DISCLOSURE: Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.
The absolute BEST hugs I’ve ever gotten were, and still are, from my down syndrome (DS) patients and friends. Their light and love just radiate a room and I consider it a true blessing to be around them. Even when they don’t feel their best or they are dealing with an illness, they remain positive and spin the best possible outcome onto any obstacle they face. They have my heart!
October is an extra special month because it’s a month where millions of people all around the world recognize down syndrome and the achievements of people with down syndrome. So many of them have overcome incredible challenges and beat unthinkable odds. When I think about some of the challenges my sweet patients had to overcome, I remember the battles encountered when they were struggling with dental health. Down Syndrome causes a range of developmental, physical, and mental impairments that contribute to dental problems and other oral health concerns.
Down syndrome (DS) is a genetic disorder that happens when a person has three copies of chromosome 21 instead of two. There are actually 3 types of down syndrome as well.
Trisomy 21: The most common type, where every cell in the body has 3 copies of chromosome 21.
Translocation Down Syndrome: This less common type presents where each cell in the body has either an entirely extra chromosome 21 or only part of it, either way, it’s attached to another chromosome instead of being its own.
Mosaic Down Syndrome: This is the rarest type of down syndrome where only some cells in the body have an extra chromosome 21.
Characteristics of Children with Down Syndrome that contribute to adverse oral conditions:
- Dental care is the number one unmet health care need among children with DS.
- Delayed eruption: Children with DS usually erupt teeth later than usual, and often in a different order than typically seen. A DS child may not get all of their baby teeth until they are 4 or 5 years old and the first molars may not erupt until age 8 or 9. This delay in eruption has a definitive effect on eating and learning to talk.
- Smaller teeth; Shorter tooth roots; Congenitally missing teeth.
- A larger than average tongue, with a smaller upper jaw makes the tongue too large for their mouth.
- Malocclusion: Having crooked teeth or a misaligned bite.
- Bruxism: Grinding of the teeth.
- Malformed teeth: Teeth that are misshaped in length, width, or placement.
- Gum disease: The most common and most serious oral condition found in DS. With an impaired immune system, DS children are at a much higher risk of gum disease at a much earlier age. Many DS children lose their permanent front teeth in the early teen years as a result of fastly progressing periodontal disease.
- Gum overgrowth is a side effect of medications like Dilantin, commonly prescribed for seizures. This increases the plaque retention rate and tissue sensitivity, making oral care difficult.
- Yellow-looking teeth due to weak and brittle enamel.
- Low muscle tone.
- Trauma and injury to the mouth.
- Dry mouth.
- Side effects from medications, including the decay rate increase due to sugary syrup concoctions commonly used to increase compliance with liquid medications.
- A compromised immune system with a low T cell count leads to a higher rate of infections, overall, especially upper respiratory infections. This in conjunction with the anatomy of the mouth makes DS children more likely to be mouth breathers. Mouth breathers have higher rates of dry mouth and when you couple that with the medications used to treat recurrent infections, DS children are at high risk for decay, gum disease, fissured tongue, aphthous ulcers, acute necrotizing ulcerative gingivitis, and candida.
- Ketogenic hypoglycemia in children with down syndrome can often be due to genetic factors that go undiagnosed or get misdiagnosed, and this can be fatal. Treatment is often starch-based, with more frequent meals and regular consumption of carbs. This can contribute to a higher risk of oral factors.
- Sensitive Mouth: Sensitive gum tissues and sensitive teeth can make oral care difficult to perform and maintain. Further increasing the risk for gum disease and decay.
Tips for decreasing sensitivity:
- Massage gums gently.
- Massage the face before performing oral care.
- Use an electric toothbrush.
- Provide teethers and chewers for stimulation and avoid sugary foods.
Preventing Oral Health Problems
Children with Down syndrome need extra help to brush and floss their teeth twice a day.
- An electric toothbrush can be very helpful
- Floss holder with a long handle.
- Antimicrobial mouthwash can reduce harmful bacteria in the mouth.
- Saliva stimulating products for dry mouth
- Reduce consumption of sweets and sugary drinks
See the dentist very early, possibly even before any teeth erupt and keep regular dental care appointments throughout the year.
Effective Oral Care Strategies for the Child with Down Syndrome:
- Their Baby teeth are important and need to stay healthy, especially since they have them longer than usual.
- Start oral care early, before the first tooth, wipe baby’s gums, tongue, and inside cheeks to remove milk residue and bacteria.
- Use silicone-based toothbrushes to continue oral care on gums and inside the mouth. These are soft and comfortable brushes.
- Introduce a bristle toothbrush as soon as the first tooth erupts. Continue to use silicone brushes on the rest of the gums and mouth.
- Xylitol is a great fluoride alternative or it can be used in combination with fluoride. Be careful of using fluoride before age 3 unless specifically instructed to do so by your dentist.
- Choose appropriately sized toothbrushes. The head should fit your child’s mouth, have soft bristles and the handle should be something you are comfortable using.
- Adults will perform all oral care for DS children until at least age 5, possibly much later. Around age 5, however, is a good time to start training a DS child to hold a toothbrush and mimic the brushing habits of a parent. Do not hand over toothbrushing to your DS child as their sole responsibility until fully discussing this with your dentist or dental hygienist.
- Brush Training can include you brushing them first, then let them copy what you did. Their abilities and technique will grow as their grip and dexterity strengthen over time but keep in mind that this may always be a struggle for them
- All teeth need to be flossed, even if they don’t touch or there are teeth missing around them.
- Flossing should become a normal part of the nightly brushing routine no later than age 5. This will be done by the adult, to begin with, and could possibly be taken over by a DS child if they have the dexterity and grip strength to implement it effectively.
Using flossers is a great alternative if regular flossing is too challenging. DS children tend to have sensitive gag reflexes due to tongue size, making it more difficult to get your fingers in the back of their mouth to floss. Using a floss holder helps tremendously when this is an obstacle and it keeps oral care effective and regular.
The best way to ensure an oral care routine is effective for your down syndrome child is to be in a regular relationship with a dentist and dental hygienist. This means you are visiting the dentist 2-4 times a year for maintenance and more often if treatment is needed. I suggest finding a good team early and making sure all your physicians are on board and communicating regularly about your child and your child’s specific needs. Oral care is not necessarily a struggle for every DS child, but they are much more likely to have some sort of challenge at some point in their lifetime. Knowing this ahead of time may help you navigate through those seasons with them
Be sure to check out our selection of toothbrushes for individuals with special needs. This includes our silicone toothbrushes that make oral care easy to start. Our DINOSAUR, PENGUIN, and DUCK character sonic toothbrushes make oral care fun. And our special soft toothbrush with our most extensive bristle count has the softest texture brush that we offer.
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Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.