Oral Health for Children with Down Syndrome

Persons with developmental disabilities such as Down syndrome should be able to have the same good oral health and teeth as that of normal patients. In the dental office, treatment plans may need to be adapted as necessary regarding each individual’s needs and condition, but cosmetic dental care, orthodontics (braces), prosthodontics (space retainers, partial dentures, dentures), and reconstructive oral surgery should not be disregarded simply because the patient/child has Down syndrome.

In fact, good home oral care and dental care is even more essential for the patient/child with Down syndrome. Although, people with Down syndrome may have some mental and physical challenges that need to be considered, providing and teaching oral care to this population can be accomplished with creativity and patience. Before attempting oral care, it is important for the care giver to understand the medical problems associated with Down syndrome that affects their oral health.

  • About half of the babies with Down syndrome are born with some type of heart abnormality. Although most children have surgery to correct their problem within the first few years of life, many will develop Mitral Valve Prolapse (MVP) by adulthood, and many patients and caregivers are unaware of this potential. An echocardiagraphy must be performed to evaluate whether or not this condition has developed. Approximately 50% of adults with Down syndrome have MVP and will need prophylactic antibiotics before dental treatment.
  • Most people with Down syndrome have compromised immune systems which makes them susceptible to a higher rate of infections and periodontal (gum) disease. This may contribute to a higher rate of aphthous ulcers, oral yeast infections, and severe inflammation of their gums.
  • Often, these children will have chronic upper respiratory infections which will consequently cause them to be mouth-breathers and have dry mouth, causing cracking of the mouth and lips. This population also has a reduced degree of muscle tone. This loss of muscle tone in the mouth may cause an imbalance of forces on the teeth and may make the tongue more forceful which contributes to the open bite often seen in Down syndrome patients. This also makes chewing and natural cleansing of the mouth less efficient, and food may remain on the teeth longer. This contributes to problems with swallowing, drooling, and speaking. Additionally, with loss of muscle tone there may be decreased manual dexterity that makes tooth brushing and flossing difficult.
  • A condition related to their reduced muscle tone is a ligamentous laxity which causes the ligaments (elastic bands of tissue that connect one bone to another) to be looser. This may affect the ligaments around the tooth root and contribute to early tooth loss. It may also cause a condition known as Atlanto-axial Instability (a looseness between two neck bones). Symptoms may include neck pain and limited mobility, numbness, tingling in the extremities, head tilt, difficulty walking, or abnormal walking. All children with Down syndrome should have an x-ray of the neck area between the ages of 2½ and 3 years, and some professionals may recommend x-rays at 3, 13, and 18 years of age. Certainly, your child should be checked before any new physical activity or surgery.
  • Teeth grow in late and in unusual order in persons with Down syndrome. Therefore, the diet may need to be altered because there may not be enough teeth to chew certain foods. There is a high rate of missing baby and permanent teeth, and some teeth may be overly small or abnormally formed. The roots of the teeth are also small and conical, which can contribute to early tooth loss.
  • Many children with Down syndrome have mild to moderate intellectual abilities, but this varies widely. Language development may also be severely delayed and the Down syndrome patient/child may understand more than what they can say.
  • Often there are other medical problems in conjunction with Down syndrome, such as epilepsy, diabetes, leukemia, hypothyroidism, and other conditions. Alzheimer’s disease and Down syndrome appear to be connected, and some people in this population have “old-age” hearing loss as early as 13 years of age!
  • There is a higher incidence of sleep apnea in the Down syndrome population. This is cause by a decreased airway size in combination with their lowered muscle tone. If this is left untreated, obstructive sleep apnea can further retard development, and may lead to congestive heart failure and pulmonary hypotension. If your child snores, has restless sleep, and unusual sleeping positions, a referral to a sleep disorder clinic may be advised.

Oral Care and Strategies

  • Remember to try to use the same time, location, and position to brush and floss.
  • Many people with Down syndrome have strong gag reflexes. Try to avoid the back top of the tongue when brushing—this area activates the reflex.
  • Children with Down syndrome can learn to brush and floss independently, but will need the same or more help in learning these activities as other children. As the child matures a power brush and a floss holder or power flosser (such as Waterpik’s Power Flosser or Oral B’s Hummingbird) may help.
  • If possible, substitute sugar-free medicines if they are available.
  • Do not reward good behavior with sweets, and avoid using candy as incentives. Try to give noncariogenic (non-cavity causing) foods for snacks such as cheese or peanut butter.
  • Medications may cause dry-mouth, so have your child drink water often.
  • In addition to their medications, many Down syndrome children breathe through their mouth which makes their mouth and oral tissues drier. Products aimed at giving relief to dry mouth may be useful, depending on the child’s age.
  • Use preventive measures to fight tooth decay such as frequent, regular dental check-ups, fluoride treatments, at-home fluoride rinses or gels, and sealants.
  • Gum disease occurs rapidly and at a very young age in people with Down syndrome. Therefore, some children may need to use an antimicrobial rinse daily. Ask your dentist.
  • Tip: If your child cannot spit after rinsing, you can spray the fluoride rinse or antimicrobial on the teeth after brushing and flossing.
Sources
“Practical Oral Care for People With Down Syndrome”, U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, NIH Publication No. 04-5193, May 2004. nohic@nidcr.nih.gov

“Dental Care for the Patient with Down Syndrome”. Elizabeth S. Pilcher. Down Syndrome Research and Practice, Vol. 5 No. 3, p 111-116, 1998. www.ds-health.com

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