the higher risk of periodontal disease, the best
way to stop its initiation and progression is to
incorporate oral health education that is tailored
to the patient’s needs and conditions. The approach used by many health-care professionals
when working with patients who have Down
syndrome is similar to that used while working
8 The caregiver might be required
to assume responsibility for ensuring proper care
8 Including the patient’s caregiver during
oral health education allows the caregiver to be
aware of what the patient
needs to be doing at home
and make sure the patient
is keeping up with oral
when providing oral health
education is to remove all
9 Patients with
Another technique to try is the hand-under-hand guidance technique (see Figure 1). Dexterity
complications are common in individuals with
10 so this technique is a form of
assisted self-care that can be used when patients
are unable to brush independently.
11 This technique can be used by the clinician when demonstrating proper brushing skills to help the patient
understand how brushing should feel and look.
A mirror is needed so the patient can watch.
The clinician or caregiver places his or her
hand on the toothbrush handle with the patient’s hand resting on top.
11 Then the clinician
or caregiver stands behind the patient while
demonstrating the brushing technique.
should be shown to the caregiver, so it can be
used at home to provide proper oral care if the
patient needs assistance.
Next, if the patient struggles with a manual
brush or cannot provide proper oral care because
of dexterity issues, the clinician can recommend
a skin fold that comes from the upper eyelid and
covers the inner corner of the eye; a flattened
facial profile and nose; decreased or poor muscle
tone; a short neck with excess skin at the back
of the neck; white spots, called Brushfield spots,
on the irises of the eyes; and wide, short hands
with short fingers.
Systemic signs of Down syndrome include
congenital heart defects, premature aging,
neuromuscular hypotonia, joint hyperexten-sibility or hyperflexibility, and many more.
These physical and systemic signs are not only
important to help identify a patient with Down
syndrome, but also to determine which oral
health modifications should be recommended
for better health outcomes.
Some oral signs commonly found in those
with Down syndrome include delayed eruption,
small or congenitally missing teeth, macroglossia,
malocclusion, and periodontal disease.
2, 3 Indi-
viduals with Down syndrome are less likely to
develop carious lesions.
4 Of those who have Down
syndrome and are under the age of 30, 60% to
100% have periodontal disease.
5 While no statis-
tics are available, the rate of prevalence after age
30 is expected to be similar. This statistic is im-
portant to keep in mind. Dental professionals
can provide early interventions to help reduce
this periodontal statistic—not only for improved
oral health, but also for improved systemic health.
Individuals with Down syndrome are at a higher
risk of developing periodontal disease because
they have weaker immune systems and do not
have some of the natural protections that people
without Down syndrome have.
6 This could be
one of the factors leading to the development of
periodontal disease in an individual with Down
The next most prevalent oral sign of Down
syndrome is malocclusion. This oral finding is
present in 28% of those with Down syndrome.
Class III malocclusion is the most common
malalignment seen with Down syndrome.
classification is clinically noticed as mandibular
protrusion, anterior open bite, posterior crossbite
and lip incompetence, which often leads to
dries the oral tissues,
which in turn causes xerostomia, exacerbating periodontal disease. Orthodontic treatment can
correct the class III malocclusion; however, proper
oral care must be provided
while orthodontic treatment is performed to prevent periodontal disease
It is important for dental providers to recognize
these signs to administer
optimal care for these patients. Dental providers
should be aware of the oral complications that
can affect patients’ systemic health. This information should be used to create a care plan that
will allow the patient to be successful in maintaining a healthy oral cavity. Here’s an example
to illustrate why this is important: xerostomia
can develop from medications used to treat
congenital heart defects, which may be present
in those with Down syndrome. If the dental
provider is unaware that a patient is taking
one of these medications, xerostomia might
not be addressed with the patient.
Developing proper oral care habits can be
challenging for patients with Down syndrome.
Intellectual disabilities add another dimension
to the likelihood of developing periodontal
disease. Individuals with Down syndrome
might not be able to understand or adequately
complete the oral care recommendations made
by dental providers.
ORAL HEALTH EDUCATION
Many individuals with Down syndrome have both
malocclusion and periodontal disease.
8 Due to
might not be able
the oral care
made by dental