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September 13, 2016.
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Published September 2013. Updated
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Patients should schedule regular debridement appointments
no further than four months apart,
due to the higher risk of periodontal disease. If periodontitis occurs,
the patient should receive treatment every three months. Be patient with these patients. Due to
their special circumstances, it is
important to modify care and
The authors would like to express
their gratitude to their professor,
Emily Holt, RDH, for her mentorship
Taylor Swisher, BS, RDH, is a
recent dental hygiene graduate of
the University of Southern Indiana
(USI), currently practicing in
Indiana. Swisher is a former
member of the Optimist
International Organization and has
previously worked with people who
have Down syndrome at The Arc of
Evansville. Swisher can be reached
Haley Pryor, BS, RDH, EFDA, also a
recent graduate of USI, practices
dental hygiene in Tennessee. She
worked with individuals with
disabilities during her clinical
internship as a certified nursing
assistant in Indiana. She can be
reached at firstname.lastname@example.org.
Daniel Schurman, BS, RDH,
received his bachelor’s degree in
dental hygiene from USI and
practices in Arizona. Schurman has
been involved in several community
health service learning projects that
targeted communities with
disabilities. He can be reached at
1. Genes and human disease. World
Health Organization website. http://www.
who.int/genomics/public/geneticdiseas-es/en/ index1.html. Accessed September
2. Birth defects: Facts about Down
the end of the appointment.
Dental providers should share
statistics on the increased risk for
developing periodontal disease for
the Down syndrome population
with the patient and caregiver.
Awareness of the risk may be a driving force for prevention through
proper oral care.
Patients with Down syndrome
are at a higher risk for periodontal
disease than the general population.
Thus, periodontal disease prevention should be a primary focus for
oral health education. This population requires dental providers to
change the way they communicate
and provide oral health education.
Patients with Down syndrome learn
best when minimal distractions are
present, using the tell-show-do ap-
proach, practicing techniques with
feedback from the practitioner, and
leaving with handouts that show
step-by-step instructions. The care-
giver should be present in the oper-
atory during the oral health educa-
tion component of the appointment
to reinforce techniques at home. The
hand-under-hand guidance tech-
nique can be used during in-office
demonstrations and again at home
when the caregiver provides oral
care. This will improve plaque re-
moval and also help the patient feel
11 Finally, toothbrush
handles should be modified if plaque
removal is not adequate due to de-
a powered toothbrush. This will
allow for easier removal of plaque
and better oral health.
10 The large
handle of a powered toothbrush
makes it easier for the patient to
10 If a powered toothbrush is
not an option for the patient because
of cost concerns, a tennis ball or
stress ball can be slipped over the
handle of a manual toothbrush to
increase the handle diameter.
If the patient is demonstrating
good brushing technique and proper
plaque control is noted, routine
flossing can be recommended. A
floss holder or floss picks can be
used to help the patient have better
control with the technique.
make it easier for the patient to obtain these interdental products, the
office can stock these items to hand
out or inform the patient or caregiver
about where to purchase them.
Encourage the caregiver to make
oral care fun for the patient. If the
oral care experience is fun, the patient might be more interested in
the tasks and more willing to complete the tasks each day.
and flossing can be turned into a
game and rewards can be given to
the individual if oral care goals are
12 The same theory applies
to oral health education in the dental
office. If the patient keeps coming
back to the office with decreased
plaque and increased oral care, the
office can give the patient a prize at