It can be difficult to achieve good oral hygiene in someone with Down’s syndrome. What is it that can make cleaning so difficult and is there any way to help prevent dental disease?

Problems associated with Down’s syndrome
Children born with Down’s syndrome, DS, have an extra piece of DNA that causes various effects all over the body. However, there are some specific effects which can make cleaning teeth much more difficult.

  • Those with DS may have smaller mouths or larger tongues – meaning that it is physically difficult to clean teeth and to reach all areas of the mouth.
  • DS can cause tooth abnormalities which may result in misshapen teeth and overcrowding. Both of these complications can make cleaning more difficult.
  • Scientists are still in debate as to whether DS causes an elevated or reduced risk of cavity formation and if so why (a,b). However they do agree that people with DS have an increased risk of gum disease, periodontal disease, because of an impaired immune system (c).
  • Finally, DS also causes behavioural changes so children may not be cooperative with teeth cleaning.

How can you help?

Modify Behaviour
Behavioural modifications can have a profound impact on oral hygiene in those with DS:

  • Twice daily cleaning is an absolute must. Skipping a clean is likely to have a worse effect on oral hygiene in people with DS than otherwise.
  • See a dentist regularly. Dentists can provide a professional clean as well as treat problems before they progress.
  • Have a brushing routine e.g. at the same time or in the same place so children know what to expect.
  • Remember to praise children after a good clean.
  • Diet modification, sugary sweets and drinks are bad for teeth full stop but are even worse considering the aforementioned problems associated with DS.

Products
There are certain products that can make the whole process much easier:

  • Some patients find an antimicrobial agent effective. One example is chlorhexidine mouthwash (Curasept Mouthwash). However this may not be appropriate with a young child or someone with swallowing problems. An alternative in this situation includes chlorhexidine toothpaste (Curasept Toothpaste)
  • Flossing is a must but can be difficult. A floss holder can make flossing much easier (Dent-O-Care Floss Holder)
  • When used correctly electric toothbrushes give a more effective clean and often have smaller heads which may help with smaller mouths. There are many to choose from but you may find that regardless of age those designed for children are more effective as often they are smaller and have easy grip handles (Vitality-Precision-Clean)

Final Words
Good oral hygiene is important whoever you are but it can be very difficult in those with DS. Remember, problems with teeth and gums are progressive, resulting from days, weeks, months or years of poor oral hygiene. Follow the advice above and start the road to good oral hygiene today.

References

  • (a) Barnet B et al.The prevalence of periodontitis and dental caries in a Down’s syndrome population. J Periodontal  May; 57(5):288-93 (1986).
  • (b) Morinushi T et al. The relationship between dental caries in the primary dentition and anti S. Mutans serum antibodies in children with Down's syndrome.  Journal of Clinical Pediatric Dentistry, 19, 279-83 (1995).
  • (c) Loureiro ACA, et al. The impact of periodontal disease on the quality of life of individuals with Down syndrome. Down Syndrome Research and Practice. 12(1):50-54 (2007).