Written by- Dr. Aditi Nanda 

Down syndrome is a chromosomal disorder associated with the trisomy of chromosome 21. It is found to occur in 1 in every 600 live births and is associated with low IQ and specific physical characteristics. Such patients require special attention when it comes to maintaining good oral health. Here are some of the common findings in individuals with Down Syndrome- 

1. Open mouth posture- these children usually keep their mouth open because of mouth breathing or vice versa. In either case, the result is Xerostomia and therefore impaired self-cleansing mechanisms, leading to dental caries. Although some claim that children with Down Syndrome are less likely to get caries, other studies show the opposite. 

Parents are advised to monitor the sugar intake of such kids and develop the habit of brushing twice a day with fluoride containing toothpaste. Guided flossing is of great help too. Regular visits to the dentist may help in diagnosing early signs of caries and therefore preventing them. 

2. Fissured or scrotal tongue- It is not uncommon to find numerous small furrows and grooves on the dorsal surface of the tongue in Down Syndrome. These cause entrapment of food debris which might result in a red, inflamed, burning tongue called glossitis. Anyways, this condition is easily preventable with regular tongue cleaning and consumption of sufficient roughage in diet. 

3. Periodontal disease - Another, sadly common, finding in Down syndrome is the severe destructive periodontitis. It develops rapidly especially in early teens. Although poor immunity is believed to be the major factor, adjuvants include malocclusion and poor oral hygiene to due to low cognitive thinking. 

Care takers are advised to administer proper oral hygiene regimen which includes brushing twice a day and flossing daily. Use of mouthwashes has proved to be of benefit too.

4. Anomalies of teeth- These can vary from congenitally missing teeth, to early shedding of deciduous and delayed eruption of permanent teeth. It is advised to schedule the first dental visit within 6 months of the first tooth eruption.  Proper and timely intervention should be done with space maintainers, where required, to prevent development of malocclusion. 

5. Anterior Open bite/ crossbite/ Class 3 malocclusion- this occurs due to underdeveloped mid face and hence maxilla. Orthodontic treatment is required in such cases, but since it will further pose problems with speech and oral hygiene maintenance, it is usually preferred to defer treatment until the child is old and has come far along in speech.  

Although it seems like a challenging and long journey initially, but it's truly rewarding to help these specially gifted individuals. The step first is awareness and second, acceptance. With little kindness, empathy & willingness to help, we can together make this world a better & beautiful place for these sweet & loving, God’s favourites.