Dental Care Guidance for Caregivers of Patients with Down Syndrome

Down Syndrome and Dental Care

Down Syndrome is when someone has an extra copy of chromosome 21.⁴ This extra copy of chromosome 21 changes how the baby’s body and brain develop. 

The oral structures of people with Down syndrome may develop differently than those without it. They often require specialized care for their dental needs. 

Best Oral Care Practices for People With Down Syndrome 

Good oral hygiene is essential for everyone, including people with Down syndrome. You can help prevent periodontal disease and other dental issues with good oral care practices.

Here are some recommended oral care practices for people with Down syndrome:²

• Brush and floss — Dentists recommend brushing twice daily with fluoride toothpaste and flossing once daily for tooth and gum health.
• Supervise tooth brushing — If you’re a parent or caregiver for a child with Down syndrome, you may need to regularly monitor their oral care routine.
• Access dental care education — Continue to educate and instruct your child on the importance of dental care, using whatever way they learn best (i.e. video or audio instruction).
• Eat a healthy diet — A balanced diet promotes good oral health and overall health. Limit the frequency of sugar and refined carbohydrates.
• Visit the dentist regularly — Standard practice is to see the dentist every 6 months, but some people may need to go more frequently.

Common Dental Conditions in People with Down Syndrome

Here are the most common dental issues that affect the teeth of people with Down syndrome:¹ 

Delayed Eruption

The baby teeth and permanent teeth of people with Down syndrome may erupt on a delayed schedule and in a different order. 

Usually, babies with Down syndrome get their first teeth at around 12 to 14 months. However, they may develop as late as 24 months. Babies without Down syndrome usually get their first teeth between 6 to 12 months.

A child with Down syndrome usually gets all 20 baby teeth by age 4 or 5. Their front permanent teeth may erupt at age 8 or 9.

Small and Missing Teeth 

People with Down syndrome often have smaller-than-average teeth. They may also be missing teeth, most commonly third molars, laterals, or mandibular second bicuspids.³

Additionally, their teeth might be shorter or have more conical roots. Shorter roots and small teeth present a challenge in the face of tooth decay, making it more likely to lead to tooth loss.

Large Tongues

People with Down syndrome may have large tongues. They could also have an average-sized tongue and a small upper jaw, making their tongue too large for their mouth. 

A larger tongue or a smaller mouth may lead to challenges in eating and talking. It can also influence the development of sleep apnea, a heightened gag reflex, and anxiety associated with oral stimulation.

Bite Problems

People with Down syndrome often have a small upper jaw. This can lead to severe crowding of the teeth, resulting in the permanent teeth being impacted without space in the mouth for them to come in. 

A small upper jaw might mean the top teeth don’t overlap the bottom teeth in a healthy bite. Instead, the bottom teeth stick out further than the top teeth in the front and/or back of the jaw. The front teeth of those with Down syndrome may not touch, known as an open bite.

Orthodontic treatments like braces can address some of these dental issues. However, orthodontic appliances can exacerbate speech challenges.

Gum Disease

People with Down syndrome are more likely to develop periodontal disease. 

Factors that contribute to an increased risk for gum disease include:³

• An impaired immune system
• Malocclusion or bad bite
• Conical tooth roots
• Poor oral hygiene

High rates of periodontal disease make it common for children with Down syndrome to lose teeth during their teenage years. Practicing proper oral hygiene and having access to dental treatment when needed is essential.

While gum disease is more prevalent in people with Down syndrome, they don’t have an increased risk for tooth decay compared to those without Down syndrome. 

Bruxism

Bruxism, or teeth grinding, is more common in people with Down syndrome, especially those under 12. 

The high incidence of teeth grinding can be attributed to:⁷

• Muscle tightness
• Mouth breathing 
• Predisposition to obstructive sleep apnea

Many adolescents with Down syndrome grind their teeth less as they get older. Dental treatment for bruxism can help prevent damage to the teeth, headaches, and temporomandibular disorders (TMDs).

Going to the Dentist with Down Syndrome

Many people with Down syndrome have a mild or moderate intellectual disability that affects their ability to learn, communicate, and adapt to their environment. This can make visiting the dentist more challenging.

Additionally, the activities of daily life and understanding the behavior of others can take time and effort. Because of this, visiting the dentist can feel confusing, scary, and strange. 

You can take a few steps to make a dental visit easier or more comfortable for yourself or a loved one with Down syndrome:

Choose a Special Care Dentist 

Special care dentists are experts in treating dental patients who might need accommodations, including people with Down syndrome. They specialize in building trust with Down syndrome patients and making the experience more comfortable.

A general dentist who has finished a general practice residency with 1 to 2 additional years after dental school has extra training in treating patients with disabilities. 

You can also locate a special treatment dentist through several different channels, including:

• Local hospitals — Many hospitals hire doctors who specialize in working with children with Down syndrome or developmental disabilities. Check the hospitals in your community to learn about dentists with special training.
• American Academy of Pediatric Dentistry — This 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.
• The Special Care Dentistry Association — This organization is an excellent resource for finding a dentist experienced in treating patients with Down syndrome. 
• Local dental schools — Many areas have a local dental school with residents or faculty experienced in caring for patients with Down syndrome. 

Prepare for the Appointment 

If you or your child has Down syndrome, you can prepare ahead for a dentist appointment. Some tips to make the experience go smoothly are:

• Know what to expect — Research what happens during a typical dental appointment. Explain it to your child so they understand what to expect before it happens.
• Talk to the dentist — Speak with your dentist before the visit regarding any medical history, concerns, or questions. You can also inform them about what might make the experience easier for your child.
• Consider sedation — Ask the dentist if sedation is appropriate for soothing your child. Sedation can be light, such as a prescription for calming medication, or full, like general anesthesia.
• Discuss medication — If you or your child have a heart condition, speak with your doctor about whether taking antibiotics or another treatment before the appointment is necessary.

Summary

People with Down syndrome have unique dental treatment needs. Their teeth and mouth may develop differently, resulting in malocclusions, small teeth, and increased gum disease.

Going to the dentist can be stressful for people with Down syndrome. Discuss what to expect with your child and your dentist to make a visit easier. You can seek a special care dentist trained to treat children with Down syndrome.

Good oral hygiene is essential to maintain your child’s health. Brush and floss daily, encourage a healthy diet and visit the dentist every 6 months or as recommended.