Down’s syndrome, also known as Down syndrome or trisomy 21, is a genetic condition that typically causes some level of learning disability and certain physical characteristics. Several of these characteristics can influence dental care and treatment.
If we start with facial features, individuals with Down’s Syndrome often have smaller bones in the middle of their face, including the upper jaw. This has two main effects:
• A smaller nasal airway – so it’s often more comfortable to breathe through the mouth. This is called mouth-breathing.
• A smaller mouth. Having a smaller mouth can mean there is less room for the tongue, so the tongue can appear to be too large and may protrude.
It also means there can be less room for the teeth, so they can become crowded. There is a reduced degree of muscle tone in Down’s Syndrome. Having weaker cheek and lip muscles means the tongue exerts more force on the teeth, and can cause the front teeth not to meet when biting.
This is called an anterior open bite. Your dentist will be able to give more advice on anterior open bite and crowding and what treatment may be available if necessary.
Mouth Breathing and Dry Mouth
Mouth breathing over a long time can cause a dry mouth. This may cause an individual’s tongue to develop cracks or grooves. Food and plaque can collect in deep grooves and cause irritation and bad breath. Because of this, it may be useful to brush the tongue as well as the teeth. The lips may also become dry and chapped. Chapped and bleeding lips can be soothed with lip balm. Sometimes redness and soreness can develop at the corners of the mouth. This is called angular cheilitis and can be caused by irritation or infection.
Having a dry mouth can also lead to a higher rate of dental decay as saliva helps cleanse the teeth. It also can lead to an increased risk of infections such as oral thrush. Oral thrush may not cause any signs or symptoms, but may cause a burning sensation or white patches in the mouth that can be rubbed off.
Your dentist or doctor will be able to help with these issues so seek their advice.
A type of ulcer, called an apthous ulcer, is common in Down’s Syndrome. This is a common type of ulcer which often last a few days and can be sore. They can recur several times a year. They normally heal on their own but may require a numbing spray or mouthwash if they are painful. If an ulcer is present for more than 2 weeks you should seek advice from your dentist, as it may need further investigation.
Eruption of Teeth and Missing Teeth
The eruption of teeth can be delayed, or teeth may erupt in an unusual order. People with Down’s Syndrome often have missing teeth because they fail to develop. This can affect both the primary or ‘baby’ teeth and the permanent teeth. Because of the delayed eruption of adult teeth and the chance of missing adult teeth, it is really important to keep a child’s baby teeth as healthy as possible. This can be done by brushing a child’s teeth with fluoride toothpaste twice a day, trying to restrict sugary foods and drinks to meal times, and attending for regular dental check-ups, and seeking prompt dental treatment should a problem arise.
A type of severe gum disease called ‘periodontal disease’ is more common in people with Down’s Syndrome. The reason the incidence of periodontal disease is higher in individuals with Down’s syndrome is thought to be due to their immune system. A type of white blood cell which helps fight infection, T Cells, are sometimes decreased in Down’s Syndrome. This means that an individual
can be more susceptible to infections and gum disease. Periodontal disease causes supporting bone to be lost from around the teeth which can make them loose, and can cause early tooth loss. In Down’s Syndrome, teeth can be smaller and have smaller roots. This provides less anchorage to the bone and can contribute to early tooth loss with periodontal disease.
A very acute sudden flare up of very sore, swollen, red gums and onset of bad breath can be a sign of a gum infection called acute necrotising gingivitis (ANUG). If this occurs, seek advice from your dentist as it requires more urgent treatment.
Periodontal disease can be managed with good oral hygiene. This means brushing the teeth for two minutes twice a day, making sure the teeth are being brushed right down to the gum. The use of floss or interdental ‘TePe’ brushes are useful as they clean in-between the teeth where plaque can often collect. Some individuals may find floss quite tricky to use, so the use a floss holder or a ‘y’ flosser may be useful. Your dentist can help show you how best to take care of your child’s teeth. Because of the risk of gum disease, regular cleaning appointments with your dentist or hygienist may be needed, and they may recommend the use of an antiseptic mouthwash or gel called chlorhexidine.
The incidence of dental decay has reported to be lower in Down ’s syndrome than the general population, however because of the high incidence of missing teeth and the need to maintain baby teeth for longer it is important that as much as possible is done to prevent dental decay. This includes brushing twice daily with a fluoride toothpaste, seeing your dentist regularly for check-ups, and limiting intake of sugary food and drink.
It may be that an individual with Down’s Syndrome may need assistance with brushing. Adjuncts to oral care can be purchased, such as three sided toothbrushes and specially adapted handle grips.
Infective Endocarditis and Dental Care:
Approximately half of all babies born with Down’s Syndrome will have some type of cardiac abnormality. Some heart conditions, including diseases of the heart valves or structural abnormalities of the heart, can put an individual at risk of infective endocarditis. This is an inflammation of the inner layer of the heart, normally the heart valves. There is a link between some types of dental treatment and infective endocarditis. If your child has a heart condition it may
be useful to read the guidance on this from the National Institute of Health and Care Excellence on the subject.
If you are concerned about the risk of endocarditis with dental treatment, speak to your dentist or cardiologist who will be able to offer further advice.