Periodontal disease in Down's syndrome: a review

Abstract

Cross-sectional as well as longitudinal studies indicate that the prevalence of periodontal disease in persons with Down's syndrome (DS) under the age of 30 years is extremely high. It is even noted in the deciduous dentition. The progression of the disease is rapid, especially in the younger age groups. Severe periodontal breakdown with horizontal bone loss is often present in the lower anteriors. The large amount of plaque and calculus alone cannot explain the severity of periodontal disease in DS persons. Many contributing factors are reported. Abnormal capillary morphology, disorders in connective tissue and anatomical aspects of teeth are some of those considered to be of influence. Alteration in immunological response may also play a role in the progression of the disease process. Disorders in the polymorphonuclear leucocyte function and monocyte function have been reported in persons with DS. T-cell functioning declines after the first 10 years of life. T-cell lymphocyte counts are low and an immature subset of T-lymphocytes is present. This latter effect occurs especially in institutions where the immunological system is under stress. The altered immune response together with higher calculus scores may explain the difference in severity of periodontal disease between institutionalized DS children and those living at home.

Views and experiences of parents and siblings of adults with Down Syndrome regarding oral healthcare: a qualitative and quantitative study

“…Whilst the differences in placement of restorations could be attributed to the lower caries rate of people with DS, [38][39] one might have similarly expected evidence of more periodontal therapy and orthodontics given the higher incidence of these problems in this population. 25,[38][39][40][41] Clearly, there are other contributory factors relating to treatment provision.…”

“…[20][21][22][23] However, a recent study demonstrated a better clinical status for adults with LD than the general population although they had fewer teeth indicating that treatment is more likely to involve extraction of teeth. 24 Whilst people with DS have an increased prevalence of periodontal disease compared with the general population and other people with learning disability, 25 a carefully planned prevention programme can reduce its impact. 26  Adults with Down Syndrome (DS) have particular oral health needs, requiring a supportive, empathic and well-informed dental team.…”

Neutrophil Chemotaxis and Periodontal Status in Down's Syndrome Patients.

“…It has also been demonstrated that in DS patients, the prevalence and severity of advanced periodontal disease are increased [9][10][11][12]. The periodontal disease associated with DS is attributed to both endogenous and exogenous factors [13].…”

Oral Health in Individuals with Down Syndrome

“…At the same time, there was only moderate relationship between dental plaque and periodontal disease severity in DS individuals (Lopez-Perez et al, 2002). Thus, rapid and severe periodontal destruction in those DS individual affected could not be explained by poor oral hygiene alone (Reuland-Bosma & van Dijk, 1986). …”

“…Recently, it has been shown that a different salivary environment of electrolytes and pH is manifested in DS children, leading to the lower reported caries rate (Davidovich et al, 2010) 3.2 Periodontal disease DS individuals usually present with poor oral hygiene and manifested as marginal gingival inflammation, acute and subacute necrotizing gingivitis, advanced chronic periodontitis, loss of attachment in form of gingival recession and increased pocket depth, alveolar bone loss, suppuration or even abscesses, furcation involvement in the molars, increased tooth mobility, and even loss of teeth (Shaw & Saxby, 1986) (Figures 5B & 6). DS individuals had a prevalence of 60 to 90% percent and increased severity of periodontal disease compared with normal age-matched controls and subjects with other mental disabilities of similar age (Cutress, 1971b;Orner, 1976;Barnett et al, 1986;Reuland-Bosma & van Dijk, 1986;, Modeer et al, 1990;Shapira et al, 1991;Ulseth et al, 1991;Desai, 1997;Gabre et al, 2001;Lopez-Perez et al, 2002;Sakellari et al, 2005;Cheng et al, 2007;Khocht et al, 2010). Obviously the severity of periodontal disease among DS individuals is milder in recent years' reports as better dental care have been employed to take care of them early in their life.…”