Down syndrome patient

Suppose oral health in any person is necessary for people with DS. In that case, prevention habits must be established from a very early age: a varied, healthy, and progressive diet without abusing food cariogenic to ensure the supply of all nutrients (mainly calcium and vitamins). Encourage good chewing function and water consumption (hydration). Perform a daily nasal cleansing with saline seawater to facilitate nasal breathing. Perform early orofacial psychomotor stimulation with emphasis on myofunctional therapy and reinforcement of lip-lingual tone, which will result in improved oronasal function. It is essential to establish efficient oral hygiene as soon as possible. Because of their disability, children With DS need help from their parents until the person acquires sufficient autonomy. The role of the parents is essential in this period. Constancy, perseverance, and patience are necessary to achieve a satisfactory mouth. It is recommended to make the first visit to the pediatric dentist.

The Committee is concerned about the lack of a clear definition of "child."

Six months. A visit to the orthodontist is also recommended around 6-8, and from that age onwards, regular check-ups every year.

Use topical fluoride on affected molars with cotton swabs to the teeth until the child learns to rinse each night.

Application every 6 months of topical fluoride gel or varnish if the patient tolerates it.

In permanent dentition, seal the molars.

The use of plaque developers to improve tooth brushing and control the level of bacterial plaque is a determining factor.

Topical use of 0.12% chlorhexidine mouthwash in acute treatment, including 0.20% gel or spray, may be required in hard-to-reach areas, and 0.05% as maintenance for a maximum of one month, applied with cotton swabs at the gingival margin of the teeth, especially on molars, until the child can rinse and keep it in the mouth at least one minute. Depending on the child and their plate control, it is recommended

to prolong the use of a chlorhexidine-free mouthwash with triclosan or similar.

Practice oral hygiene every 6 months and teach the child and parents about brushing. The use of electric toothbrushes can help better control bacterial plaque. However, children with DS often reject it because of noise and movement. Therefore, it is recommended that it be postponed until adolescence or adulthood.

Antibiotic prophylaxis to prevent infection and infectious endocarditis.

Daytime bruxism predominates and begins early in childhood, decreasing with age. It usually does not require dental treatment. 

The degree of tooth abrasion depends on the parafunction's duration, frequency, intensity, and individual resistance factor.

Lack of tone in facial muscles due to generalized hypotonia

in children with DS promotes mouth opening at rest, lip version lower, protruding tongue, and oral respiration.

Therefore, early myofunctional therapy by the speech therapist is desirable to obtain masticatory and tongue position and function

correctly.

Single or bilateral cross-bites bite anterior crossings of one or more teeth, open bites, moderate to severe dental crowding or spacing by agenesis, and protrusion of incisors.

Depending on the severity of the malocclusion (skeletal and/or dental, sagittal, transversal, and/or vertical), the dentition, and the child's age, the orthodontist will decide the type of treatment.

The concept is that because of their disability, they cannot tolerate orthodontic treatment. However, it will require the collaboration of the parents and a lot of patience and understanding from the orthodontist and his team. Given the complexity of the problems presented

A child with DS is often considered for two phases of treatment, the first in mixed dentition and the second in permanent dentition.

The appliance of choice is fixed as it does not interfere with diction, and the child's cooperation is not required. It only requires oral hygiene strict to avoid gingivitis and regular check-ups of the periodontal condition. Low friction and self-ligating brackets are recommended to prevent elastic ties and facilitate the first stages of alignment and leveling of teeth.

Preschool age (2-6 years). The presence of the mother or father in the clinic for the first visit is an excellent help in transmitting security to the child. As your child grows, your presence will be less critical and may negatively influence and deteriorate contact between the professional and the child. Previous negative experiences or the fact that the child has been manipulated by different professionals can make it difficult for them to collaborate. During this period, praising all positive behavior and giving simple but firm orders are essential. Distraction with

Playing games with the little ones or words with the older ones is useful. However, it requires great understanding, patience, and affection.

School-age (6-12 years). This stage requires a great deal of understanding. The professional must explain what is being done and praise all positive behavior. It's interesting to use a pediatric substitute vocabulary that eliminates connotations of anxiety:

Tooth counter instead of a probe, photograph as an X-ray, and brush with pressurized water as a turbine. At this stage, the technique.

Explain-Show-To-Do can be used to familiarize the child with the treatments and instruments of the dental office. Patience and affection are indispensable. Voice control can restore uncooperative behavior, consisting of a sudden change of tone. The older the child, the more you need to motivate him/her to acquire good dental hygiene habits.

Adolescence. We must continue to work to motivate him to take responsibility for their own dental health. However, according to the degree of disability, parents should check hygiene daily for dental work. You must avoid treating the child with excessive authority. It should be explained to him in detail what is being done and what dental treatments he needs. It is fundamental to guide him toward what is convenient with tact and patience. At this age, the use of an electric toothbrush is convenient.

Maintaining good oral hygiene and performing regular dental check-ups every 6 months is essential to avoid an unfavorable evolution of oral pathologies associated with DS with consequent loss of teeth.

Collaborating with the family, parents, and defective siblings or guardians is fundamental if they are institutionalized persons.

The use of an electric toothbrush is recommended.

Any septic focus should permanently be eliminated.

It is possible to successfully perform osseointegrated implant treatments and prosthetic rehabilitation in cases of multiple tooth loss. However, weigh the risk of failure.

In acute cases, topical use of 0.12% chlorhexidine mouthwash for 10 days, supplemented with gel or spray at 0.20% in areas of difficult access, and go to 0.05% as maintenance for a maximum of one month because of the risk of staining. Depending on controlling bacterial plaque, it may be necessary to use a chlorhexidine-free mouthwash for longer.

Use of interproximal brushes to maintain good interdental hygiene.

Antibiotic therapy in cases of acute periodontitis (spiramycin-metronidazole)

The practice of oral hygiene every 6 months and control of bacterial plaque and tooth brushing every 3 to 6 months according to the periodontal and general state of the patient.

Antibiotic prophylaxis to prevent superinfections and infectious endocarditis one hour before amoxicillin hygiene, 2g v.o. In case of allergy to penicillin, will be prescribed clindamycin 600 mg v.o

The patient has to get used to the environment and equipment of the practice.

Managing the behavior of a child with DS to achieve good dental treatment often requires careful dedication that is perfectly manageable with a good behavior management technique.

The child with DS must become progressively more aware of the office space, the professional, and his team, who will have to perform the treatments progressively. Depending on your behavior, it may be necessary to use anxiolytics or sedatives such as antihistamines(Hydroxyzine) or benzodiazepines (Diazepam / Midazolam) approximately 1 hour before the visit.

In adults, it may also be necessary to gradually introduce the precise treatments depending on your collaboration.

Perform antibiotic prophylaxis before any cruel treatment.

It is essential that the professional acts with understanding, patience, and tact.

In complex cases that require urgent dental treatment of short duration, which is not expected to last more than an hour, sedation can be used consciously intravenous with monitoring and supervision by a medical anesthesiologist.

In cases of non-cooperation requiring multiple dental treatments and long-term, deep sedation in a half-hospital. With general anesthesia, consider intubation for the micrognathia and the relative macro.