Dental Care Guidance for Caregivers of Patients with Down Syndrome

Down Syndrome and Dental Care

Down Syndrome is a condition in which someone has an extra chromosome. Chromosomes are small ‘packages’ of genes in the body.

Chromosomes determine how a baby’s body develops and functions as it grows throughout pregnancy and after birth.

A baby is usually born with 46 chromosomes. However, babies with down syndrome have an extra copy of one of these chromosomes. This is chromosome 21.⁴ 

This extra copy of chromosome 21 changes how the baby’s body and brain develop. This can lead to both mental and physical challenges for the baby.

While people with down syndrome may act and look similar, each person has different abilities. Those with down syndrome typically have an IQ in the mildly-to-moderately low range. They are often slower to speak than other children.

People with down syndrome often require specialized care for their unique dental needs. 

Most Common Dental Conditions Seen in Down Syndrome Patients

Here are the most common dental issues seen in people with down syndrome:¹ 

Delayed Eruption

The teeth of down syndrome patients may erupt late compared to those without the condition. This includes both baby and permanent teeth. 

Usually, babies with down syndrome get their first teeth at around 12 to 14 months. However, they may develop as late as 24 months. 

In comparison, babies without down syndrome usually get their first teeth between six to 12 months.

A child with down syndrome usually gets all their 20 baby teeth at four or five years. 

Children without down syndrome usually get all their baby teeth between two to three years of age. It is also likely for the teeth of children with down syndrome to erupt in a different order.

Small and Missing Teeth

People with down syndrome often have smaller than average and missing teeth. They also have teeth with roots that are shorter than average.

Large Tongues

People with down syndrome have large tongues. Or, they may have an average-size tongue and a small upper jaw. This can make their tongue too large for their mouth. 

It is also common for down syndrome patients to have grooves and fissures on their tongues.

Bite Problems

People with down syndrome often have small teeth. This can cause spacing between the teeth. 

They may also have a small upper jaw. This can lead to crowding of the teeth, resulting in the permanent teeth being impacted as there is no space in the mouth for them to come in. 

Having a small upper jaw might mean that the top teeth do not go over the bottom teeth the way they are supposed to. 

Instead, the bottom teeth stick out further than the top teeth in the front of the jaw, back of the jaw, or both. The front teeth of those with down syndrome may not touch.

Braces may be able to address some of these dental issues. However, orthodontic appliances can pose challenges to speech, which is even more of a problem for down syndrome patients.

Gum Disease

Even when people with down syndrome do not have a lot of plaque and tartar, they are more likely to develop gum disease. This is due to an impaired immune system. 

While gum disease is more prevalent in patients with Down Syndrome, they do not have an increased risk for tooth decay compared to those without Down Syndrome. 

Why Going to the Dentist Can be an Issue

The mental capability of people with down syndrome varies widely. 

However, most down syndrome patients have a mild or moderate intellectual disability that affects their ability to learn, communicate, and adapt to their environment.

Language development is usually delayed or impaired. Many down syndrome patients understand more than they can verbalize.²

Additionally, ordinary activities of daily living and understanding the behavior of others can be challenging for down syndrome patients. Because of this, visiting the dentist can be confusing, scary, and strange.

Special care dentists must give down syndrome patients more time and attention to make them feel comfortable. Gaining the patient's trust is important for successful treatment.

How to Find the Right Special Care Dentist 

It is essential to find the right dentist so that you or your child receives the best dental care possible.

Many hospitals have dentists trained to work with children who have down syndrome or other developmental disabilities. It is best to check the hospitals in your community to learn which hire dentists with special training.

For children, the American Academy of Pediatric Dentistry website can be useful in finding a dentist. Pediatric dentists have two to three years of education following dental school. This includes learning about kids with special needs like down syndrome.

For adults, general dentists’ comfort levels and expertise with some of the needs of people with down syndrome vary. 

A general dentist who has finished a general practice residency with one to two additional years after dental school has extra training in treating patients with disabilities. 

The Special Care Dentistry Association is an excellent resource to find a dentist experienced in treating patients with down syndrome. 

You can also try calling your local dental school. They are likely to have residents or faculty experienced in caring for patients with down syndrome. 

Some hospitals also have dental departments. These dentists are usually trained in treating people with down syndrome.

How to Prepare for the Appointment 

If you or your child has down syndrome, you can prepare ahead for a dentist appointment.

You should:

• Speak with your dentist before the visit regarding any medical conditions, concerns, or questions
• Ask the dentist if you might require sedation to calm your child. Sedation can be light, such as a prescription for calming medication, or full, like anesthesia
• If you or your child have a heart condition, speak with your doctor about whether taking antibiotics before the appointment is necessary

Best Oral Care Practices for Patients With Down Syndrome 

Here are some recommended oral care practices for patients with down syndrome:²

• Practice good oral hygiene. Brush twice daily and floss once daily
• Supervise tooth brushing for your child with down syndrome
• Provide or watch education on dental care management (e.g., via videotapes) 
• Eat a healthy diet. Limit the frequency of sugar and bread-based snacks
• Visit the dentist regularly. It is best to attend every six months. Some people may need to go attend often