10/5/2016

DentalIssues&DownSyndromeNationalDownSyndromeSociety

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Dental Issues & Down Syndrome

Dentalcareisimportantforeverybody,butpeoplewithDownsyndromecanhaveanumberofdifferencesthatcanrequire
specialattention.

What is Different About the Teeth of People With Down Syndrome?

DELAYEDERUPTION
TheteethofpeoplewithDownsyndrome,bothbabyteethandpermanentteeth,maycomeinlatecomparedtochildrenwithout
Downsyndrome.Onaverage,babieswithDownsyndromegettheirfirstteethat12to14months,butitmaybeaslateas24
monthsofage.BabieswithoutDownsyndrometypicallygettheirfirstteethbetween612months.Itistypicalthatachild
withDownsyndromemaynotgetall20babyteethuntilheorsheis4to5yearsofage,ratherthan23yearsofage,whichis
typicalforchildrenwithoutDownsyndrome.Thefrontpermanentteethandpermanent6yearoldmolarsmaynoteruptuntil8
9yearsofage.ItisalsocommonfortheteethofchildrenwithDownsyndrometoeruptinadifferentorderthaninchildren
withoutDownsyndrome.

SMALLANDMISSINGTEETH
Frequently,peoplewithDownsyndromehavesmallerthanaverageteethandmissingteeth.Itisalsocommonfortheteethof
peoplewithDownsyndrometohaverootsthatareshorterthanaverage.

LARGETONGUES
PeoplewithDownsyndromemayhavelargetonguesortheymayhaveanaveragesizetongueandasmallupperjawthat
makestheirtonguetoolargefortheirmouth.ItisalsocommonforpeoplewithDownsyndrometohavegroovesandfissures
ontheirtongues.

PROBLEMSWITHBITE
PeoplewithDownsyndromemayhavesmallteeth,whichcancausespacingbetweentheteeth.Theyalsotendtohaveasmall
upperjaw.Thismaycausecrowdingoftheteethandmayresultinthepermanentteethbeingimpactedbecausethereisno
roominthemouthforthemtocomein.Thesmallupperjawmaycreateasituationwherethetopteethdonotgooverthe
bottomteeththewaytheyaremeanttoinstead,thebottomteethmaybeoutfurtherthanthetopteethinthebackofthe
jaw,thefrontofthejaw,orboth.ItisalsocommonthatthefrontteethofpeoplewithDownsyndromedonottouch.
Orthodontics(braces)maybeabletoimprovesomeoftheseissues.Orthodonticsrequirealotofcooperationandmakethe
teethevenmoredifficulttokeepclean,soitmaynotbepossibleinallpeople.Itmaybeagoodideatowaituntilachildisolder
andabletotolerateitabitbetter.Havingorthodonticappliancesinthemouthcanalsoposechallengestospeech.Children
withoutDownsyndrometypicallyadapttheirspeechquicklyhowever,inachildwithDownsyndrome,wherespeechmay
alreadybeanissue,adaptingtotheappliancesmaybeverydifficult.Therefore,itmaybeagoodideatodelayorthodontic
treatmentuntilachildisolderandhisorherspeechisfurtheralong.

GUMDISEASE
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PeoplewithDownsyndromeareatanincreasedriskforgumdisease(periodontaldisease).EvenwhenindividualswithDown
syndromedonothavealotofplaqueandtartar(calculus),theygetperiodontaldiseasemorefrequentlythanothers.Thisis
becausepeoplewithDownsyndromehaveanimpairedimmunesystemanddonothavesomeofthenaturalprotectionsagainst
thediseasethatpeoplewithoutDownsyndromehave.Topreventgumdiseasebrushtwicedaily,focusingthebristlesalongthe
gumline,flossdailyandbesuretovisitthedentistregularlytohavegumhealthmonitoredandtotakeXraystomonitorbone
levels.Ifthegumsbleedthatmeansthattheyareinflamed.Brushingandflossingshouldnotbestoppedbecauseofthis.In
fact,brushingandflossingwillkeepthegumscleanandhelptominimizetheinflammation.

CAVITIES
SomeresearchsaysthatpeoplewithDownsyndromeareatlessofariskforcavitieshowever,muchofthatresearchwas
donewhenpeoplewithDownsyndromelivedininstitutionsandhadveryrestricteddiets.PeoplewithDownsyndromedoget
cavities,sobrushingwithfluoridetoothpaste,flossingbetweenanyteeththattouch,andlimitingtheamountandfrequencyof
sugarandrefinedcarbohydrateseatenwillhelptopreventthedevelopmentofcavities.

What Can I Do to Prevent Cavities and Gum Disease?

Brushteethtwicedailywithasofttoothbrushandfluoridetoothpaste.Childrenlessthan2yearsshouldgetathin
smearoffluoridetoothpaste,andchildren2to5yearsshouldgetasmallpeasizedamount.
Limitthefrequencyofsugarandcracker/breadbasedsnacks.
Thefirstdentalvisitshouldbewithin6monthsofthefirsttootheruptingorby1yearofage.
Visitthedentistregularlyitistypicallyrecommendedthatyougoevery6months,butsomepeoplemayneedtogo
moreoften.

How Do I Find a Dentist?

Forchildren,theAmericanAcademyofPediatricDentistrywebsitecanbeausefultoolinfindingadentist.Pediatricdentists
have23yearsofeducationafterdentalschoolinthecareofchildren,includingkidswithspecialneedssuchasDown
syndrome.
Foradults,generaldentistscomfortlevelswithsomeoftheuniqueneedsofpeoplewithDownsyndromemayvary.Ageneral
dentistwhohascompletedageneralpracticeresidency,12additionalyearsafterdentalschool,hasextratrainingincaringfor
patientswithdisabilities.TheSpecialCareDentistryAssociationisaresourcetofindadentistexperiencedintreatingpeople
withDownsyndrome.
Youcancallyourlocaldentalschool,becausetheywilltypicallyhaveresidentsorfacultywhoareexperiencedincaringfor
peoplewithDownsyndrome.
SomehospitalshavedentaldepartmentsandthesedentistsaretypicallytrainedincaringforpeoplewithDownsyndromeas
well.

What If I Do Not Think My Child Can Cooperate for Dental Care?

Pediatricdentistsareexperiencedinworkingwithchildrenofallagesandchildrenwhohavedifferentabilitiestocooperate.
Pediatricdentistshavemanyskillstohelpchildrenhaveasuccessfuldentalvisit.Somechildrenwhoneeddentaltreatment
mayneedsomeformofsedation.Yourdentistwillbeabletodiscussthiswithyoudependingonyourchildsdentalneedsand
medicalconditions.

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Do People with Down Syndrome Need to Take Antibiotics Before

Going to the Dentist?
Peoplewhohave,orhavehad,certainkindsofheartdefectsneedtotakeantibioticsbeforetheirdentalappointment.Askyour
physicianorcardiologistifantibioticsareneededandbesuretoinformyourdentistofallhealthconditions,includingheart
issues.

What Can I Do About My Child Grinding His or Her Teeth?

Itisverycommonforchildrentogrindtheirteeth.Typicallyitdoesnotcausedentalproblems,andchildrentendtogrowoutof
itontheirown.However,sometimeschildrenwithneurologicaldisabilitiesdonotoutgrowitortheydoitsoseverelythatit
causesdamagetotheteeth.Adentistcanexamineyourchildsteethtoensurethatthegrindingisnotcausinganyproblems.
Typically,mouthguardsarenotmadeforchildrenwhogrindtheirteeth,becausetheriskofthechildchokingonthemouthguard
ifitbreaksistoogreat.
***
NDSSthanksguestauthorDr.JessicaDebord,DDSforcontributingthisarticle.

NDSSRESOURCES

HealthCareGuidelines
Anesthesia&DownSyndrome
OralHealthandDownSyndrome:WebinarSlides
EXTERNALRESOURCES

AmericanAcademyofPediatricDentistry
www.aapd.org
Findadentistatwww.aapd.org/finddentist
AmericanAcademyofPediatricDentistryBrochures
AmericanAcademyofPediatricDentistryPoliciesandGuidelines
NationalInstituteforDentalandCraniofacialResearchSpecialNeeds
www.nidcr.nih.gov/OralHealth/OralHealthInformation/SpecialNeeds
PracticalOralCareforPeopleWithDownSyndrome
SpecialCareDentistry
www.scdonline.org
Tofindadentist,clickonOnlineReferralSystem
BOOKS
OffWeGototheDentist.Webster,A.Bethesda,MD:WoodbineHouse.(2007)

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