Periodontal Changes In Down Syndrome: A Literature Review

Understanding the intricate relationship between Down Syndrome and periodontal health requires a
comprehensive analysis of existing literature. This literature review delves into the complexities of
periodontal changes associated with Down Syndrome, shedding light on the challenges and potential
interventions in managing oral health in individuals with this genetic condition.

Down Syndrome, a chromosomal disorder caused by the presence of an extra chromosome 21,
manifests various physical and cognitive characteristics, including distinctive facial features,
intellectual disabilities, and often, compromised immune function. Among the array of health
concerns associated with Down Syndrome, periodontal disease stands out as a significant issue
affecting oral health and overall well-being.

Research indicates that individuals with Down Syndrome are more susceptible to periodontal
problems compared to the general population. Factors contributing to this heightened risk include
immune system dysfunction, genetic predisposition, poor oral hygiene practices, and anatomical
abnormalities such as microdontia and malocclusion. Moreover, individuals with Down Syndrome
often face challenges in accessing dental care due to communication barriers, sensory sensitivities,
and behavioral issues, further exacerbating their oral health disparities.

Periodontal changes in individuals with Down Syndrome encompass a spectrum of conditions,

ranging from gingivitis to severe periodontitis. Studies have shown a higher prevalence of gingival
inflammation, gingival hyperplasia, periodontal pocketing, and alveolar bone loss in this population
compared to their typically developing counterparts. Additionally, the progression of periodontal
disease in individuals with Down Syndrome tends to be more rapid and aggressive, posing
significant challenges for effective management and treatment.

Effective management of periodontal health in individuals with Down Syndrome necessitates a

multidisciplinary approach involving dental professionals, caregivers, and healthcare providers.
Strategies aimed at prevention, early detection, and treatment of periodontal disease in this
population are crucial for mitigating oral health complications and improving overall quality of life.

In conclusion, the literature underscores the importance of addressing periodontal changes in

individuals with Down Syndrome through comprehensive assessment, tailored interventions, and
ongoing support. By staying informed about the unique challenges and considerations associated
with periodontal health in this population, dental professionals and caregivers can play a pivotal role
in promoting optimal oral health outcomes.

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Alzheimer disease is a problem in later life of DS individuals. One study made the comparison to a
normal adult reference serum pool. The objective of this chapter is to review in a systematic fashion
all the involved factors previously reported together to generate a hypothetical collective model of
the pathogenesis of periodontal disease in individuals with DS. MMP activity was assessed with a
variety of techniques including gel electrophoresis, Western blot analysis and ELISA. Content Alerts
Brief introduction to this section that descibes Open Access especially from an IntechOpen
perspective How it Works Manage preferences Contact Want to get in touch. This study aimed to
identify genetic variations associated with periodontitis in individuals with DS. Our group ( Khocht,
et al., 2010 ) recently showed in a multivariate model including traditional risk factors for
periodontitis combined with mental disability that loss of periodontal attachment in DS individuals
was not associated with mental disability. All selected studies compared neutrophil chemotaxis of
DS individuals to a matched comparison group. It was observed significant reduction in PI and GI
with superior outcomes for the youngest age group. Severe form of such cardiac complications may
associate with increased risk in infection of the myocardium or increased general anesthesia
complications. Samples of GCF and plaque were isolated from central incisors. Characteristics of
included studies about prevention. All selected articles met the minimum inclusion criteria previously
described. Signs of more severe gingival inflammation were present in the DS group. Further review
of full texts resulted in inclusion of 20 articles. Early symptoms of gingival inflammation Gingival
crevicular fluid. Defective neutrophil chemotaxis in Down’s syndrome patients and its relationship to
periodontal destruction. Evaluation of Surgical and Non-Surgical Periodontal Therapies, and
Immunological Status, of Young Down’s Syndrome Patients. Introduction. Periodontium Gingiva
Periodontal ligament: Cementum: Alveolar bone. They have less carious teeth, but experienced more
severe and extensive periodontal diseases. None of the included studies evaluated radiographic bone
loss. The most likely reason for this increased susceptibility to infection and reduced immunity in DS
individuals is an increased dosage of a protein product or products encoded by chromosome 21. The
presence of 5mm or more space between the posterior aspect of anterior arch of the atlas and the
odontoid process is considered atlantoaxial instability and is at a higher risk of spine translocation.
Inflammatory mediators such as interleukin-1, interleukin-6, tumor necrosis factor alpha and
prostaglandins induce osteoclasogenesis ( Cochran, 2008 ). The tongue in DS is large (macroglossia)
relative to the size of the oral cavity. In addition, the evaluated parameters should be assessed in the
same manner between the groups. The following focused question was addressed: “Which type of
periodontal preventive and therapeutic approaches presents superior periodontal outcomes in DS
patients?”. This chapter is distributed under the terms of the Creative Commons Attribution-
NonCommercial-ShareAlike-3.0 License, which permits use, distribution and reproduction for non-
commercial purposes, provided the original is properly cited and derivative works building on this
content are distributed under the same license. This limited research makes it difficult to conclude
whether implants are an option for these patients. Score 2: when only DS diagnosis, inclusion of a
comparison group, clinical periodontal measures and laboratory measures were reported.
N Z Dent J, 100 1 4 9 0028-8047 13. Bradley C. Mc Alister T. 2004 The oral health of children with
Down Syndrome in Ireland. New York: Springer-Verlag, 3 14 ISBN 038796987X. 82. Vigild M.
1985 Prevalence of malocclusion in mentally retarded young adults. The followings are brief
summary regarding how aspects of such features can affect oral health. 4.1. Development, behavior,
mental status, cognitive and early aging Persons with DS certainly have learning disability. The
authors concluded that periodontopathic pathogens establish a presence at a very early age, and that
certain bacteria, like P. The respiratory system of these patients presents with a smaller tracheal tube
for age-matched controls, high adenoidal hypertrophic incidence, macroglossia, a high- and narrow-
arched palatal vault, and preoperative existence of respiratory tract infection. 44 Cardiovascular
challenges include a predisposition to pulmonary hypertension stemming from a left to right shunt.
44 Anatomic differences in T21 are often seen in atlantoaxial instability (AAI). Ulseth et al. (1991 )
had also found that while the caries prevalence of adults with DS was lower than Norwegian general
population, it was similar to that of people with other disabilities. The elevated antibody titers in DS
serum corroborate the gingival immune cellular activity described previously. Appropriate
modification of periodontal therapy involves non-surgical periodontal therapy adjuncted with regular
use of chemical plaque control agents, and frequent recall schedule in DS adults may be a way
forward. You can either rephrase your question or wait until it is less busy. One study positively
correlated such reduced chemotaxis with measures of periodontitis ( Izumi, et al., 1989 ). Another
study gave hope that despite reduced neutrophil chemotaxis, periodontal therapy aiming at reducing
plaque and correcting periodontal architecture is still helpful ( Zaldivar-Chiapa, et al., 2005 ). Buffer
activity. This is the capacity of saliva to lower acidic pH and maintain it at adequate levels,
diminishing the risk of developing dental decay. A few studies attempted to investigate the
association between presence of periodontopathic bacteria and clinical periodontal parameters in DS
individuals. If true, such elevated microbial presence, unchallenged and unchecked, would induce an
intense inflammatory reaction within the gingival tissues. Early colonization of the dentogingival
region with periodntopathic bacteria. Levels of MMP-2 and MMP-8 in DS patients were higher than
those in healthy control subjects. Publishing on IntechOpen allows authors to earn citations and find
new collaborators, meaning more people see your work not only from your own field of study, but
from other related fields too. In addition, the evaluated parameters should be assessed in the same
manner between the groups. The most frequently involved teeth were central incisors, lateral incisors
and canines. The study included 150 subjects of both genders, aged between 5 and 21 years. The
authors reported that DS patients had significantly lower chemotaxis compared to healthy controls.
DS is predominantly due to non-disjunction of chromosome 21; while translocation of an extra copy
of the same chromosome accounted for a small proportion of the condition. One of the studies
investigated the relation between neutrophil chemotaxis measures with clinical and radiographic
periodontal measures. Inadequate if only bivariate analysis was presented. Local antimicrobial
therapy after initial periodontal treatment. Publishing on IntechOpen allows authors to earn citations
and find new collaborators, meaning more people see your work not only from your own field of
study, but from other related fields too. Ment Retard Dev Disabil Res Rev, 13 3 221 227 1080-4013
74. Shyama M. Al-Mutawa S. A. Honkala S. Honkala E. 2003 Supervised toothbrushing and oral
health education program in Kuwait for children and young adults with Down syndrome. Most
procedures have zero downtime, allowing you to resume regular activities the same day. Not taking
care of your oral hygiene Acid Bacteria that forms cavities. URBN Dental is the expert in General
Dentistry, Invisalign, and Cosmetic Dentistry. Parents and caregivers should be educated on the need
to help with tooth brushing until the individual has acquired sufficient motor skills ( Desai, 1997 ).
This would indicate that the increased amount of active MMP-2 produced in DS could be linked to
the simultaneous expression of MTI-MMP, which could also be connected to the cause of
periodontal disease that is seen in a majority of DS patients. Personal accounts showed a happier
living experience when independence was afforded. 56. Data analysis: adequate when multivariate
analysis adjusting for confounders was presented. When living with other patients with T21, they
performed daily routines and various responsibilities. Comparisons of patients with mental challenges
and those with T21 have demonstrated individuals with T21 had higher amounts of periodontal
pathogens in addition to greater amounts of interproximal bone loss and periodontitis. 31 Cichon
found high levels of P. October 2003 OMS 813. Embryology. The parotid anlagen are the first to
develop, followed by the submandibular gland, and finally the sublingual gland. Arch Oral Biol, 16
11 1329 1344 0003-9969 23. Cutress T. W. 1971b Periodontal disease and oral hygiene in trisomy 21.
The authors found no significant differences in the bacterial profiles between the groups. Courtesy
PreViser Corporation, all rights reserved. Overview. What is risk? What are the clinical implications.
Expand 1 PDF Save The Prevalence of Caries in Down Syndrome Children at POTADS Foundation
Huzaifah Mahbubi Vycke Yunivita Kusumah I. Sasmita W. Soewondo Medicine 2020 TLDR It was
concluded that the prevalence of caries in Down Syndrome children at the POTADS Foundation is
high and caused by a disruption in motor skills and lack of parental supervision. Publishing on
IntechOpen allows authors to earn citations and find new collaborators, meaning more people see
your work not only from your own field of study, but from other related fields too. To date our
community has made over 100 million downloads. Description and clinical evaluation of a new
computerized periodontal probe—the Florida probe. J Periodontol, 48 6 337 340 0022-3492 68.
Shott S. R. Amin R. Chini B. Heubi C. Hotze S. Akers R. 2006 Obstructive sleep apnea: Should all
children with Down syndrome be tested. Davidovich E. Aframian D. J. Shapira J. Peretz B. 2010 A
comparison of the sialochemistry, oral pH, and oral health status of Down syndrome children to
healthy children. Persons with DS are susceptible to upper respiratory tract and chest infections.
They also assessed the collagenase and gelatinase activities in the gingival crevicular fluid (GCF) and
saliva samples collected from DS patients and from the controls. After 7 years observation, Agholme
et al. (1999 ) found the prevalence of bone loss increased from 35% to 74% among 33 DS
individuals. You can either rephrase your question or wait until it is less busy. The higher incidence
of Class III malocclusion is due to underdevelopment of the midface and not to prognathism.
Children with DS maintained a certain similarity in eruption sequence and symmetry compared with
normal children. Lymphocytes are recruited to the gingival lesion to initiate an adaptive immune
response and help with containing the infection ( Kornman, 2008 ). Click the target next to the
incorrect Subject Area and let us know. Four of the selected studies compared the antibody serum
titer or saliva levels in DS individuals to matched controls. Two studies examined prostaglandin E2
(PGE2) and one study examined interleukin-1 (IL-1) in gingival fluid. Despite the fact that the latter
two diseases are preventable, there are inadequate resources in many communities for DS subjects or
their caretakers to upkeep their oral health. Journal of Clinical Periodontology, Vol.37, No. 7, (Jul),
pp. 675-684, 1600-051X. In addition the increased levels of prostaglandin E2 in combination with
increased activity of MMP-9 suggests increased osteoclastic activity and explains the increased
alveolar bone loss described in DS individuals. Thus, oral hygiene procedures are dependent of
knowledge, attitude and supervision of a responsible person. In addition, macrophages and other
gingival resident cells (fibroblasts) seem to be engaged in high production of degrading enzymes.