Approach to patients with Down syndrome

The dentist has a duty to treat each patient to the best of his or her professional ability and technical means.

The caregivers of patients with various forms of disability should not neglect their oral hygiene, as much general pathology have their starting point in the oral cavity.

Trisomy 21 or Down’s syndrome is an abnormality characterized by the extra presence of a single chromosome in the DNA structure.

It is not a preventable condition, its incidence increases exponentially with the age of the mother and it has some distinct features:

  • Facial features: the face is small and round and the eyes have an oblique, mongoloid appearance of the eyelids

  • Neck: short and wide

  • At birth, cardiac, ocular, digestive or orthopedic malformations may be detected.

  • Patients with this syndrome have a variable degree of retardation

Patients with Down syndrome are usually cooperative, quiet, warm and enthusiastic. The dentist will explain all therapeutic procedures slowly, clearly and in simple words that the patient understands.

Implications in dentistry

Caregivers of patients with trisomy 21 should be aware of some of the specifics of the disease that may interfere with dental treatment, in order to inform the doctor to adapt the treatment plan and means.

  • Hearing impairment – is present in most cases of Down syndrome. While in some cases it is compensated for by wearing a hearing aid, in the absence of a hearing aid, loud noises that may drown out the doctor’s voice should be avoided. It is also insisted that eye contact is maintained where possible to get constant feedback from the patient.

  • Periodontitis – is resorption of the alveolar bone, accelerated destruction of hard tissue followed by tooth loss. It is the most common dental pathology that can occur in a patient with Down syndrome. Aggressive forms of periodontitis manifest themselves from an early age. That is why the hygiene protocol must be meticulous from the start, in order to maintain the gingival attachment for as long as possible. Caregivers will be guided to optimize the patient’s hygiene.

Factors favoring accelerated tooth loss:

  • Poor hygiene

  • Malocclusion – unfavorable occlusal ratios

  • Bruxism – teeth grinding, especially during sleep, can lead to tooth sensitivity and temporomandibular joint pain that can radiate to the cephalic level

  • An abnormal response of the immune system, which may be impaired or even compromised.

  • Malocclusion – due to delayed tooth eruption as well as a tendency to lose teeth early, patients with trisomy 21 often have malocclusion. Orthodontic treatment is not a contraindication for these patients but local conditions, the patient’s health and the possibility of independent brushing should be carefully considered.

  • Dental anomalies – we can find dental agenesis (lack of tooth buds and therefore lack of teeth on the dental arches), teeth with irregular shapes, malpositioned or with delayed eruption. The caregiver should be aware that these abnormalities are common among those with Down’s syndrome and that treatment solutions are individualized to each case.

Patients with Down’s syndrome should not neglect visits to the dentist because by treating existing pathologies and monitoring the oral health status, satisfactory results can be achieved, with reduced risk of loss of dental units.

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