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Down syndrome patient

Oral and dental care Down's syndrome

Down syndrome patient

Dental Interventions in Children with Syndrome

 General recommendations

If oral health in any person is important, in people with DS is essential, so habits of prevention must be established from a very early age: varied, healthy, and progressive diet without abusing food cariogenic to ensure the supply of all nutrients (especially 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 basic to establish a efficient oral hygiene as soon as possible. Because of their disability, children With DS they need help from their parents until the person acquires sufficient autonomy. The role of the parents is basic 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 the term "child".
Six months. A visit to the orthodontist is also recommended around the age of 6-8 and from that age onwards, regular check-ups every year.

 Enamel hypoplasia

Use topical fluoride on affected molars applied 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.

 Gingivitis / Periodontitis

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 with reinforcement to the child and parents about the brushing technique. The use of electric toothbrushes can help better control bacterial plaque. However, children with DS often rejects it because of noise and movement. It is recommended that it be postponed until adolescence or adulthood.
Antibiotic prophylaxis to prevent infection and infectious endocarditis.

Dental Eruption

Due to the delay in the eruption, the retention of temporary parts and possible dental anomalies of number (mainly agenesis), microdontology and position and eruption, the tooth replacement.
From the first visit, check the existing teeth and possible agenesis. Extraction of retained temporary teeth that prevent the eruption of permanent teeth or move them out of the arch, to facilitate
that the permanent teeth are placed in a better-arched position.
It is useful from the age of 8 to obtain an orthopantomography to evaluate possible dental anomalies

 Bruxism 

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 duration, frequency, and intensity of the parafunction as well as the individual resistance factor.

 Muscle hypotonia

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.
Early myofunctional therapy by the speech therapist is desirable to obtain masticatory function and tongue position and function
correct.

 Malocclusion 

Single or bilateral cross-bites, bites 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 age of the child, the orthodontist will decide the type of treatment.
The concept that because of their disability they cannot tolerate orthodontic treatment, although 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 the fixed one 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 avoid elastic ties and facilitate the first stages of alignment and leveling of teeth.

 Recommendations for each pediatric age group

Preschool age (2-6 years). The presence of the mother or father in the clinic for the first visit is a great help in transmitting security to the child. As your child grows, your presence will be less important and may even 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 it is important to praise all positive behavior and give simple but firm orders. Distraction with
Playing games with the little ones or with words with the older ones is useful. It requires great understanding, patience, and affection.
School-age (6-12 years). This stage requires a great deal of understanding for The professional must give detailed explanations of 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 X-ray, 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 serve to restore uncooperative behavior, consisting of a sudden change of the 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, although according to the degree of disability it is advisable for parents to check hygiene daily 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 towards what is convenient with tact and patience. At this age, the use of an electric toothbrush is convenient.

Dental Interventions in Adults with Syndrome

 General recommendations

It is essential to maintain good oral hygiene and perform regular dental health check-ups every 6 months to avoid an unfavorable evolution of oral pathologies associated with DS with consequent loss of teeth.
It is fundamental to the collaboration of the family, parents, and in its defect siblings or guardians, if they are institutionalized persons.
The use of the electric toothbrush is recommended.
Any septic focus should always be eliminated.
Nowadays it is possible to successfully perform osseointegrated implant treatments and prosthetic rehabilitation in cases of multiple tooth loss. Weigh the risk of failure.

 Gingivitis/periodontitis 

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 the control of 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

  Standards of conduct in consultation with a patient with Down syndrome

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 space
of the office, the professional, and his team, who will have to carry out 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 difficult cases that require urgent dental treatment of short duration, which is not expected to last more than an hour, sedation can be used consciously via 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

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