Gretchen PierceAP LitMs. TilleryFall 2011 A Different Style in Dentistry Going to the dentist is a necessity in life. No matter the age, race, or gender, everyonemust visit the dentist in order to achieve the right oral hygiene. Failure to do so can result in achronic bacterial infection that affects the gums and bones that support the teeth, also known asperiodontal disease. Plaque is the biggest cause of periodontal disease and is caused by bacteriathat is present in the mouth and found between the teeth and at the gum line. Gingivitis is a mildform of periodontal disease that is characterized by swelling and bleeding of the gums caused bythe build-up of untreated plaque removal (SAID). Cavities are another result of plaque not beingcontrolled. Cavities are caused by the softening of the enamel on the teeth creating permanentholes. Left untreated, cavities can lead to tooth loss. Proper brushing, flossing and frequent vis-its to the dentist can help control or eliminate these oral infections. While most people visit the dentist for a regular check-up every six months, children withspecial needs should be seen by a dentist on a much more frequent schedule than others. Chil-dren with Down syndrome are often classified as having special needs. According to researchers,Down syndrome was first diagnosed in 1866 when the first case of it was sought out and discov-ered. Scientist John Langdon Down had named and learned all about the condition. It wasn’t un-til later in 1963 when all the physical attributes were put together in order to separate normal
from special needs (Desai). The different infections caused by being special needs were later dis-covered and are still being researched today. Children who have special needs have a higher risk of developing periodontal disease. Byhaving good oral hygiene, special needs children reduce the risks of oral diseases and have agood opportunity to have a healthy mouth (Mueller). When treating patients with special needs, aroutine check-up can become very complex. Dentists, if choosing to be able to care for thosewith special needs, should specialize in this specific area and be able to perform special and dif-ferent procedures that a dentist would not normally practice on other patients. Down syndrome patients have many health issues that make it quite challenging to per-form proper dental care. These patients are more likely to have respiratory infections that makeit difficult for them to breathe. Obviously, having the medical skills to deal with this circum-stance is important. This same issue also causes dry mouth and causes cracking of the skinaround the mouth and lips causing a dentist to use more caution when treating these patients.Also, Down syndrome children tend to have low muscle tones in their mouth. This is a reasonwhy it is harder for oral cleansing to take place. Many also have difficulty swallowing and thiscan make it challenging when rinsing during oral hygiene care. Macroglossia, where the tongue is oversized, is a common characteristic with a personhaving Down syndrome. This creates cracks all around the oral cavity and could make chewinginefficient, thus making it very difficult to maintain healthy oral hygiene. There are also severalcharacteristics regarding their teeth that are common. There can be a delay of baby teeth as wellas permanent teeth coming through the gums. Some patients also never develop some of theirpermanent teeth. Many have smaller teeth and large gaps between their teeth causing pockets forinfection to begin. The mid-facial area may be underdeveloped which include areas such as the
bride of the nose, the palate and the lips (Pilcher). This can affect the function of the oral cavitycreating additional complications with oral care. There are many methods dentists use in order to help Down syndrome patients maintain ahealthy mouth. Considering all of their disabilities, taking proper care of their mouth is very vi-tal. Not only do you have to take their oral and behavioral disabilities in to consideration, but youalso have to consider the challenges they face with facial and dental development. Simply brush-ing, flossing, and using mouthwash twice a day can help a special needs patient keep healthy.Down syndrome patients have an especially low enamel level. Also, getting fluoride treatmentson a more frequent basis can help them maintain a healthier mouth. People with Down syndrome tend to lose their permanent teeth at an earlier age than oth-ers due to multiple gum diseases. When developing this disease, the gums start to deteriorate inthe front and bottom molars (NICHHD). One way to lower the chances of gum disease is to un-dergo through, multiple deep cleaning procedures throughout life. This is typically a painful ex-perience but proves to be very beneficial. Despite all of the detailed treatments one might re-ceive when being special needs, using simple hygiene methods at home will also keep a healthymouth and a good smile! Using oral motor skills is something every human being must learn and adapt to as theygrow up. Oral motor skills typically include: muscle tone, muscle strength, range of motion,speed, and coordination (Kumim). Having Down syndrome or any special need may prevent aperson from being able to have a normal level of oral motor skills. These motor skills are all as-sociated with having a healthy, functioning mouth. Parents or guardians of the patient with spe-cial needs are encouraged to give at home tests to determine the level of disability when it comesdown to the oral motor skills. This also may determine how often one should visit the dentist of-
fice for a check-up. Those who have trouble cleaning, speaking, and keeping healthy may needto go on a regular basis of once a month instead of the normal every six month check-up. Tooth decay happens frequently in patients with special needs. They are 51% more likelyto have tooth decay than someone without special needs (Pilcher). Decay is normally caused bya deterioration or infection within the gums. Patients need to equip themselves with proper nutri-tion, excluding things like: sweeteners, sugars, soft drinks, candy, and chocolate. By eatinghealthy and preforming proper hygiene, it is less likely a patient with Down syndrome will expe-rience bad tooth decay. Technology has been a wonderful thing in today’s society. There have been several tech-nological advancements in the field of dentistry that aided in the oral health care of Down syn-drome patients, one being the use of x-rays. The type of x-ray equipment used as well as themeans of viewing them has greatly improved over the years. Using a panoramic x-ray oftenfeels less intimidating than a traditional individual x-ray and allows for one full picture of themouth (Ford). The field of orthodontics has also seen improvement over the years. While this isan option for Down syndrome patients, good daily hygiene is a must for orthodontic care to be asuccess. The orthodontic hardware as well has the teeth and gums must stay extremely clean andmaintained. Another advancement in technology is the vast improvement of the comfort and useof dentures. When a patient is overcome with periodontal disease, extracting all of their teethand replacing them with new custom fit dentures is an option. Providing dental implants is alsoanother option. With advancements in both of these areas, both dentures and implants make forviable options for permanent tooth replacement. Dentistry that specializes in Down syndrome has come a long way over the years. Thereare many specialty degrees that are offered in the School of Dentistry at many colleges and uni-
versities. However, taking simple precautions in order to make it a safe and positive experiencein a dentist office are also ways to aid in the visit for the special needs patient (Dental Fear Cen-tral). Some easy precautions a dentist should take when treating a special needs patient wouldbe to listen actively and speak clearly to the patient. A special needs person has a difficult timecommunicating with others most times. Talking slowly and going through each step of thecleaning process allows for no surprises to the patient. A dentist should also learn the character-istics of that particular patient by speaking to their caregiver. Having knowledge of the patient’slimits, daily habits and the state of mind on the particular day of the visit will also help make thevisit more positive. The dentist can adapt to the particular needs based on the communication.Conducting hands on demonstrations in the office of brushing and flossing to ensure the patientand caregiver are aware to the correct method of care is also beneficial. Consistency with timingand location are important factors when teaching oral care as a routine at home. Creating a comfortable environment for treatment is another simple way to allow for asuccessful office visit. Using body pillows for comforting as well as offering a stuffed animal tohold are helpful tools. The use of television screens and showing movies as a distraction fromsome of the loud and often strange noises in a dentist office that may intimidate patients is alsohelpful. All of these simple precautions can make for a positive experience. Practicing dentistry can be challenging at times, especially when working with childrenwho have special needs, specifically, Down syndrome. With patience, dedication, and a highlytrained skill level treating these patients can be successful and rewarding (NIDCR). The specialdynamics that a Down syndrome patient present require specific instructions and precautionarymeasures to be implemented in the dental office. Technology and additional skills learned allow
a dentist to successfully treat these patients and give them the guidance needed to have a healthymouth for life!
ReferencesDental fear Central. (2004). How to prevent tooth decay [tips on how to prevent tooth decay, etc.].Desai, S. S. (1997, September). Down Syndrome: A review of Literature [Gives the overview of history of dental work with Down syndrome kids and how doctors describe it]. Retrieved from HYPERLINK "http://www.riverbendds.org" http://www.riverbendds.org/in- dex.htm?page=desai.htmlDr. Ford. (2008). The Ford Clinic [Explains how a special needs dentistry office operates].Kumim, L. (2009). Resource Guide to Oral Motor Skill Difficulties in Children with Down Syn- drome.Mueller, E. (n.d.). Dentistry for Children with Down’s Syndrome---More Important Than You Know!! [Why Down Syndrome dental methods are so important ]. Retrieved from HY- PERLINK "http://www.mvdsa.org" http://www.mvdsa.org/JimS/Medical/Dentistry- forChildrenwithDowns.pdfNational Institute of Child Health and Human Development. (2011, March 25). Practical Oral care For People With Down Syndrome [How to work with people who have down syn- drome in a dental situation]. Retrieved from HYPERLINK "http://www.nidcr.nih.gov" http://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/PracticalOral- CarePeopleDownSyndrome.htmNIDCR. (2011, March 25). Practical Oral Care for People With Down Syndrome [Basics of down syndrome dentistry].
Pilcher, E. (1996`). Dental Care for the Person with Down Syndrome [Different complications with DS and dentistry].Pilcher, E. (2011). Dental care For the patient With down Syndrome [Describing in detail what good dental care with down syndrome people would include. ]. Retrieved from HYPER- LINK "http://www.down-syndrome.org" http://www.down-syndrome.org/reviews/84/SOUTHERN ASSOCIATION OF INSTITUTIONAL DENTISTS. (n.d.). Down Syndrome: A Review For Dental Professionals. Retrieved from HYPERLINK "http://saiddent.org" http://saiddent.org/modules/11_module3.pdf