Caring for the Teeth and Gums of Children with Down Syndrome (Pt. 1)

Caring for the Teeth and Gums of Children with Down Syndrome

Children with Down syndrome are at an increased risk for developing problems with their teeth and gums. Early preventive dental care and rigorous home hygiene will help reduce many of these problems and eliminate some of them entirely. This article will relate the problems children can develop, describe how Down syndrome can complicate the oral condition, and finally instruct children and families on how to care for the teeth at home.


Dental diseases

Most parents are familiar with gum disease and dental cavities as the main oral health problems that children develop. In addition to these concerns, children with Down syndrome develop an increased number of canker sores, oral yeast infections and destructive periodontal problems.
Dental decay is the result of bacteria in our mouths converting fermentable carbohydrates into acid, which over time creates the infected holes in our teeth that we know as cavities. Eliminating dental decay requires restoring or filling existing cavities and changing dietary and hygiene habits.

Periodontal disease is the gradual loss of bone and supporting structures around our teeth due to inflammation. Gum disease can cause teeth to fall out over time if the bone and surrounding structures cannot hold the teeth in place. Many patients with Down syndrome develop significant periodontal problems by their teen years.


Complicating factors of Down syndrome

Natural cleansing of the mouth via saliva for patients with Down syndrome can be compromised due to a dry mouth from medications or from mouth breathing. Mouth breathing also creates more hard tartar deposits on the teeth, which can worsen gum disease.

The mouths of patients with Down syndrome tend to be smaller than average, therefore making it harder to brush the teeth. The tongue may seem larger, when in reality it is most likely only relatively larger due to a small mouth. Getting the toothbrush into all areas may be more challenging as a result. Poor muscle tone of the cheeks and tongue may also reduce the mouth's ability to cleanse itself. Food debris can stay on the surface of teeth longer and cause more decay if not properly cleaned off.

This tendency to have a small mouth can be complicated by misshapen teeth or an imperfect biting relationship. Crowded teeth are more difficult to take care of and may worsen periodontal problems. Children with Down syndrome tend to have reduced immune responses and therefore more infections due to a lower number of T-cells. This makes them much more susceptible to developing destructive periodontal disease.

It seems to be a widely held belief that patients with Down syndrome develop fewer dental cavities than average. Many parents have heard this and it may be a myth based on outdated research. The thing to remember is that the negative outcomes of these cavities may be worse for children with Down syndrome. Clearly preventing dental problems before they start is the best strategy for all patients.

Preventive strategies for home and at the dental office To prevent dental problems it is important to take a child to the dentist early. The American Academy of Pediatric Dentistry recommends the first dental visit within six months of the eruption of a child's first tooth. This is usually between ages one and two.

At home, a child's teeth should be brushed at least two times a day. Ideally, you should brush your child's teeth after breakfast and at bedtime. It is not necessary to use toothpaste with fluoride until a child has mastered the swallowing reflex and will not ingest the toothpaste, around age 3-5 years on average.

Depending on a child's age and development, they will need assistance brushing their teeth. It is important to introduce to a child how they should care for their teeth. Children with Down syndrome often benefit from using a mechanical toothbrush to better access difficult areas of the mouth. They may also find it more enjoyable to brush their teeth with a mechanical brush and will consequently spend more time at it. Some children have limited fine motor control and use of a floss holder should be considered.

It is important to establish a consistent schedule for brushing and caring for your child's teeth. You should try to use the same location and time so children will be comfortable and make it part of their daily routine.

Oral rinses should be used at home as well to reduce development of decay and gum disease. Fluoride rinse can be sprayed or brushed on the teeth if the child has not yet mastered the swallowing reflex. Brushing on a fluoride rinse at night can greatly reduce the number of cavities children develop.

In addition, an antimicrobial rinse such as Listerine, or chlorhexidine by prescription, can be used to reduce the progression of gum disease. Antimicrobial rinses should be not be used at the same time of day as a supplemental fluoride rinse, so after the morning brushing would be ideal. Children with Down syndrome tend to develop cracks or fissures in their tongue and lips that house bacteria. Daily brushing of the tongue, in conjunction with a rinse, can reduce the bacterial levels in a child's mouth.

Diet modification is very important in reducing dental problems. Due to breathing primarily through the mouth and the use of some medications, children with Down syndrome can be dehydrated and often thirsty. You should use sugar-free medications and vitamins whenever possible. It is also important that your child drink plenty of water to remain hydrated, especially in arid climates.

Significant dental decay can develop if a child drinks sweetened beverages throughout the day to quench their thirst. Sports drinks and fruit juice can be as destructive as soda pop to the teeth, if a child's teeth and mouth are exposed to them over long periods of time on a daily basis. Foods high in sugar should not be used as rewards or motivational tools regularly. All children should avoid grazing and sipping patterns of food intake to reduce dental decay, and their caloric intake should match their level of activity.

Preventive care at the dental office is important as well. Dentists treating patients with Down syndrome should be aware of gum disease developing. This may mean taking more frequent x-rays looking for bone loss around the teeth, or prescribing a mouth rinse or medication to reduce inflammation of the gums.

Crowded teeth and small mouths contribute to developing orthodontic problems. An orthodontic consultation and possible intervention may be helpful to prevent some gum problems, or to reduce biting forces if the teeth in one area of the mouth are being worn down unevenly due to bruxism or grinding.

More frequent examinations and cleanings can help identify and prevent problems. Dental sealants can be placed in the grooves on the biting surfaces of teeth to prevent decay; unfortunately sealants do not prevent cavities on the tooth surfaces between teeth. A combination of fluoride treatments, sealants and diet modification can greatly reduce the amount of decay patients with Down syndrome develop.

Conclusion

Children with Down syndrome have unique concerns that can make them more susceptible to developing problems with their teeth and supporting structures. Identifying and treating these concerns with aggressive preventive therapies can help maintain a healthy mouth throughout a lifetime.

In Part 2 of this article, I will discuss how early preventive dental care is essential in the overall health of children with Down syndrome.