Elizabeth S. Pilcher, DMD Department of Prosthodontics College of Dental Medicine Medical University of South Carolina P.O. Box 250507 171 Ashley Avenue Charleston, SC 29425 (803) 792-2341; Fax: (843) 792-1593

Reprinted with the permission of the author, Elizabeth S. Pilcher, DMD © Down Syndrome News, Vol. 20, Num. 9, page 114, November 1996, p. 144. Newsletter of the National Down Syndrome Congress. Distribution of this article, including posting at another website is allowed with the permission of the author.

     There are some unique dental characteristics in Down syndrome but most dental care can be achieved by a general dentist with a minimum of fuss. As with any small child, a pediatric dentist's office may be more suited to your child's needs during their early years. Pediatric dentists receive extra training that includes the treatment of young patients with disabilities.

     Your child's first tooth may erupt much later than expected. First teeth usually appear between the age of six months to one year. In Down syndrome this can be delayed a year or more. Also, the order in which your child's teeth erupt may be different from that of your other children. Frequently there are missing teeth or teeth that are slightly malformed.

     As with the eruption of the primary teeth, the eruption of the permanent teeth is usually later as well. The permanent teeth often appear small, with spaces between the teeth due to this reduced size and teeth that have not formed. Your child's dentist will take radiographs which will provide information on missing teeth. Knowing which teeth are missing will help in planning for optimal occlusion.

     Poor occlusion (bite) is almost universal in individuals with Down syndrome. This is due to the under development of the mid face. The upper arch is usually not as large as it should be resulting in an underbite in the anterior region and often a cross bite in the back teeth. Certain appliances such as palatal expanders can be used during the childhood years to help expand the upper arch and promote a healthier bite.

     The effect of the tongue is also very important. Persons with Down syndrome often have a tongue of normal size but the jaws are smaller than usual. This combined with the low muscle tone of the lips and cheeks results in an abnormally large force to the teeth from the tongue. The front teeth are often pushed outward by the tongue and this results in an open bite. This open bite can make biting and chewing difficult as well as being unaesthetic. Early training in proper tongue position and proper swallowing technique can help minimize the effects of the tongue.

     You may have heard that persons with Down syndrome don't get dental decay. This is not true. Recent studies have shown that there is a lower rate of dental decay in Down syndrome but not as much as we once thought. So all of the factors important in preventing decay such as proper home care, diet and fluoride are also important for persons with Down syndrome. Because of low muscle tone, chewing may not be as efficient and more food may remain on the teeth after eating. So proper oral hygiene is very important.

     The advantage that individuals with Down syndrome have with a reduced caries rate is more than offset by an extremely high rate of periodontal disease. Periodontal (gum) disease may be severe and begin as early as the teenage years. Left untreated, this will result in loss of teeth. It is thought that the high incidence of periodontal disease in Down syndrome is due to the reduced immune response. In addition to proper brushing and flossing, the best way to keep periodontal disease under control is to have frequent dental appointments for professional cleanings. Your dentist may recommend one of the new antimicrobial mouth rinses or perhaps antibiotic therapy for the control of periodontal disease.

     Don't let the anticipation of how your child may behave in the dental office cause you to delay dental care. Visits should begin as soon as your child has teeth so that you can learn proper home care and your child can get used to the dental office. Visits should continue at a rate of twice a year, sometimes more often, depending on the needs of the patient. Good behavior in the dental office is learned over a period of time.

     How do you find the right dentist for your child? Look for a dental office that you can communicate with. The staff and doctor should be willing to take a little extra time if needed for your child's visits. The staff should communicate directly with your child, at his/her level of understanding. Hard and fast rules such as no parents allowed in the operatories may not be the best situation for your child. Discuss these and other issues with the office staff prior to your child's appointment. Talk to other parents and perhaps your local Down syndrome association to get names of dentists in your area who have an interest in working with patients with special needs. If there is a teaching hospital or children's hospital in your area, someone there may be able to provide names. Your state Dental Association may also be able to provide names. Finally, there is an organization currently available in twenty states called the National Foundation of Dentistry for the Handicapped which provides referrals of dentists willing to treat patients with disabilities at no charge or at a reduced charge. Their number is (800) 366-3331.

     If you have any questions, please feel free to contact me at the above address.