Down Syndrome

Question 1

What is Down syndrome?

Answer 1

trisomy 21, genetic disorder in which their is an extra full set of chromosome 21

Question 2

What are the risk factors for having a child with Down syndrome?

Answer 2

• increased maternal age
  
  • over 35 years old
• parental translocation
  
  • parent carries rearrangement of genes
• prior child with Down syndrome
  
  • familial Down syndrome

Question 3

What are the three different types of Down syndrome?

Answer 3

• trisomy 21
• mosaic trisomy
• translocation trisomy

Question 4

How can it be determined in utero whether a baby will have Down syndrome?

Answer 4

• amniotic fluid and blood test
  
  • 20 weeks
• ultrasounds
  
  • nasal bones

Question 5

What conditions might a child with Down syndrome live with and how can these affect dental treatment?

Answer 5

• intellectual disability
  
  • highly variable
  • dental implications
    
    • difficulty understanding OHI
    • difficulty understanding importance
• hypotonia
  
  • poor motor skills
  • dental implications
    
    • challenging to use a toothbrush
• congenital heart defects
  
  • most commonly VSD
  • tetralogy of fallot and valvular defects
  • dental implications
    
    • increased risk of infective endocarditis
• dementia/Alzheimer’s
  
  • more common at an early age
  • dental implications
    
    • guardianship and consent issues
    • special care involvement
• diabets
  
  • dental implications
    
    • bidirectional with periodontal disease
• obesity
  
  • associated with diabetes
  • poor diet/highsugar intake
  • dental considerations
    
    • weight capacity of dental chair
    • risk of general anaesthetic increased
• hearing loss
  
  • variable severity
    
    • 1 or both ears
    • hearing aids may berequired
  • dental implications
    
    • turn of hearing aid for high speed
    • determine preferred communication
• gastrointestinal issues
  
  • GORD
  • increased risk of coeliac disease
• leukaemia
  
  • increased risk
  • immunocompromised during treatment
    
    • bleeding and infection risk high
  • dental implications
    
    • presents in the mouth
    • linear gingival erythema
    • no obvious plaque related cause
    • gingival hypertrophy
    • palpation of nodes
• instability of cervical spine
  
  • dental implications
    
    • move chair carefully
    • consideration for GA

Question 6

What are the common oral manifestations associated with Down syndrome?

Answer 6

• macroglossia
  
  • large tongue
  • difficult for moisture control
  • difficult for oral hygiene
• microdontia
  
  • small teeth
• delayed tooth eruption
• hypodontia
  
  • congenitally absent teeth
• malocclusion
  
  • most commonly class III
    
    • skeletal and dental
  • anterior open bite
• gingival hyperplasia
• enamel hypoplasia/hypomineralisation
• oral hypersensitivity
• cleft lip/palate
  
  • seen within cleft-service
  • many appointments and procedures
  • prevention vital
    
    • provide ortho with all possible options
• bifid uvula
• high arched palate
  
  • omega shaped
• small roots
  
  • increased risk of tooth loss
    
    • periodontal disease
• hypersalivation
  
  • drooling
  • good for buffering
  • family often do not like it
    
    • hyoscine patches can be used
• increased caries risk
  
  • difficulty performing oral hygiene
  • difficulty understanding importance
• fissured tongue

Question 7

What can cause cracking and bleeding of the lower lip in patients with Down syndrome?

Answer 7

• hypersalivation
  
  • slanted commissures lead to saliva pooling
• hypotonia
  
  • poor oral seal
    
    • mouth breathing

-malocclusion
- class III
- anterior open bite

• management
  
  • vaseline application
    
    • regularly
    • before toothbrushing or dental exam
  • regular hydration
  • angular cheilitis treatment
    
    • miconazole
      
      • candida
      • gram positive cocci (streptococci)
      • avoid with warfarin and statins
    • fusidic acid based produce
  • local measures to stop progression

Question 8

What is the caries risk for a patient with Down syndrome and how should this be managed?

Answer 8

• high caries risk
• enhanced prevention pathway
  • 3 monthly appointments
  • personalised OHI
    
    • bring own toothbrush and toothpaste
  • flavourless toothpaste
    
    • oronurse
      
      • 1,000 or 1,450ppmF
      • non-foaming
      • SLS free
  • high fluoride toothpaste
    
    • 2,800 Duraphat
  • fluoride varnish
    
    • every 3 months
    • consider contraindications
  • fissure sealants
    
    • for caries free teeth
    • challenging in lower due to tongue
    • likely better with GI
  • diet advice
  • regular bitewings