Dental care is important for everyone, but people with Down syndrome may have certain differences that require special attention.
What Is Different About the Teeth of People with Down Syndrome?
Delayed Tooth Eruption
Both baby (primary) and permanent teeth may erupt later in children with Down syndrome than in other children. On average, the first teeth appear in children with Down syndrome between 12 and 14 months of age, though eruption may be delayed until 24 months. In comparison, the first teeth typically appear in other children between 6 and 12 months. A child with Down syndrome may not have all 20 primary teeth until the age of 4–5 years, compared to 2–3 years in typically developing children. The permanent front teeth and first permanent molars — which usually appear around age 6 in other children — may not emerge until age 8 or 9 in children with Down syndrome. It is also common for teeth to erupt in a different order than is typical.
Small or Missing Teeth
The teeth of people with Down syndrome are often smaller than average, and some teeth may be absent or fail to develop altogether. It is also common for their tooth roots to be shorter than normal.
Large Tongue
Some people with Down syndrome have a tongue that is larger than average, or their tongue may be of normal size but appear large relative to the mouth due to a small upper jaw. Grooves and fissures on the tongue are also commonly seen in this population.
Bite Problems
Small teeth may cause spacing between teeth, while a small upper jaw may lead to crowding and impaction of permanent teeth due to insufficient space. A small upper jaw can also result in the upper and lower teeth not meeting properly — the lower teeth often protrude further than the upper teeth, either at the back, the front, or both. It is also common for the front teeth not to meet at all in people with Down syndrome.
Orthodontic treatment may be able to improve some of these conditions, but it requires considerable cooperation and makes maintaining oral hygiene more difficult, so it may not be a feasible option for everyone. It may be beneficial to wait until the child is older and better able to manage orthodontic appliances. The presence of braces in the mouth can also interfere with speech. While most children without Down syndrome adapt their speech relatively quickly, those with Down syndrome may find this adjustment more difficult. For these reasons, it may be advisable to delay orthodontic treatment until the child is older and speech has reached a more advanced level of development.
Gum Disease
People with Down syndrome face an increased risk of gum disease. Even when there is little plaque or tartar present, they tend to develop gum disease at higher rates than others. This is due to a weakened immune system and a lack of certain natural protections against disease.
To prevent gum disease, people with Down syndrome should brush their teeth twice daily, focusing the bristles along the gum line, floss daily, and visit the dentist regularly for gum health monitoring and bone-level X-rays. If the gums bleed, this is a sign of inflammation, but brushing and flossing should not be stopped as a result. On the contrary, maintaining these habits helps keep the gums clean and reduces inflammation.
Tooth Decay
Some research suggests that people with Down syndrome are less prone to tooth decay, but much of this research was conducted on individuals living in institutional settings and following a restricted diet. In general, people with Down syndrome do develop tooth decay, so brushing with fluoride toothpaste, flossing, and reducing the amount and frequency of sugar and refined carbohydrate consumption will help prevent cavities.
Do People with Down Syndrome Need Antibiotics Before a Dental Visit?
People who have — or have had — certain types of heart defects may need to take antibiotics before visiting a dental clinic. The physician or cardiologist responsible for the patient should determine whether antibiotics are necessary, and the dentist should enquire about all medical conditions, including cardiac issues.
Source: Information in this section has been reproduced under an exclusive arrangement with the National Down Syndrome Society (NDSS). Available at: www.ndss.org