It is important to be aware of the type of anatomical soft tissue and dental anomalies which are part of the typical developmental pattern of people with Down's Syndrome, which have influence on dental problems.

Iona M Loh (UK)

Introduction
The orofacial and skeletal development associated with Down's Syndrome contribute to dental problems. It is important to be aware of the type of anatomical soft tissue and dental anomalies which are part of the typical developmental pattern of people with Down's Syndrome, which have influence on dental problems.

Anatomical development changes the cranial base, the mid third of the face and the proportion between the maxilla and mandible. This alteration of the skeleton leads to people with Down's Syndrome having a recognisable facial appearance. The soft tissue feature most affected is the tongue, which is fissured and protrusive. The tongue appears large because it has to rest in a narrow dental arch. The tonsils and adenoids are also enlarged.

Dental anomalies are related to the tooth morphology in that there is:

  • Decreased root to crown ratio
  • Decreased tooth size
  • Hypodontia or partial anodontia
  • Delayed eruption


Dental Problems
The normal development of oral structure and function is altered leading to compromised development of suckling, swallowing, mastication and speech; and to drooling unless there is effective intervention. The degree of difficulty varies from person to person:

Preventive measures and therapy are needed to ameliorate the problems found in swallowing and mastication. Here an integrated approach can be adopted with the Speech and Language Therapist.

Dental Disease
People with Down's Syndrome are prone to the same degree of dental disease as the general population. Periodontal disease: People with Down's Syndrome develop more severe forms of periodontal disease than the general population. This may be related to immunological deficiency factors. This disease is most rampant in young people between 16 and 20 years old. The progression of the disease gives rise to periods of acute infection and pain, which may result in changes in behaviour, refusal to eat or swallowing food whole.

Picture 1: Gingivitis of the anterior teeth

Picture 2: Disclosing solution (left) shows the plaque which is present by invisible on the same teeth without solution (right)

Picture 3: Tooth decay and gingival inflammation

Caries: Various studies have shown a reduced incidence of caries in children and young adults with Down's Syndrome. This may be due to the fact that many of these children are under supervision in regard to their diet in order to prevent their tendency to obesity. This is where the dentist and the dietician can work together to make sure the food being consumed is working towards oral and general health improvement.

Risk associated with infection is raised in people with Down's Syndrome as the incidence of congenital cardiac disease is increased in this group (3% to 40%), resulting in a serious risk of endocarditis.

The gag reflex can occur even in the anterior portion of the oral cavity. Any further back than the premolars a gag reflex may be accompanied by a gastro-oesophegal reflux. Children find this most uncomfortable.

Bruxism occurs in people with Down's Syndrome and may be triggered by a state of chronic anxiety, dental malocclusion, temporo mandibular joint dysfunction due to laxity of the supporting ligaments, and/or underdeveloped nervous control.

Dental trauma is frequently experienced due to lack of motor development. Fracture or luxation of the anterior teeth is frequent and often involves loss of tooth vitality.

Treatment and prevention

  • Good oral hygiene and supervised tooth brushing programmes
  • Education, e.g. via videotapes
  • Diet, communication and use of oral muscles. This requires an integrated approach to care, as it involves a team of professionals and carers.
  • Management of any malocclusion requires a multi-disciplinary team to carry out diagnoses and treatment planning (e.g. Orthodontist, Restorative and Oral Maxillo-Facial Surgeons)

This article was first published on the site in 2002.