personal-hygiene > dental-care-for-children-and-adults-with-heart-problems-and-downs-syndrome

Oral hygiene plays an important part in preventing decay and gum disease. Regular brushing prevents plaque sticking to the teeth allowing bacteria to convert sugars in to the acid which attacks the enamel. Plaque also irritates the gums making them red and swollen which in turn often causes bleeding which can allow bacteria into the blood stream. To improve brushing, provide better control over the toothbrush by using one with a small head and a handle that is easy to grip, and check the effectiveness of brushing using disclosing tablets. Remember that teeth have three surface to clean – the back, front and biting surface – and the gums should also be brushed. Brushing after meals and at bedtime is important to limit the time plaque is present on the teeth – bedtime obviously being the MOST important

Prevention is better than treatment so regular dental ”check-ups” should be started from an early age

Dental Development in Children with Down’s Syndrome

Children with Down’s Syndrome may have delayed development of the teeth and jaw with the first (baby) teeth not appearing until the age of two and it may take another two to three years for them all to be present. Similarly the eruption of the permanent (adult) teeth may be delayed with baby teeth still being present at fourteen years; teeth may also present in an unusual order. It is very common for some of the baby and adult teeth to be missing, and for teeth to be smaller than normal.

Problems associated with Dental Treatment in people with Down’s Syndrome There are a variety of problems that need consideration by the dentist when treating someone who has Down’s Syndrome:

People with Down’s Syndrome may be less compliant at the dental surgery so visits need to be carefully planned and the dentist and staff need a clear understanding of what level of communication should be used with the patient. More time should be allowed so that each procedure can be fully explained and demonstrated first; many will respond well to the use of rewards. Ideally checkups should begin at an early age so as to promote familiarity with the surroundings and procedures
Often the tongue appears to protrude from the mouth, usually due to the mouth being smaller than normal and less able to accommodate it. This can make it more difficult to clean the teeth because the tongue gets in the way. It can also make treatment more awkward for the dentist
Poor manual dexterity may make cleaning and flossing difficult for people with Down’s Syndrome – electric toothbrushes and floss holders may assist
Reduced muscle tone in the mouth may result in less efficient chewing with more food being left on the teeth after eating
A small percentage of people with Down’s Syndrome will have Atlanto-axial Instability (an increase in mobility between the C1 and C2 cervical vertebrae) which is diagnosed by x-ray. Careful positioning in the dental chair is required for these patients to avoid any potential damage to the spinal cord
Small nasal passages may cause mouth breathing which results in a dry mouth and fissuring of the tongue and lips. This can be a contributory factor in bad breath (halitosis), so patients should be advised to brush their tongue at the same time as their teeth

(published with permission in writing from:http://www.dhg.org.uk)