Tufts OpenCourseware
Authors: John Morgan, Bonnie F. Zimble

Down Syndrome:

Dental Manifestations, Oral and Dental Considerations,


Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008

Study Questions

  1. List the major dental manifestations seen in Down syndrome.

  2. Describe seven oral and dental considerations relevant to patients with Down syndrome.

  3. Describe the five major components of a preventive dental management program.

Before beginning this section, recall that the National Oral Health Information Clearinghouse, associated with the National Institute of Dental and Craniofacial Research (NIDCR) branch of the National Institutes of Health (NIH), provides information and photos on oral and dental conditions in Down syndrome.

 Click here to visit the site:   You can print or save a PDF copy of this document! 

In fact, a broad range of materials is available from:

National Oral Health Information Clearinghouse
Bethesda, MD 20892-3500
Voice: (301) 402-7364
E-mail: nohic@nidcr.nih.gov
Internet: http://www.nidcr.nih.gov/HealthInformation

Dental Manifestations in Down syndrome

Patients with Down syndrome may present with the following dental manifestations:   

  • Delayed eruption of both primary and permanent dentitions

  • 35-55% microdontia, clinical crowns are short, conical, small, roots complete   

  • Enamel hypocalcificiation and hypoplasia common

  • DS patients 50% more likely to have congenitally missing teeth, taurodonts are frequent finding

  • 1/3 more caries resistant than their non-DS siblings

  • Gingivitis develops earlier and more rapidly and extensively in persons with DS, perhaps because of an abnormality in host defenses. Patients with DS have altered microbiological composition of subgingival plaque, including increased Actinomyces and Hemophilus strains.

  • V-shaped palate, incomplete development of the midface complex, soft palate insufficiency

  • Hypotonic O. Oris, Masseter, Zygomatic, Temporalis Muscles

  • Absent incisors make articulation difficult

  • High incidence of laryngeal-tracheal stenosis, also upper airway obstruction and sleep apnea common

  • Scalloped, fissured tongue with bifid uvula, cleft lip/palate, enlarged tonsils/adenoids

Oral and Dental Considerations in Down syndrome 

  • Higher incidence of congenitally missing primary and permanent teeth in as many as 50% of patients

  • Reduced salivary flow

  • Tongue enlargement is relative (as a result of underdeveloped maxilla, tongue appears to be enlarged)

  • Crowding is frequent, especially in maxilla, due to underdevelopment

  • Higher incidence of bruxism, particularly in ages 0-6 years. Bruxism tends to decrease after age six.

  • Higher incidence (96%) of periodontal disease (misaligned teeth contribute to this secondarily)

Current research suggest that reduced neutrophil and monocyte chemotaxis, reduced phagocytosis, and a defect in T-cell proliferation and maturity may be reasons for the increase in periodontal disease seen in these patients 

An important note about pre-medication:

Patients with Down syndrome are more likely to require SBE prophylaxis prior to dental procedures because of their increased incidence of congenital heart defects. Consultation with the patient's physician may be necessary. See Dajani AS, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Circulation. 1997 Jul 1;96(1):358-66 for the American Heart Asoociation's recommendations.

Dental Management

An aggressive preventive dental program is recommended for patients with Down syndrome. The program should include:

  • Three to four month recalls: Consistent preventive care can help reduce periodontal disease

  • Dietary counseling and encouragement of good oral hygiene: Practical advice to minimize consumption of cariogenic foods and the effects of such foods on tooth structure

  • Topical fluoride application: For caries prevention and/or reduction of dentinal hypersensitivity

  • Chlorexidine gluconate 0.12% rinse: For reduction of bacteria that cause periodontal disease

A word on oral care from the National Institute of Dental and Craniofacial Research (NIDCR): 

The following advice is reprinted from NIDCR’s Practical Oral Care for People with Down Syndrome:

Although the intellectual ability of people with Down syndrome varies widely, many have mild or moderate intellectual disability that limits their ability to learn, communicate, and adapt to their environment. Language development is often delayed or impaired in people with Down syndrome; they understand more than they can verbalize. Also, ordinary activities of daily living and understanding the behavior of others as well as their own can present challenges.

  • Listen actively, since speaking may be difficult for people with Down syndrome. Show your patient whether you understand.

  • Talk with the parent or caregiver to determine your patient's intellectual and functional abilities, then explain each procedure at a level the patient can understand. Allow extra time to explain oral health issues or instructions and demonstrate the instruments you will use.

  • Use simple, concrete instructions, and repeat them often to compensate for any short-term memory problems.”