Manual Down Syndrome: An Overview

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Loss of their permanent successors before the mid-teens is more common. There is separation of the attached gingival margin with pocket formation and progressive loss of supporting bone. This continues with age, and the involvement of the mandibular incisors followed by the maxillary incisors and the latter much of the rest of the dental arches [22].

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Radiographically, there is a lack of clarity of the lamina dura and the bone trabeculae appear shorter and thicker with consequently smaller marrow spaces. The roots of the incisors are short. Although the oral hygiene is often poor, it has little correlation with the degree of periodontal disease [23]. Calculus is not and material alba were abundant in these children. Most of the Mongolism children were having tongue thrusting with lack of lip seal, high frenal attachment or in tight contact and traumatic occlusion could be contributing factors for periodontal diseases [24].

The increased occurrence of class III malocclusion can be probably attributed to an underdeveloped maxilla, an enlarged and abnormally positioned tongue, or a relatively large and prognathic mandible. They exhibit asymmetric mocrognathic jaws with tooth malformations [26]. There may be a posterior cross bite on one or both sides in addition to a reversed incisor overjet.

Half of the patients have a tongue thrust, due in a few cases to an enlarged tongue, but in the majority of the children there is a lack of space for a tongue of apparently normal size. The majority of posterior crossbites are bilateral while anterior crossbites represented the second largest category and there were approximately equal percentages of unilateral right sided and unilateral left sided crossbites. This could be explained by the mandibular arch widths tended to exceed those of the maxilla.


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Crossbites likely to increase with increasing age in both sexes [28]. The etiological factors associated with open bite is deficient maxillary growth accompanied by tongue thrust. This may result in an anterior open bite. There is often lack of lip seal and these factors may produce proclination of the mandibular incisors, accentuating the reversed incisor relationship [29].

The tongue upon subjective evaluation, appeared to be either protruding on lying on the floor of the oral cavity. Maxillary arch widths were consistently largerer than those of the mandible in normal children but in contrary, the mandibular arch widths were frequently equal to or larger than the maxillary arch widths. This could be due to the high incidence of unilateral cross bites and class III tendency. Male dimensions were lll larger than female dimensions, the left side being more distant from the midline than the right side [30].

The degree of cooperation with dental treatment is largely dependent on the level of intelligence.

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For lower grades the treatment must be tailored to the institutionalized case. There is no contraindication to local anesthesia in these children [41,42]. Compliance issues should be dealt with in much the same way as for any other child presenting for dental treatment. The dental provider should demonstrate patience and respect for the individual when rendering care. All interventions should be explained to the child before beginning care. The child with Down syndrome may simply require a little and patience - especially during the first few visits. Sedation should only be used as a last resort, and only in extreme cases where care is vital and may not be performed in other way [44,45].

Those children with congenital heart disease must have this taken into account when considering any plan of treatment. In such cases extractions and deep scaling should be done under antibiotic coverage and root canal therapy is contraindicated. This and the susceptibility to chest infection will influence any decision to use a general anesthesia either for extraction or for conservation [46].

The periodontal condition constitutes the principal difficulty in attaining any degree of dental health. Treatment of the gingival condition is in accordance with general principles but must be of a simple type. The possibility of the development of leukemia should be borne in mind [47]. Both orthodontic and prosthodontics appliances are not very commonly used for several reasons.

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The gingival condition is poor, relatively large tongue and poor muscle tone make retention difficult, and temperamentally the cooperation is usually completely inadequate. Removable prothesis may be considered as a contraindication. The limited work to date has only shown partial success, but no conclusions can be drawn and further research is necessary to determine if patients with Mongolism are good candidates for implant therapy. The short roots are also disadvantageous for orthodontic tooth movement [38].


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Develop trust and consistency between the dental staff and the patient. Life spans have increased dramatically for people with Down syndrome. Today, someone with Down syndrome can expect to live more than 60 years, depending on the severity of health problems. There's no way to prevent Down syndrome. If you're at high risk of having a child with Down syndrome or you already have one child with Down syndrome, you may want to consult a genetic counselor before becoming pregnant.

A genetic counselor can help you understand your chances of having a child with Down syndrome. He or she can also explain the prenatal tests that are available and help explain the pros and cons of testing. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.


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  5. This content does not have an English version. This content does not have an Arabic version. The genetic basis of Down syndrome There are 23 pairs of chromosomes, for a total of Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. References What is Down syndrome?

    National Down Syndrome Society. Accessed Dec. Down syndrome fact sheet. Messerlian GM, et al.

    Dental Concerns of Children with Down’s Syndrome - An Overview

    Down syndrome: Overview of prenatal screening. National Library of Medicine. Down syndrome. Genetics Home Reference. Facts about Down syndrome. Centers for Disease Control and Prevention. Frequently asked questions. Prenatal genetic diagnostic tests. The Center for Down Syndrome is directed by Dr.

    Melanie Manning. Manning is a pediatrician and clinical geneticist. She has years of experience in the care and evaluation of children with disabilities. She has particular interest and expertise in children and adults with chromosome abnormalities.