Mental Disorders
Developmental Disorders:
Down Syndrome
Trisomy
21 (Down Syndrome) is probably the most common developmental disability.
It is associated with an extra chromosome of the twenty first group. These
individuals have 47 chromosomes rather than the normal complement of 46.The
overall incidence of Down Syndrome is one in 700 live births, however,
the incidence increases with the age of the mother; e.g., at age 54 the
incidence is 1 in 54.
The typical facial appearance includes:
- midface hypoplasia
- slanted eyes
- broad flat nose
- flat occiput
-
short stature
Medical consultation is important, associated conditions include:
- mental retardation
-
congenital cardiac anomalies (antibiotic propohylaxis is often required)
- seizure disorders
-
immunological impairment
-
upper respiratory disease
- leukemia
-
hepatitis
Oral conditions include:
- low caries rate
- increased risk of severe periodontal disease
- short conical roots
- tongue thrusting
- protruding tongue
- macroglossia
- fissured tongue
- malocclusion (Class III)
-
narrow palate
- delayed eruption
- bruxism
- drooling
-
self injurious behavior (SIB)
Clinical management includes:
- possible seizure management
-
restricted nasal passages may prevent the use of nitrous oxide
-
possible increased gag reflex
-
sedation may help to control patient anxiety
-
difficult cases may require treatment under general anesthesia
The treatment plan must consider problems with drug-induced gingival overgrowth.
Optimal oral hygiene is required to prevent gingival overgrowth. Removable
prostheses may be contraindicated if the seizure disorder is not well contolled.
If anterior teeth are repeatedly traumatized and repaired; consider acrylic
veneers instead of porcelain in fixed prostheses.
Extra attention should be focused on oral hygiene. Educate caregivers.
Prescribe a chlorhexidine rinse. Perioguardª tastes better than Peridexª.
