Sadie Keeney

Disabilities Research Paper

Dental Hygiene III

One of the most common disabilities in the world is down syndrome. In

1866, John Langdon Down published a description of the down syndrome
condition and named the disease after him. In 1959, Professor Jerome
Lejuene found that down syndrome is a disability of the chromosomes. It is
the most common form of mental retardation caused by a chromosome
disability. In patients with down syndrome there are 47 chromosome cells
present where there are only 46 normally present. Chromosomes are are
what facilitate all of our genes. Children are born with 23 chromosomes
inherited from each parent. People with down syndrome are born with two
copies of the 21 chromosome. This is what causes their physical
charachteristics and mental disabilities. Scientists are not sure why this
happens. Some speculate that the age of the mother plays an important role.
As a mother ages the more likely she is to have a child with down syndrome.
Down syndrome is a congenital disability. This means that people with down
syndrome are born this way. Down syndrome can occur in every race and
ethnicity. There are no general treatments for down syndrome but certain
medications can be taken to help with the symptoms of the disability.
Down syndrome can affect many systems of the body. The most
serious complications are heart defects and blood disorders. Half of the
babies that are born with down syndrome are born with heart defects. Most
of the time these defects are repaired with surgery. Mitral valve prolapse is
present in more than half of the adults with this disability. In some cases,
there is a risk of developing valve disfunctions which can eventually lead to

congestive heart failure. Down syndrome can be the main contributor to

many blood disorders including leukemia which is cancer of the blood. People
with this disablity are more susceptible to oral and systemic infection and
illness due to their lowered immune system. This may lead to higher
incidences of periodontal disease, apthous ulcers, oral candida infections,
and ANUG. Mouth breathing in these people can cause xerostomia, fissuring
of the lips and tongue, and a higher risk of caries.
In some cases, babies born with down syndrome are also born with
abnormally formed digestive organs. This can cause blockage of the GI tract
and may require surgical procedures to correct the problem. They are also
more prone to celiac disease. This is when their body does not absorb the
nutrients that is essential to stay healthy. Celiacs disease is caused by
eating gluten, which is found in wheat.
There are many hormonal problems associated with down syndrome.
Individuals with down syndrome often do not produce enough of the thyroid
hormone. This can cause weight fluctuation and require them to take
medication for the remainder of their life. People with this disability are also
at a higher risk of Type 1 diabetes. Type 1 diabetes is when there are high
levels of sugar (glucose) in the body. This requires them to have insulin
injections. There are also skeletal problems associated with down syndrome.
The spine can be compressed and cause pain, tilt the head to one side, or in
extreme cases cause paralysis.

Along with major complications there are also others including vision
and hearing loss. Most children born with down syndrome have atleast one
vision problem. This could be, nearsightedness, farsightedness, astigmatism,
weak eye muscles(cross-eyed), and abnormal eye movements. These can
often be corrected with glasses. They may also develop some type of hearing
impairment. These will sometimes require a hearing aid. Ear infections are
another illness that people with disability are more prone to.
Hypotonia affects the muscles in many areas of the body. This
condition can cause an open bite. Muscles of the face can be affected and
this will cause problems with chewing, swallowing, drooling, and speaking.
Seizures can occur in individuals with this disability. These seizure episodes
can be controlled with anticonvulsant medications. The oral cavity can be at
risk during seizures. People can bite tongues and chip teeth. Patients who
have controlled seizures can be treated in dental offices very easily.
Along with all of the medical concerns and illnesses associated with
down syndrome there are many oral complications that occur in these
patients. The first and most important is periodontal disease. Many children
lose their teeth early in life due to rapid periodontal disease. This can be due
to poor oral hygiene, bruxism, malocclusion, conical-shaped roots, and
compromised immune systems. A prescription of chlorhexidine may be
beneficial to remove bacteria from their mouth. You should take into
consideration the patients ability to rinse due to their disability.

Children with down syndrome are less likely to have dental caries than
children without down syndrome. This is because of late eruption of
permanent teeth, smaller teeth, larger spaces, and missing teeth. In
addition, adults with down syndrome are more likely to have dental caries
than adults without down syndrome. Cariogenic foods, xerostomia, and
hypotonia(chewing problems) can contribute to adulthood caries.
Orofacial structures in people with down syndrome differ from that of
someone who does not have this disability. The bones of the maxillary area
tend to be smaller in down syndrome patients. This can cause mouth
breathing which leads to xerostomia and dental caries. The palate is more
narrow and leaves no room for the tongue. This can affect chewing and
speaking. The lips of patients with down syndrome are larger and thicker
than normal. Fissured lips, drooling, and open mouth breathing all contribute
to angular chelitis.

Malocclusion is common in people with down syndrome.

This is caused by late eruption of permanent teeth and the size of the
maxilla.The ability of the patient should be considered when deciding on
orthodontic care for people with down syndrome.
Along with malocclusion, trauma to the face and mouth can be very
common in people with down syndrome. This is due to more falls and
accidents occurring. A tooth saving kit could be helpful in the home in case
of an incident. Proper instruction on how to take care of a broken tooth or a
tooth being knocked out is important for care givers. Care givers also need to

be aware that oral injuries can be a sign of physical abuse. This abuse needs
to be reported.

As health care providers for our patients with down

syndrome we should be aware of how to care for a patient with his disability.
Their appointments should be scheduled early in the day. This can make sure
that everyone is alert and aware during the appointment. Take each step
very slowly to be sure that the patient will tolerate the procedure before
moving on. This may take a while longer and it may take a few appointments
to finish giving care.
The patients along with their caregivers should be aware of all the
measures they should take to prevent oral infections. This can be
accomplished by proper OHI and regular dental visits. While patients with
down syndrome are in your chair it is important to understand that they are
sometimes very fragile. You should be aware if the patient is uncomfortable.
You can use pillows to make their head and neck more comfortable.
Caring for a patient with down syndrome can be challenging. Some
individuals with down syndrome may be fully capable of taking care of their
oral hygiene on their own. Others may need some assistance. Floss holders,
bike handle grips, or a power toothbrush are simple ways to help these
patients. Also, be sure that they know the importance of oral hygiene and
what can happen if they do not take care of their teeth. There are many
factors to take into consideration. If you take your time, stay aware, stay
gentle, and be understanding when caring for these patients nothing should

be more rewarding. You need to realize that there are many issues that these
patients face every day. Sometimes, these patients cant control the
problems going on in their mouth due to other problems that they are
dealing with on a systemic level. Be patient and realize that you are helping
to do so much more than take care of just their teeth.

References

Ostermaier, K. K. (2013, November 12). Down syndrome: Clinical features

and diagnosis. Retrieved from Up to Date website:
http://www.uptodate.com/contents/
down-syndrome-clinical-features-and-diagnosis#H3

Waldman, B. H. & Borg, P. A. & Perlman, S.P. (2010). How to serve those with
special needs: Follow those guidelines in treating patients with Fragile
X Syndrome and Down Syndrome in the general dental practice.
Dimensions of Dental Hygiene, 8(10). 66, 69-71.

Chin, M., Fenton, S. J., Lyons, R., Miller, C., Perlman, S. P., & Tesini, D. (2009).
Practical oral care for people with down syndrome [Pamphlet].
Bethesda, MD: National Oral Health Information Clearinghouse.

Mandal, A. (2014, June 29). Down syndrome history. Retrieved June 29, 2014,
from News Medical website: http://www.news-medical.net/health/DownSyndrome-History.aspx