mik G, Gholve PA, Scher DM, et al. Down syndrome: orthopedic issues. Curr Opin Pediatr. 2008;20:30–36.
- Dykens EM, Shah B, Davis B, et al. Psychiatric disorders in adolescents and young adults with Down syndrome and other intellectual disabilities. J Neurodev Disord. 2015;7:9.
- National Down syndrome Society. Mental health issues and Down syndrome. Available at: https://www.ndss.org/resources/mental-health-issues-syndrome/#:~:text=The%20most%20common%20mental%20health,progressive%20loss%20of%20cognitive%20skills. Accessed May 11, 2021.
- Hefti EJ, Blanco JG. Pharacotherapeutic considerations for individuals with Down syndrome. Pharmacotherapy. 2017;37:214–220.
- Aldosssary MS. Down syndrome: A review for the dental professional. IOSR J Dent Med Sciences. 2017;16:61–66.
- National Institute of Dental and Craniofacial Research. Practical oral care for people with Down syndrome. Available at: https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-down-syndrome.pdf. Accessed May 11, 2021.
- Al-Maweri, SA, Tarakji B, Al-Sufyani GA, et al. Lip and oral lesions in children with Down syndrome. A controlled study. J Clin Exp Dent. 2015;7:e284–e288.
- Ferreira R, Michel RC, Greghi SL, et al. Prevention and periodontal treatment in Down syndrome patients: A systematic review. PLOS One. 2016;11:e0158339.
- Al-Sufyani GA, Al-Maweri SA, Al-Ghashm AA, et al. Oral hygiene and gingival health status of children with Down syndrome in Yemen: A cross-sectional study. J Int Soc Prev Community Dent. 2014;4:82–86.
- Deps TD, Angelo GL, Martins CC, et al. Association between dental caries and Down syndrome: A systematic review and meta-analysis. PLOS One. 2015;doi:10.1371/journal.pone.0127484.
- Oredugba F. Oral health condition and treatment needs of a group of Nigerian individuals with Down syndrome. Down Syndr Res Pract. 2007;12:72–76.
- Sixou JL, Vernusset N, Daigneau A, et al. Orofacial therapy in infants with Down syndrome. J Dentofacial Anom Orthod. 2017;20:108.
- AlJameel AH, Watt RG, Tsakos G, et al. Down syndrome and oral health: mothers’ perception on their children’s oral health and its impact. Journal Patient-Reported Outcomes. 2020;4:45.