February is National Down Syndrome Consciousness Month and coincidentally, it is also National Intellectual Disability Week (February 14-20). We would like to focus on our patients with Down Syndrome (DS) to give you a better understanding of how dental care can significantly create a positive impact on our patients’ lives. DS is the most common chromosomal abnormality wherein a baby is born with an extra chromosome, giving them a total 47 chromosomes instead of the typical 46 chromosomes. This genetic disorder of having an extra copy of chromosome 21 is medically referred to as Trisomy 21. According to the Down Syndrome Association of the Philippines, Inc., there are approximately 1, 875 babies born with DS each year. A prevalence of 1 out of 800 live births brings the number to about 100,000 households living with someone with DS. It is quite easy to tell if a person has Down’s Syndrome because they look similar to one another. Physical attributes include a flattened nose bridge, almond eyes that slant upwards, small ears, small hands and feet, a single line across the palm (palmar crease),a short neck, short stature, and a large tongue that tends to stick out of the mouth. Intellectual disability is also associated with DS patients. Some people with DS can also have major birth defects such as hearing loss, obstructive sleep apnea, ear infections, eye diseases and heart defects present at birth. DS is a lifelong condition. This is the reason why children with DS should be monitored regularly by health care providers. Down Syndrome is not a disease but a chromosomal condition that displays mild to moderate intellectual disability. It is very rare for them to have severe cognitive impairment.
There are three types of Down syndrome. The most common type is Trisomy21. About 95% of people with DS has this type. Translocation Down syndrome occurs in about 3% of the population while the rarest type is Mosaic Down syndrome which only occurs in 2% of the population and whose physical attributes may be less than those with Trisomy21.
Normal development of oral structures in children with DS is altered leading to decreased tooth size, altered crown shape, delayed eruption and hypodontia. They also have a narrow palate and macroglossia (large tongue). These features put them at high risk from developing oral health problems such as periodontal disease, malocclusion and dental caries.
Pediatric Dentistry Center Philippines aims to provide a holistic approach in providing dental care for children with special needs like children with down syndrome. Early professional treatment and daily oral care at home can allow children with DS to enjoy the benefits of a healthy oral cavity.
Early visit to the dentist by age 1 will be the foundation of early dental care. It can be beneficial to your child to have an initial appointment for them to get used to the dental environment. There are many strange noises, smells and new faces that your child will need to get familiar with. We make sure that your child will be welcomed and greeted with friendly smiles and we try our best to make the visit a pleasant one. Schedule appointments early in the day as much as possible. Early appointments can help ensure that everyone is alert and awake with good enough energy. We want to limit waiting time and reduce anxiety and stress for all.
We try to be consistent in all aspects of dental care. We want to sustain familiarity which helps in making the child more relaxed and cooperative. As much as possible, we use the same operatory, use the same dental team, schedule visits at the same time and create an environment that is non-threatening.
Establishing good dental habits such as brushing and flossing is key to maintaining good oral hygiene. Toothpaste with 1000ppm fluoride should be used and supervised brushing should be done until age 7. Bring the toothbrush and toothpaste you use at home when you go to the dentist so the dentist can teach you the proper techniques with tools that you already have.
We encourage non-cariogenic food and beverage for snacks to decrease sugar intake which may lead to dental caries. We also recommend preventive treatment such as fluoride treatment and sealants. Some patients may also benefit from chemotherapeutic agents such as chlorhexidine swabs and rinses.
Malocclusion is found in most people with DS. Congenitally missing teeth are common. Third molars, laterals and mandibular premolars are the most common missing teeth. Having DS is not a contraindication to orthodontic treatment. It depends on the ability of the child and caregiver to comply with the treatment to make it successful.
Since heart defects are common in patients with DS, a medical consult with the child’s physician may be warranted. Collaboration with other health care specialists is important in dealing with children with special needs. We are open to working with speech therapists, psychologists, and other health care workers to provide the best care for our patients.
Behavior management is not usually a problem with children with DS because they tend to be warm, sweet and well-behaved. Some can be stubborn and uncooperative but most just need an extra time to feel comfortable. Having people that the child trusts during appointments will be a big help to make a successful dental visit.
Making a difference in the oral health of patients with Down syndrome may start slowly at first considering the many obstacles and challenges brought about by their medical condition. But consistency and determination can bring positive results. We hope to leave a significant impact on our patients’ quality of life.