Dentistry and Down Syndrome Abstracts

Int J Paediatr Dent 13 (5): 327-35 (2003 Sept)

Children with Down Syndrome: oral development and morphology after use of palatal plates between 6 and 18 months of age

Backman B, Grever-Sjolander AC, Holm AK, Johansson I
Department of Odontology/Paediatric Dentistry, Umea University, Umea, Sweden

OBJECTIVES: The aim of this study was to describe oral development and morphology in 18-month-old children with Down syndrome (DS) treated with palatal plates in combination with structured communication and speech training. The aim is further to describe the design of the palatal plates, compliance in their use and to give a brief report of their effect on oral motor function and speech. SAMPLE AND METHODS: Forty-two children with DS were followed from = 6 months of age until 18±3 months old. In addition to language intervention, and oral motor and sensory stimulation provided by speech therapists for all children with DS in Sweden, palatal plates provided by dentists are included in the training programme. In the evaluation, the children in the project were compared with two control groups of children matched for age; one group of children with DS who had not been treated with palatal plates, and one group of children with normal development. RESULTS: Compared to the children with normal development, both groups of children with DS had fewer teeth erupted and a lower prevalence of sucking habits. Deviant morphology of the tongue in the form of diastase, lingua plicata or a sulcus in the anterior third of the tongue was only seen in children with DS. All children with normal development had positive values for overjet compared to 53% of the children with DS. The palatal plates were used 2-3 times daily for a total mean time of 15 min. Compliance in use of the plates decreased with age, mainly due to eruption of teeth and subsequent loss of retention. Evaluation of oral motor function and speech show that the children with DS in the project had better motor prerequisites for articulation than the control children with DS. CONCLUSION: Palatal plate therapy did not affect oral parameters, i.e., eruption of teeth, types and prevalence of sucking habits, tongue morphology and symptoms of hypotonia. In combination with oral motor and sensory stimulation, palatal plate therapy had a positive effect on oral motor performance and prerequisites for articulation.
Acta Odontol Scand 61 (1): 39-46 (2003 Feb)

A four-year longitudinal study of palatal plate therapy in children with Down syndrome: effects on oral motor function, articulation and communication preferences

Carlstedt K, Henningsson G, Dahllof G.
Department of Pediatric Dentistry, Karolinska Institutet, Stockholm, Sweden

The orofacial function in 20 children with Down syndrome was evaluated after 4 years of palatal plate therapy in 9 of the children (PPG); the remaining 11 were untreated age-matched controls (CG). All 20 children had received continuous orofacial physical therapy from their speech therapist during the treatment period. A clinical extra- and intraoral examination was performed, including oral motor function, facial expression, the occurrence of malocclusions, and hypertrophic tonsils. A questionnaire requesting data on breathing patterns, drooling, eating problems, and communicative preferences was answered by the parents. An articulation assessment was performed by two speech and language pathologists blinded to the treatment status of the children in order to find out whether the palatal plate had stimulated to improved oral speech behavior. The results for oral motor function showed significant differences between the groups in favor of the PPG for the summary variables for: visible tongue (P < 0.01), visible tongue during non-speech periods (P < 0.05), and lip-rounding during spontaneous speech (P < 0.01). During non-speech time, the PPG had their mouths open significantly less than the CG (P < 0.05). Expressivity of facial expression on a visual analog scale in the PPG scored 75.6 ± 13.3 compared to 51.8 ± 25.7 in the CG (P < 0.05). The intraoral examination showed that 6/9 children in the PPG and 7/11 in the CG had enlarged tonsils, resulting in more than 50% inter-tonsillary space reduction. Despite these findings, and no significant differences between the groups with respect to mouth/ nose breathing, nocturnal snoring was significantly less in the PPG than in the CG (P < 0.05), according to the parental questionnaire. After 4 years of palatal plate therapy, orofacial function had improved significantly in the 9 PPG children and specifically in terms of tongue position and lip activity.
Aust Dent J 47 (1): 30-5 (2002 Mar)

Tooth wear in children with Down syndrome

Bell EJ; Kaidonis J; Townsend GC
Dental School, The University of Adelaide, South Australia

BACKGROUND: Several studies have described the impact that dental caries and periodontitis may have on the dentitions of individuals with Down syndrome, but there are few reports about the effects of tooth wear. This investigation aimed to compare the aetiology, prevalence and severity of tooth wear in 49 cytogenetically confirmed Down syndrome children with 49 non-Down syndrome controls. METHODS: This study involved three aspects: an oral examination, including obtaining dental impressions; a dietary analysis spanning three days; and a questionnaire seeking information about habits, medical problems and medications. Tooth wear severity was scored on a 4-grade scale (none-to-little; moderate; severe; very severe), while aetiology was classified as being due to attrition mainly, erosion mainly, or a combination of both. Double determinations established scoring method reliability and chi-square tests assessed associations between samples. RESULTS: Tooth wear was significantly more frequent (p<0.01) in the Down syndrome than the non-Down syndrome sample (67.4 per cent cf 34.7 per cent), with more of the Down syndrome children showing severe to very severe wear (59.2 per cent cf 8.2 per cent). Significantly more Down syndrome children (p<0.05) displayed a multifactorial aetiology of tooth wear, i.e., both attrition and erosion (46.7 per cent cf 28.6 per cent), although no particular dietary link was established. Gastric reflux and vomiting were reported in over 20 per cent of the Down syndrome sample. CONCLUSIONS: Given the potential consequences of high levels of tooth wear, associated with tooth grinding and an acidic oral environment in Down syndrome children, educational programmes aimed at increasing awareness of carers and health professionals are needed urgently.
J Orofac Orthop 62 (4): 255-63 (2001 Jul)

Retrospective clinical investigation of the impact of early treatment of children with Down's syndrome according to Castillo-Morales

Schuster G, Giese R.
Department of Orthodontics, Stiftung Carolinum, University of Frankfurt/Main, Germany

BACKGROUND: Infants and toddlers with Down's syndrome are treated at the Department of Orthodontics, University of Frankfurt/Main only when the tongue protrudes over the lower lip, hindering mouth closure. No plate therapy is applied in patients with less tongue protrusion. This study aimed to assess objectively the treatment effects of stimulation plate therapy after Castillo-Morales at this early stage of development. PATIENTS AND METHOD: The follow-up covered 33 children, 20 of whom showed no mouth closure with the tongue resting protrusively on the lower lip at first examination at the age of 8 months. These 20 children received orthodontic treatment based on a stimulation plate. The parents were advised to insert the plate four times a day for about half an hour respectively. The overall treatment time was ca. 2 years. The second group (13 children) received no early treatment, as the functional parameters were only slightly altered at the age of 7 months. At follow-up, the children of the treatment group were between 8.8 ± 2.3, and those of the control group 8.9 ± 3.0 years old. The children underwent clinical examination; the parents answered a questionnaire. Additionally, study casts and intraoral photographs were taken along with frontal and profile photographs. The factors assessed were various functions, dentition, facial development, and subjective rating of the parents. RESULTS: In contrast to the initial findings, no difference between the two groups was found at follow-up. CONCLUSION: Early treatment using a stimulation plate thus appears to mitigate or even normalize the initially more severe dysfunctions recorded in the study group as compared to the controls.
Developmental Medicine & Child Neurology 41: 275-83 (1999)

Significance of oral health in persons with Down syndrome: a literature review

M Hennequin, D Faulks, J-L Veyrune, P Bourdiol
Faculté de Chirurgie Dentaire, Université d'Auvergne, 11 Boulevard Charles de Gaulle, 63000 Clermont Ferrand, France

Down syndrome (DS) is an autosomal chromosomal anomaly resulting from trisomy of all or a critical part of chromosome 21. It affects approximately 1 in 700 to 800 live births. Despite the development of prenatal diagnosis, the incidence of DS births is predicted to remain static or even to increase over the next decade, partly due to increased maternal age in Western societies. Many of the medical and physiological characteristics of DS have direct consequences for the oral health of subjects affected and indirect consequences for the quality of life of persons with DS and their carers. This article aims to give an overview of the current literature concerning the orofacial problems confronting patients with DS, and to explain the different treatment modalities available.
Ann Periodontol 3 (1): 370-80 (1998 Jul)

Early-onset periodontitis associated with Down's syndrome—clinical interventional study

Cichon P; Crawford L; Grimm WD
Department of Periodontal, University of Witten/Herdecke, Germany

Individuals with Down's syndrome (DS) have an increased prevalence of periodontal disease compared with otherwise normal, age-matched control groups and other mentally handicapped patients of similar age distribution. The exaggerated immune-inflammatory response of the tissues cannot be explained by poor oral hygiene alone and might be the result of an impaired cell-mediated and humoral immunity and a deficient phagocytic system. As far as the progression and severity of destruction, the oral manifestations of DS patients are consistent with the juvenile periodontitis (JP) disease pattern. The purpose of the present study was 1) to assess the periodontal clinical and microbiological status of 10 DS patients aged 20 to 31 years (mean: 26.3 years) relative to that of 11 patients with cerebral palsy (CP) aged 23 to 53 years (mean: 36 years) without defective immunological functions, and 2) to determine the effect of supragingival plaque control and oral hygiene instruction in these patient groups. Subsequent to the initial examination and a professional tooth cleaning program, clinical and microbiological parameters were monitored over a period of 12 weeks. The clinical examination included the recording of plaque index (P1), gingival index (GI), probing depth (PD), and clinical attachment level (CAL). Subgingival plaque samples were always obtained from the same pocket with the highest disease activity (deepest bleeding site at baseline examination) in each subject for a morphotype analysis by dark field microscopy and for identification and quantitation of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, Bacteroides forsythus, Fusobacterium nucleatum, Treponema denticola, and Campylobacter rectus by DNA probes. The results of the baseline examinations demonstrated that DS patients and patients with cerebral palsy had inflamed gingiva associated with a high amount of plaque. The mean probing depth and percentage of sites with probing depth> 4 mm corresponded to age and poor oral hygiene in CP patients. Deep pockets in DS patients demonstrated a high prevalence of periodontal disease compared with age-matched children with mental retardation and non-handicapped patients. Regarding the young age of onset, the severe destruction of periodontal tissues and pathogenesis of periodontitis in DS patients are consistent with the juvenile periodontitis disease pattern. The missing clinical benefit and alteration of the subgingival flora following supragingival plaque control in DS patients underlined the alteration in the immunological response.
J Clin Pediatr Dent 22 (2): 141-146 (1998)

Neutrophil Chemotaxis in Down Syndrome and Normal Children to Actinobacillus Actinomycetemcomitans

Sreedevi H, Munshi AK Department of Pedodontics and Preventive Children Dentistry, A.B. Shetty. Memorial Institute of Dental Sciences, Kannada, Karnataka State, India

During the last decade a lot of attention has been diverted to the study of Actinobacillus actinomycetemcomitans (Aa) as the principal micro-organism in the pathogenesis of periodontal disease. Because of the defective body defenses, there is an increased likelihood of periodontal disease among the Down syndrome patients. An attempt has been made herein to correlate the relationship between the gingival and periodontal health status to the isolation of Aa from the subgingival plaque in Down syndrome cases and to compare it to the neutrophil chemotactic activity to the normal subjects. Strong association between the occurrence of Aa as well as significant differences between the healthy and Down syndrome subjects in neutrophil defense activity were observed.
J Periodontol 68 (7): 626-31 (1997 Jul)

The Relationship between Gingivitis and the Serum Antibodies to the Microbiota Associated with Periodontal Disease in Children with Down's Syndrome

Morinushi T; Lopatin DE; Van Poperin N
Department of Pediatric Dentistry, Kagoshima University Dental School, Japan

Gingival inflammation in Down's syndrome children (DS) develops earlier and is more rapid and extensive than in non-DS children. Abnormalities in host response to the oral flora have been proposed as etiological factors of this gingival inflammation. However, the relationship between gingivitis and the host response to oral microorganisms in DS by age has not been determined. The objective of this study was to clarify this relationship. Sera were obtained from 75 DS subjects (aged 2 to 18 years) and their gingival health assessed using a modified PMA Index (M-PMA). Antibody titers to Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Treponema denticola (Td), Fusobacterium nucleatum (Fn), Selenomonas sputigena (Sel), Actinobacillus actinomycetemcomitans (Aa), and Streptococcus mitis (Mi) were determined using the micro-ELISA. DS subjects under 4 years old were found to have significantly more gingival inflammation than did normal children the same age. A significant positive correlation (r = 0.548, P < 0.0001) existed in the relationship between M-PMA score and plaque score for subjects in the G1 age group (deciduous dentition). At G1, the average antibody titers to Aa, Mi, and Fn exceeded those of the normal adult reference serum pool. In addition, IgG antibody titers to Pg, Aa, Fn, Sel, and Mi correlated significantly with the M-PMA scores in the G1 age group. There was a correlation between age (2 to 18 years) and these antibody titers. IgG antibody titers to Pg, Aa, Sel, and Mi increased significantly with increasing M-PMA score. Furthermore, the IgG antibody titers to Pg were higher (P < 0.05) in the most extensive disease group compared to the DS no-disease group. The IgG antibody titers to Pg at G3 (early puberty) were significantly higher when compared to G1 (preschool children). The IgM antibody titers to Aa at G3 were higher (P < 0.05) when compared to G1. This study suggests that colonization by Aa and Fn are closely associated with the onset of gingival inflammation in DS patients under 5 years old. Colonization by Pg, Aa, Sel, and Mi in DS appears to be associated with gingivitis at puberty.
Cleft Palate Craniofac J 32 (3): 188-93 (1995 May)

Tooth Malalignments in Chilean Children with Down Syndrome

Ondarza A; Jara L; Bertonati MI; Blanco R
Department of Experimental Morphology, Faculty of Medicine, University of Chile, Santiago

The present study analyzes the frequencies and types of anomalies in tooth alignment in a sample of 136 children with Down syndrome, 147 mentally-impaired individuals without Down syndrome, and 149 normal individuals. Patients with Down syndrome showed a higher frequency of malalignments in both the deciduous and permanent dentitions compared with the children in control groups. In the three groups studied, the frequency of malalignments was higher in the permanent than in the deciduous dentition. In the deciduous dentition, the frequency of malalignments in the three groups was similar in the maxilla and mandible, and in both boys and girls. In the permanent dentition, the frequency of malalignments was higher in Down and mentally-impaired girls without Down syndrome, while the frequency of malalignments in the mandible was only increased in mentally-impaired individuals who did not have Down syndrome. In the deciduous dentition, the Down group presented a higher frequency of malalignment in the upper central incisor, lateral incisor, and canine regions compared with the normal children. When comparing teeth of Down children with those of mentally-impaired individuals who did not have Down syndrome, differences in malalignment were observed only in upper central incisor and canine regions. In the permanent dentition, the Down group showed a higher number of tooth malalignments than the normals (13 out of 28 teeth). A comparison of Down with non-Down mentally-impaired individuals, revealed only 8 teeth out of 28 were different. The most frequent malalignments in the deciduous dentition in Down patients were mesiopalatal, mesiolingual, and mesiovestibular. In the permanent dentition, the most frequent malalignments were distopalatal or distolingual.
J Periodontol 55 (4): 466-71 (1995 Feb 13)

Tooth Agenesis in Down Syndrome

Russell BG, Kjær I
Copenhagen County Hospital for Handicapped Children, Vangedehuse, Gentofte, Denmark

We studied the frequency and pattern of tooth agenesis in a Danish population with Down syndrome, trisomy 21 (46 females and 54 males). The control group consisted of a normal Danish population (2424 females and 2431 males) [Rølling, 1980: Scand J Dent Res 88:365-369; Ravn and Nielsen, 1973: Tandlaaegebladet 77:12-22]. We found that individuals with Down syndrome have an occurrence of agenesis that is some 10 times greater that in the general population with a higher frequency in males than in females. Agenesis occurred more frequently in the mandible than in the maxilla and most often on the left side. The highly significant differences were primarily found in the occurrence of agenesis of the mandibular central incisors, followed by the maxillary lateral incisors and second premolars and the mandibular second premolars. The main components in the pattern of agenesis observed in Down syndrome are supposed to be related to the peripheral nervous system and abnormal cartilagenous tissue. The present study on Down syndrome suggests that the dentition, with its many different anomalies, from agenesis to malformation, can be used as an indicator in evaluating different aspects in the patheogenetic of aneuploidy conditions.
Spec Care Dentist 14 (6): 246-251 (1994 Nov)

Toxic shock and Down Syndromes in a Dental Patient: A Case Report and Review of the Literature

Navazesh M, Mulligan R, Sobel S

A literature review of Toxic Shock Syndrome is presented, including epidemiology, etiology, signs, symptoms and management, and its relationship to infection susceptibility in the Down Syndrome patient. A case of a Down Syndrome patient with Toxic Shock Syndrome is described, and the role of odontogenic infection is discussed.
Int J Orofacial Myology 19: 30-7 (1993 Nov)

The Castillo-Morales Approach to Orofacial Pathology in Down Syndrome

Limbrock GJ; Castillo-Morales R; Hoyer H; Stöver B; Onufer CN
Kinderzentrum Munchen, Institute for Social Pediatrics and Youth Medicine, University of Munich

Infants with Down syndrome often present with a familiar orofacial disorder which exists at birth or becomes more pronounced by the end of the first year. The primary pathology includes hypotonicity of the perioral muscles, lips, and masticatory muscles and a protruding tongue, later followed by active tongue protrusion. This results in problems with sucking, swallowing, drooling and dentition. Early intervention methods employing the combination of Castillo-Morales Manual Orofacial Therapy and his specially designed palatal plate, can improve orofacial function, facial appearance and prevent secondary conditions like pseudoprognathism, dental diseases, malocclusions, open mouth habit and pseudomacroglossia. This retrospective study examines the outcome of therapy, as prescribed by Castillo-Morales, in 39 children with Down syndrome. Normally, the average age to begin oral therapy is between six to eight months. The children were treated with the Castillo-Morales Manual Orofacial Therapy and his palatal plate for an average of 17.9 months. In this study, clinical evaluations at the beginning and the end of therapy focused only on open mouth posture and tongue protrusion. In addition, the direct stimulating effect of the palatal plate on tongue protrusion was evaluated. Significant positive results were observed in all three areas.
Arch Oral Biol 38 (1): 85-9 (1993)

Sequence of Eruption of Deciduous Dentition in a Chilean Sample with Down's Syndrome

Ondarza A; Jara L; Muñoz P; Blanco R
Department of Experimental Morphology, Faculty of Medicine, University of Chile, Casilla, Santiago

The eruption of the deciduous teeth in Down's individuals is reportedly delayed, but the extent of delay in comparison to normal children has been little studied. The eruption characteristics of the deciduous teeth in a sample of Chilean individuals with Down's syndrome were compared with those of the normal Chilean population. The sample consisted of 255 Down's individuals (all with trisomy 21), 127 males and 128 females. Boys with Down's syndrome showed significantly delayed eruption in six teeth: in the maxilla the right central incisor and right and left lateral incisors, and in the mandible the right central incisor and right and left canines. Girls with Down's syndrome showed significant delays in the eruption of 11 teeth: in the maxilla the right and left lateral incisors, right and left canines and first left molar, and in the mandible the left central incisor, right and left lateral incisors and canines and second right molar. The chronological sequence of eruption in Down's children was not completely different from that of normal individuals. With a few exceptions no significant departures from Gaussian distribution were found in the age of eruption among both normal and Down's individuals. The variance was significantly larger in cases of Down's syndrome.
Developmental Medicine and Child Neurology 33 (4): 296-303 (1991)

Castillo-Morales' Orofacial Therapy: Treatment of 67 Children with Down Syndrome

Limbrock GJ, Fischer-Brandies H, Avalle, C
Kinderzentrum München, Institute for Social Pediatrics and Youth Medicine, University of Munich, Germany

Infants with Down syndrome often present with a typical orofacial disorder, the features of which include hypotonicity of the perioral muscles, lips and chewing muscles, and a protruding tongue, later followed by active tongue protrusion, as well as problems with sucking, drooling, etc. This study presents the effects of Castillo-Morales' therapy with 67 Down syndrome children (average age at start of therapy 13.9 months), who wore the palatal plate intermittently for an average of 12.1 months. Significant positive results were obtained in spontaneous tongue position, upper and lowe lip tonicity and position, mouth closure, drooling and sucking.
J Dent Child 58: 64-68 (1991)

Mandibular and Dental Development Subsequent to Thyroid Therapy in a Boy with Down's Syndrome. Report of a Case

Reuland-Bosma, W.; Dibbets, J.M.H.
School of Dental Medicine of Marburg, Department of Orthodontics

Down's syndrome goes together with retarded growth, leading to shortness in stature, characteristic development of the face and a delayed dental development. Additional growth retardation because of hypothyroidism, which is often present, may therefore remain unnoticed. However, the dentist can recognize timely hypothyroidism by a substantially delay in the transition of the dentition and less so in delay in dental age compared to chronological age. On a panoramic radiograph a retained deciduous dentition and a permanent dentition of which the apices were in close proximity to the lower border of the mandible was observed. After the diagnosis hypothyroidism, treatment with thyroid hormone was started and catch up growth in body length and mandibular jaw development was observed. The vertical height of the corpus continued to be small. The progression of the dental age was not accelerated. The transition of the dentition however accelerated considerably. Several events in general about eruption of teeth and growth of the mandible could be noted and are summarized as follows: 1. The dentist should be alert on diagnosing hypothyroidism in Down's syndrome children. 2. Dental age is more or less independent of thyroid hormone therapy and is more closely related to the effect of the syndrome 3. root formation is independent of occlusal drift 4. eruption and root formation are separately regulated phenomena 5. the growth processes of the mandible may be regulated locally at different sites under influence of different endocrine hormones.
ASDC J Dent Child 57 (6): 442-4 (1990 Nov-Dec)

Orofacial Regulation Therapy in Children with Down Syndrome, Using the Methods and Appliances of Castillo-Morales

Hoyer H; Limbrock GJ
Children's Hospital, Hamburg, Germany

The varying hypotonia in Down syndrome is one of its most dramatic signs. In particular, the facial expression and oral dysfunctions of these handicapped persons are uniquely characteristic. The more-or-less permanently open mouth; the prolapse of the tongue, exposed on the everted lower lip; and a lack of mastication, deglutition and speech are primarily caused by the hypotonic orofacial muscles. Breathing through the mouth leads to a dehydration of bacteria and plaque on gums and teeth, and ultimately to premature destruction of the dentition. This developmental syndrome indicates the need for early functional training of the orofacial muscles. Oral Regulation Therapy as described by Castillo-Morales was applied to seventy-four children here, with encouraging results.
ASDC J Dent Child 57 (6): 437-441 (1990 Nov)

Regulation Therapy by Castillo-Morales in Children with Down Syndrome: Primary and Secondary Orofacial Pathology

Limbrock GJ, Hoyer H, Scheying H

Since Castillo-Morales developed the Orofacial Regulation Therapy for children with Down syndrome in the mid 1970s, close observation of orofacial symptoms in the growing child has led to new findings. Primary orofacial signs are present at birth through age one; secondary alterations develop with untreated school-age children. A synopsis of the most important disorders in children with Down syndrome is given. Findings that relate to malfunction are summed up; these findings can be influenced by Orofacial Regulation Therapy.
Deutche Zahnarzteblatt Z 45 (3): 157-9 (1990 Mar)

The Eruption of Deciduous Teeth in Children with Various Forms of Down's Syndrome

Müssig D; Hickel R; Zschiesche S
Poliklinik für Kieferorthopadie der Universität Erlangen-Nurnberg

This study demonstrated that both congenital cardiovascular defects and the cytogenetic form of trisomy 21 have considerable effects on the chronology of the first dentition. The delay in the eruption of the deciduous teeth was even greater in children with congenital heart defects than in those with free trisomy 21. So-called mosaic-types of Down's syndrome, on the other hand, were associated with almost regular times of eruption.
European Journal of Orthodontics 10 (3): 255-263 (1988)

Cephalometric comparison between children with and without Down's syndrome

Fischer-Brandeis H
Department of Orthodontics, University of Munich, West Germany

Craniogacial development is analysed in 1,896 patients with Down's syndrome (age 0-14 years) in comparison to a matching control group consisting of 1,154 healthy children. The midface area and cranial base are under-developed in the youngest age group (0-3 months, n=130). The length deficit increases up to the 14th year of life. The NSBa angle is obtuse, indicating a flat cranial base. The maxila is under-developed but on the average exhibits normal forward-downward growth pattern without an anterior or posterior rotation. Mandibular size starting from normal values is mildly hypoplastic at the age of 14. The gonion angle develops normally. The upper and lower incisors show increasing protrusion, the latter to a minor degree. These findings indicate that craniofacial dysplasia is already present at birth, becoming more severe with increasing age. An anterior open bite and Class III malocclusion, which are frequently described in patients with Down's syndrome, may be due mainly to proclination of the incisors, under-development of the maxilla and a more anterior position of the hypoplastic byt normally shaped mandibule.
J Periodontol 59 (4): 249-53 (1988 Apr)

Nonspecific and specific immune responses in a child with Down's syndrome and her sibling. A case report

Reuland-Bosma W, van den Barselaar MT, van de Gevel JS, Leijh PC, de Vries-Huiges H, The HT
Department of Peridontology, University of Groningen, The Netherlands

In a child with Down's syndrome (DS) and her sibling, host immune responses were evaluated under experimental gingivitis conditions. The children live in the same environment under identical conditions. In the DS child an earlier and more extensive gingival inflammation than in her sibling had been observed. Investigation of nonspecific host defense mechanisms revealed identical results in both children for the phagocytosis and intracellular killing of Candida albicans by polymorphonuclear leukocytes in crevicular washings (CR-PMNs), in blood (PB-PMNs) and blood monocytes. Furthermore, CR- and PB-PMNs were able to secrete identical amounts of hydrogen peroxide upon stimulation. The chemotactic response of PB-PMNs in the DS child was impaired, however. The results of the studies performed on parameters of specific host defense mechanisms showed low blastogenic responses to phytohemagglutinin (PHA) and pokeweed (PWM) by lymphocytes of the DS child as compared with her sibling. Also a lack of immune regulation leading to prolonged helper/inducer cell activation on a local (gingival) and circulation level and a less pronounced T-cell depression in PB were shown. Together, these differences observed in specific and nonspecific host response mechanisms may be responsible for the earlier and more extensive gingival inflammation found in the DS child.
J Periodontol 57 (11): 709-15 (1986 Nov)

Periodontal Destruction in Down's Syndrome and in Juvenile Periodontitis. How Close a Similarity?

Shaw L; Saxby MS

Advanced destruction of the periodontium, with similarities in alveolar distribution, age range, and diminished host responses of varying severity, may be seen in Down's syndrome and in juvenile periodontitis. This review compares and contrasts periodontal destruction and immunologic mechanisms in the two conditions. Both are characterized by raised serum immunoglobulins, selective cell-mediated immunodeficiencies, and defective neutrophil polymorphonuclear leukocyte chemotaxis. There is a possibility of defective monocyte chemotaxis in both conditions, although this is less clear in juvenile periodontitis. By contrast, antigen-induced DNA synthesis is enhanced in Down's syndrome, but reduced in juvenile periodontitis.
J Periodontol 57 (5): 288-93 (1986 May)

The prevalence of periodontitis and dental caries in a Down's syndrome population

Barnett ML, Press KP, Friedman D, Sonnenberg EM

The prevalence rates of periodontitis and dental caries in 30 Down's syndrome patients and 30 matched, otherwise retarded, controls were compared. The populations were older than those usually studied, with mean (± SE) ages of 27.4 (± 2.1) and 28.9 (± 2.3) for the Down's syndrome and control groups, respectively. Bone loss was found in 60.0% of sites in the Down's syndrome patients, compared with 9.3% sites in controls. In Down's syndrome, bone loss was first seen at about age 16, with 92% of patients 16 or older having loss; in contrast, only 42% of control patients 16 or older had bone loss, which first appeared at about age 28. There was a considerable difference in caries prevalence in the two groups, with the Down's syndrome patients having a lower overall prevalence which was most noticeable with respect to interproximal lesions. Seven Down's syndrome patients over age 15 were caries-free, as opposed to only one control patient.
Am J Phys Anthropol 52 (2): 169-173 (1980 Feb)

Fluctuating Dental Asymmetry: A Measure of Developmental Instability in Down Syndrome

Barden HS

Subjects with Down syndrome provide a useful model for investigating the effect of chromosomal aneuploidy on developmental pathways. Studies suggest that a major effect of trisomy is a decrease in developmental stability. The present study examines fluctuating dental asymmetry in Down syndrome. Mesiodistal crown diameters were measured from dental casts of 114 Down syndrome subjects. Correlation coefficients for antimeric permanent teeth served as an index of dental asymmetry. These values were compared with normal values obtained from the literature. Fluctuating dental asymmetry is thought to reflect the relative success of developmental homeostasis in countering developmental disturbances. Down syndrome subjects have significantly increased dental asymmetry. In addition, they show a disproportionate increase in dental asymmetry for those teeth reported to have the least developmental stability. These results support the contention that the chromosomal imbalance in Down syndrome results in amplified developmental instability.