Down's+Syndrome

=** Case #6 - Patient with Down's Syndrome **=



There is increased periodontal breakdown when compared to normal plaque levels in normal patients.
 * Effect of Down's syndrome and its correlation to periodontal disease**

Earlier periodontal breakdown (begins at ages 6-15)

Common findings include marginal gingivitis, acute/sub-acute NUG (necrotizing ulcerative gingivitis), advanced periodontal disease, gingival recession and pockets, horizontal and vertical bone loss with suppuration, bifurcation and trifurcation involvement with molars, mobility, and frequent tooth loss.

Gingival and periodontal disease occurs in approximately 90% of affected individuals.

Free: Generalized erythemic, edematous, hemorrhagic, rolled, blunted, shiny, and glossy
 * Gingival description**

Attached: Generalized pinkish red, edematous, glossy, and shiny


 * Periodontal classification**

Extraoral: Palpable bilateral submandibular lymph nodes, eyes appear slanted Intraoral: Dry lips, fissured tongue, teeth are crowded Maximum opening: 30 mm Angles: bilateral class III molar relation Skeletal Profile: prognathic MBI: 87% BOP: 95% Probing depths: generalized 5-6 mm pockets Recession: Please see perio chart. Mobility: Please see perio chart. Fremitus: Please see perio chart. Furcation: Please see perio chart. Caries stage: stage IV in 7 and 10 Calculus code: medium Generalized ADA III AAP: generalized severe chronic perio due to plaque calculus, modified by Down’s syndrome
 * Assessments**

Go over oral hygiene instructions with patient and caregiver or guardian at every appointment. Recommend tongue brushing to prevent halitosis with fissured tongue. Recommend fluoride for at-home use to prevent tooth decay and recommend a power tooth brush with a wider handle for easy dexterity and for better oral care for the patient or caregiver due to the oral issues that present with the condition. Visits should be every 3 months and OHI needs to be reviewed and stressed. Most patients that have Down’s syndrome are good-natured, cooperative within their ability, affectionate, and receptive to dental care. We would need to discuss with the caregiver the importance of good oral hygiene and that it is critical for the patient's oral health. Retention of teeth is very important because patients may not tolerate dentures or partials.
 * Oral Hygiene Instructions**

Appt 1 - assessment, x-ray check, DDS exam, 2nd check-in, PI, OHI Appt 2 - OHI, Scale right 1/2 mouth with anesthesia Appt 3- OHI, scale Left 1/2 mouth with anesthesia, fluoride varnish tx Appt 4 - Re-eval 4-6 weeks Appt 5 – 3-month recare
 * Treatment plan**

The prognosis for this patient would be considered poor. This is because the patient has moderate to advanced bone loss, tooth mobility, the patient’s cooperation may not be available because this patient has Down’s syndrome, and the patient has difficult-to-reach areas due to his small mouth.
 * Prognosis**

Questions
1. All Down’s syndrome patients have periodontal disease. a. True b. False

2. Down’s syndrome has 4 of chromosome 21. The normal chromosome amount is 2 for a total of 47. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

3. Patients with Down’s syndrome often have macroglossia. This macroglossia is often not considered true macroglossia because the tongue is of normal, size but the oral cavity is smaller than normal. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

4. Down’s syndrome patients will always have a caregiver or guardian with them when they come to the dental office. a. True b. False

5. Many patients with Down’s syndrome are born with existing cardiac conditions or develop mitral valve prolapse in their lifetime. It is not important to consult with the Down’s syndrome patient’s physician before they come in for their first visit to your dental office. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

6. Patients with Down’s syndrome often have a lot of food and plaque left on their teeth because a. They have an open bite that decreases efficiency of chewing their food. b. They have decreased muscle tone which causes and unbalanced chewing forces in the mouth. c. They are not able to clean their teeth as well because of physical limitations that they might have and because of the physical makeup of their oral cavity. d. A and C e. All of the above

7. Which of these characteristics of patients with Down’s syndrome help contribute to good oral hygiene? a. They often have wider gaps between their teeth because of missing teeth or smaller teeth. b. Their larger tongue helps to keep their teeth clean because it is constantly rubbing against them. c. Many Down’s syndrome patients eat less cariogenic foods because they are often on diets that help to keep their health and weight under control. d. A and C e. All of the above

8. Most patient with Down’s syndrome are good natured, cooperative, affectionate, and receptive to dental care. a. True b. False

9. It is important when giving oral hygiene instruction that you educate the patient as well as the caregiver. This will help maintain the patient’s oral health care because the Down’s syndrome patient may not be providing himself/herself with proper oral hygiene. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

10. Why do we recommend brushing the tongue especially for the Down’s syndrome patient? a. To help reduce redness b. To prevent halitosis with fissured tongue c. To prevent white hairy tongue d. To reduce macroglossia

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