Dental Care in Patients with Down Syndrome

In the Region of Murcia it is common to find more and more relatives of patients affected by Down's Syndrome who want to improve their quality of life, including specialised dental care, requesting information on the care and considerations that should be taken in these cases.

What does it consist of?

Down's Syndrome is the most frequent cause of congenital mental disability in humans. It occurs due to the alteration of one chromosome, chromosome 21, which is why it is also known as Trisomy 21, which determines a series of physical alterations in the individual, to which special attention must be paid by the individual and his or her relatives.

Characteristic physical features that these patients usually present include disorders of the mouth and teeth of the patient with respect to other patients. Therefore, the oral care of these patients should start at the earliest possible stage. as early as the rest of the children.i.e. from the eruption of the first tooth.

This is also particularly important in cases where the patient's psychomotor skills are reduced and they are unable to brush properly, at which point parental assistance with daily oral hygiene becomes necessary (the use of a Oscillating-Rotating electric toothbrush), and care by expert paediatric dentists for regular hygiene in a dental clinic.

What effects does it have on oral health?

Generally, the teeth of children with Down's Syndrome 'erupt' or erupt later than usual, especially the primary or 'milk' teeth, and may finish at 5-6 years of age, when they are usually all in the mouth by the age of 3.

Similarly, the primary teeth and even the permanent (adult) teeth may be smaller than usual (microdontia) and the tongue may be larger in proportion to the rest of the mouth (macroglossia). In addition, it is common for a permanent tooth to be missing in the patient's mouth (dental agenesis), something that is solved once the patient's growth is complete, in adulthood.

On the other hand, due to the presence of a 'weak' (hypotonic) tongue, they tend to stick out their tongue and to mouth breathingwhich encourages the development of gum diseases and respiratory tract infections, so again, regular monitoring is important, depending on the patient's characteristics and the dentist's recommendations.

For all these reasons, the periodontal disease (gum disease) is present in practically all of these patients, so dental cleaning by paediatric dentistry professionals should begin at an early age in order to avoid excessive inflammation of the gums, problems of halitosis (bad breath) or discomfort when eating due to bleeding of the mucous membranes.

In addition, dental malocclusions are also very frequent due to the small size of the jaws, so it is very common the need to orthodontic and/or dentofacial orthopaedic treatment with devices that are as minimally invasive and comfortable as possible to reduce the possibility of discomfort due to them.

What considerations should the dentist take into account?

The behaviour and co-operation of these patients is variable, so dental treatment may require the use of light sedation with nitrous oxideThe procedure is harmless and very comfortable for the patient, and in more complex cases, the treatment can be performed under general anaesthesia.

Finally, it should be borne in mind that many patients with this syndrome may have heart disease that will make it necessary to give them a antibiotic prophylaxis to prevent bacterial endocarditis. This prophylaxis consists of taking an antibiotic one hour before dental treatment to prevent bacteria from the mouth passing into the bloodstream and reaching the heart, thus making the treatment 100% safe for the patient and avoiding any risk.

Recommendations for dental care in patients with Down's Syndrome:

- Start dental hygiene as soon as the first tooth erupts. Make a consultation with your Paediatric Dentist at this time, taking the patient to the dental clinic for hygiene and prevention instructions.

- Have your mouth cleaned by a dental professional every 3 months to prevent gingivitis and periodontal disease.

- Determine, together with the patient's cardiologist, the need for bacterial endocarditis prophylaxis, to be taken into account each time treatment is performed.