Down Syndrome

By Group 1: Abadies, Abregoso, Apugan, Arong, Balio, Belza,

Buentipo, Calixtro, Cantiga & Carpina
What is Down Syndrome?

● A genetic disorder where a person has an extra chromosome compared to the

normal 46.
● Also known as Trisomy 21.
● This extra copy changes how the baby’s body and brain develop, which can
cause both mental and physical challenges.
● People with DS usually have an intellectual disability and developmental
delays are common.
Physical Characteristics
● A flattened face
● Almond-shaped eyes that slant up
● A short neck
● Small ears
● A tongue that tends to stick out of the
mouth
● Tiny white spots on the iris of the eye
● Small hands and feet
● A single line across the palm of the hand
(palmar crease)
● Small pinky fingers that sometimes curve
toward the thumb
● Poor muscle tone or loose joints
● Shorter in height
Types of Down Syndrome

● Trisomy 21: About 95% of people with Down syndrome have Trisomy 21. Each cell in
the body has 3 separate copies of chromosome 21 instead of the usual 2 copies.
● Translocation Down syndrome: Occurs in about 3% of people with DS. This occurs
when an extra part or a whole extra chromosome 21 is present, but it is attached or
“trans-located” to a different chromosome rather than being a separate chromosome
21.
● Mosaic Down syndrome: Affects about 2% of the people with DS. Some cells have 3
copies of chromosome 21, but other cells have the typical two copies of chromosome
21. People with this type of DS may have fewer features of the condition due to the
presence of some (or many) cells with a typical number of chromosomes.
Causes and Risk Factors

● Researchers know that Down syndrome is caused by an extra chromosome,

but no one knows for sure why Down syndrome occurs or how many different
factors play a role.
● One factor that increases the risk for having a baby with Down syndrome is the
mother’s age. Women who are 35 years or older are more likely to have a
pregnancy affected by Down syndrome than women who become pregnant at
a younger age.
How common is Down Syndrome?

● The estimated incidence of Down syndrome is between 1 in 1,000 to 1 in 1,100

live births worldwide.
● Each year, approximately 3,000 to 5,000 children are born with this
chromosome disorder.
● It remains the most common chromosomal condition diagnosed in the United
States.
● In the Philippines, 1 in every 800 babies is born with the condition.
Oral Conditions
What is different about the oral cavity of a
person with down syndrome?
- DELAYED ERUPTION
- SMALL AND MISSING TEETH
- LARGE TONGUE
- MALOCCLUSION
- PERIODONTAL DISEASE
- TOOTH CARIES
DELAYED ERUPTION
The teeth of people with Down syndrome, both primary teeth and permanent
teeth, may come in late compared to children without Down syndrome. On
average, babies with Down syndrome get their first teeth at 12 to 14 months,
but it may be as late as 24 months of age. It is typical that a child with Down
syndrome may not get all 20 baby teeth until he or she is 4 to 5 years of age,
rather than 2-3 years of age, which is typical for children without Down
syndrome. The anterior permanent teeth and permanent 6 year old molars
may not erupt until 8-9 years of age. It is also common for the teeth of
children with Down syndrome to erupt in a different order than in children
without Down syndrome.
SMALL AND MISSING TEETH
Frequently, people with Down syndrome have smaller than average
teeth and missing teeth. It is also common for the teeth of people
with Down syndrome to have roots that are shorter than average.
LARGE TONGUE
People with Down syndrome may have large tongues or they
may have an average size tongue and a small upper jaw that
makes their tongue too large for their mouth. It is also common
for people with Down syndrome to have grooves and fissures on
their tongues.
MALOCCLUSION
People with Down syndrome may have small teeth, which can cause spacing
between the teeth. They also tend to have a small upper jaw. This may
cause crowding of the teeth and may result in the permanent teeth being
“impacted” because there is no room in the mouth for them to come in. The
small upper jaw may create a situation where the top teeth do not go over the
bottom teeth the way they are meant to; instead, the bottom teeth may be out
further than the top teeth in the back of the jaw, the front of the jaw, or both.
Open bite is also common to people with Down syndrome
PERIODONTAL DISEASE
People with Down syndrome are at an increased risk for gum
disease (periodontal disease). Even when individuals with Down
syndrome do not have a lot of plaque and tartar (calculus), they get
periodontal disease more frequently than others. This is because
people with Down syndrome have an impaired immune system and
do not have some of the natural protections against the disease
that people without Down syndrome have.
LESS SUSCEPTIBLE TO DENTAL CARIES
Some research says that people with Down syndrome are at less of a risk for
cavities; however, much of that research was done when people with Down
syndrome lived in institutions and had very restricted diets. The low caries
prevalence in Down syndrome children appears to be due to immune
protection caused by the elevated salivary S. mutans specific IgA
concentrations.
People with Down syndrome do get cavities, so brushing with fluoride
toothpaste, flossing between any teeth that touch, and limiting the amount and
frequency of sugar and refined carbohydrates eaten will help to prevent the
development of cavities.
SYSTEMIC
DISEASES
CARDIAC DISORDERS / HEART DEFECTS

Mitral Valve Prolapse ➡ Mitral Regurgitation ➡

Congestive Heart Failure
Mitral Valve Prolapse - part of the mitral valve slips backward loosely into the chamber
called the left atrium. This happens when the main heart muscle, called the left ventricle,
squeezes during each heartbeat.
Mitral Regurgitation - a condition in which some blood flows backward through the
mitral valve with each heartbeat.
Congestive Heart Failure - weakness of the heart muscle
● high blood pressure in the lungs
● cyanosis
● Symptoms: shortness of breath with exertion, swelling in the legs and feet
SEIZURES
Epilepsy
● usually occur either during the first 2 years of life or after the third decade of
life.
● medications: anticonvulsants

Management in the Clinic:

● know the frequency of seizures and the medications used to control them
● know and avoid any factors that could trigger the patient’s seizures
● always be prepared on what to do whenever a seizure occurs during the
appointment
● do not attempt to insert any objects between the teeth during a seizure
● stay with your patient, turn him to one side, and monitor the airway
VISUAL IMPAIRMENTS
Management in the Clinic::
● Cataracts ● Determine the level of assistance
the patient needs in order to move
● Glaucoma safely around the clinic
● Strabismus ● Use the patient’s other senses to
connect with them
● Myopia ● Face the patient as you speak, use
a clear and descriptive language in
● Rapid and involuntary explaining the procedures
eye movements ● Provide a written instructions in
large print with 16 point or larger
COMPROMISED IMMUNE SYSTEM
Lead to more frequent oral and systemic
infections and a high incidence of periodontal
disease in people with Down syndrome.
Aphthous ulcers, oral candida infections, and
acute necrotizing ulcerative gingivitis are
common. Chronic respiratory infections
ccontribute to mouth breathing, xerostomia, and
fissured lips and tongue.
> Treat acute necrotizing ulcerative gingivitis and
other infections aggressively.
> Talk to patients and their caregivers about
preventing oral infections with regular dental
appointments and daily oral care.
> Stress the importance of using fluoride to
prevent dental caries associated with
xerostomia.
> Use lip balm during treatment to ease the strain
on your patients lip.
HYPOTONIA
Affects the muscles in various areas of the body,
including the mouth and large skeletal muscles.
When it involves the mouth, it leads to an
imbalance of forces on the teeth and contributes
to an open bite. If the muscles controlling facial
expression and mastication are affected, > Maintain a clear path for movement throughout
problems with chewing, swallowing, drooling, the treatment setting.
and speaking can result. A related problem is
> Determine the best position for your patient in
atlantoaxial instability, a spinal defedt that
the dental chair and the safest way to move his
increases the mobility of the cervical vertebrae
or her body, especially the head and neck. Talk
and often leads to an unsteady gait and neck
with the physician or caregiver about ways to
pain.
protect the spinal cord. Use pillows to stabilize
your patient and make him or her more
comfortable.
HEARING LOSS and DEAFNESS
May further complicate poor communication
skills, but these, too, can be accommodated with
planning. Patients with a hearing problem may
appear to be stubborn because of their seeming
lack of response to a request.
> Patients may want to adjust their hearing aids or
turn them off, since the sound of some instruments
may cause auditory discomfort.
> If your patient reads lips, speak in a normal
cadence and tone. If your patients uses a form of
sign language, ask the interpreter to come to the
appointment. Speak with this person in advance to
discuss dental terms and your patients’ needs.
> Visual feedback is helpful. Maintain eye contact
with your patient. Before talking, eliminate
background noise. Sometimes people with a hearing
loss simply need you to speak clearly in a slightly
louder voice than normal. Remember to remove your
facemask first or wear a clear face shield.
Treatment and Management
Treatment

Down syndrome itself cannot be cured.

There is no medical cure for Down syndrome, however, children with
Down syndrome benefit from early access to medical care and
developmental interventions beginning in infancy. Beneficial therapies
for Down syndrome include physiotherapy, occupational therapy,
behavioural therapy, and speech therapy.
Management

Children with down syndrome can often benefit from speech therapy, occupational
therapy, and exercise to help improve their motor skills. Since people with Down
syndrome can have birth defects and other health problems, they will need regular
medical care. They may need to have certain extra health screenings to check for
problems that happen more often in people with Down syndrome.
Dental Management
Early professional treatment and daily oral care at home can allow people with
down syndrome the benefits of healthy mouth. It is important for the patient to be comfortable to the dentist
so that a routine could be made, making the child less anxious for every dental appointment.

Oral problems manifested in the mouth of children with down syndrome could be minimized especially
during childhood through ways on managing dental care for a child with down syndrome, like:

● Begin dental visits early

● Be aware of dental anxiety
● Coordinate medical and dental care
● Make dental hygiene easier
● Drinking plenty of fluids to alleviate dry mouth
● By stressing the importance of using fluoride to prevent oral infections
● Limit contributing factors by frequent dental check ups and updated oral health care for the patient
THANK YOU!