Medical Professionals Treating Children with Down Syndrome (Trisomy 21)

Oral Health Fact Sheet for Medical Professionals Treating Children with Down Syndrome (Trisomy 21)

Down syndrome is a chromosome disorder associated with an extra chromosome (Trisomy 21) resulting in intellectual disability and specific physical features. (ICD-9 code 758)

Oral Manifestations and Considerations

Oral

• Early onset severe periodontal disease (most significant oral health problem)
• Lower prevalence of dental caries
• Delayed eruption of permanent teeth, malocclusion
• Congenitally missing and malformed teeth are common
• Hypoplasia of mid-facial region
• Hypodontia, microdontia
• Macroglossia, fissured and protruding tongue
• Tongue thrust, bruxism, clenching, mouth breathing

Other Potential Disorders/Concerns

• Epilepsy
• Cardiac defects
• Atlantoaxial instability (fragility of cervical vertebrae/spinal cord)
• Compromised immune system
• Sleep apnea
• Increased risk of leukemia
• Hearing loss
• Vision problems
• Hypothyroidism

Oral Side Effects of Commonly Prescribed Medications

Parent/Caregiver Support and Anticipatory Guidance

• Discuss with parents if antibiotics are needed for dental treatment.
• Discourage consumption of cariogenic foods and beverages.
• Prescribe sugar-free medications, if available.
• Recommend preventive measures, such as topical fluoride and sealants.
•  Advise the use of fluoridated toothpaste twice daily and support the family in following dental care instructions.
• Instruct caregiver on appropriate protocol following dental trauma (locate/preserve missing tooth and put in cold milk; seek immediate professional care).
• Review safety issues appropriate to the age of the child, such as mouth guards to prevent oral-facial trauma.
• Recommend rinsing with water thoroughly after taking each dose of sugar containing medication and frequent water intake for patients taking xerostomic medication.
• Discuss habits that may harm the child’s teeth, such as propping baby bottles, putting child to bed with bottle.
• Refer to dentist any oral developmental abnormalities.

References

• Hennequin M, Faulks D, Veyrune JL, Bourdiol P. (1999) Significance of oral health in persons with Down syndrome: a literature review. Dev Med Child Neurol. 41(4):275-83.
• Fiske, J., and Shafik, H. (2001) Down ’s syndrome and Oral Care. Dent Update, 28(3): 148-156.
• Morgan, J. (2007) Why is periodontal disease more prevalent and more severe in people with Down syndrome? Special Care Dentist, 27(5):196-201.

Additional Resources

• NIH Institute for Down Syndrome
• Special Care: an Oral Health Professionals Guide to Serving Young Children with Special Health Care Needs
• Bright Futures Oral Health Pocket Guide
• American Academy of Pediatric Dentistry: 2011–2012 Definitions, Oral Health Policies and Clinical Guidelines
• MCH Resource Center
• ASTDD – Special Needs
• Block Oral Disease, MA
• Free of charge CDE courses: MCH Oral Health CDE (4 CDE hours) NIDCR CDE (2 CDE hours)