Dental Care for Someone With Down Syndrome (Guide)

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Table of Contents

  1. What is Down Syndrome?
  2. Oral Health Challenges
  3. Dental Care Challenges
  4. Treating Issues
  5. Dental Care Tips
  6. Dental Visits
  7. Resources
  8. References

Individuals with Down syndrome are more likely to experience certain oral health problems that include missing teeth, orthodontic issues, and gum disease.

Gum disease is linked to a number of health problems. It is prevalent among people with Down syndrome because of their weakened immune system.

A consistent daily dental hygiene routine and regular dentist visits can help to prevent and treat these concerns.

What is Down syndrome?

Down syndrome, also called Trisomy 21, is a genetic condition caused by an extra chromosome. When a baby is born with Down syndrome, the extra chromosome affects how their body forms and functions and results in developmental challenges. 

Down syndrome is the most prevalent chromosomal condition diagnosed in the United States. In 2008, it was estimated that there were about 250,000 people in the U.S. living with Down syndrome.  

Modern medicine and other factors (including more individuals with down syndrome living with families or caretakers rather than in institutions) have resulted in a generally improved quality of life and increased life expectancy in the past three decades. However, individuals with Down syndrome still face many health challenges, including their oral health.

Oral health challenges faced by individuals with Down syndrome

People with Down syndrome face some unique challenges related to their oral health.

Individuals with Down syndrome may be more likely to have certain dental characteristics, including these:

  • Small or missing teeth

  • Shorter teeth roots

  • Oversized or larger tongues

  • Grooved tongues

  • Spacing problems

  • Bite and alignment problems

Some studies indicate that children with Down syndrome are less likely to have tooth decay. This may be due to missing teeth and the delayed eruption of teeth. 

Adults with Down syndrome, however, may be more likely to experience developmental weaknesses in teeth, such as weakened enamel, that can eventually lead to tooth decay.

Gum disease is a major concern for individuals with Down syndrome. It’s the most common oral health issue they face. 

Gum disease is caused by plaque, a film buildup of bacteria that’s produced by the mouth. The bacteria create toxins that irritate the gums. If left untreated, the bacteria can enter the bloodstream and create other health problems, and it will also harden into hard-to-remove tartar. 

Gum disease in its early stages is called gingivitis, and it is characterized by swollen gums that may also bleed. Periodontitis, or advanced gum disease, is very serious and can result in the gums separating from the teeth, creating “pockets” of bacteria and particles that ultimately will weaken the bone structures supporting the teeth. This can lead to tooth decay or tooth loss.

Because individuals with Down syndrome may have weakened immune systems, their risk of gum disease may be much higher. Their gums may be more sensitive to the bacteria caused by plaque and unable to fight off infections and buildup. 

Early-stage gum disease may advance much more quickly to periodontitis if left untreated.

Some children and adults with Down syndrome grind their teeth. This condition is called bruxism, and over time, it can lead to oral health issues like weakened enamel, jaw problems, and exposed tooth nerves. It can also lead to headaches. 

Some individuals may only grind their teeth at night while sleeping. This is called sleep bruxism.

Individuals with Down syndrome may be more likely to experience gastroesophageal reflux, also known as GERD or acid reflux, which causes natural stomach acids to travel up to the throat and mouth. This acid can wear away at tooth enamel and cause decay.

In addition to an increased risk of gum disease, the compromised immune systems of individuals with Down syndrome may increase the likelihood of other oral health issues, including certain types of ulcers, oral Candida yeast infections, and chronic respiratory infections that can lead to dry mouth, mouth breathing, and lip and tongue fissures.

Dental Care Challenges

Depending on the level of developmental or behavioral challenges faced by an individual with Down syndrome, they may need assistance or supervision in completing daily oral hygiene routines regardless of their age.

Daily dental care may feel uncomfortable to an individual with Down syndrome due to sensory overload or the challenge of brushing or flossing. Some may experience a gagging feeling when they brush or bleeding gums (this is an early sign of gum disease). 

People with Down syndrome may also strongly dislike the smell or taste of their toothpaste or the vibration of an electric toothbrush.

Why is treating dental issues so important for individuals with down syndrome?

Strong daily dental hygiene routines and regular dentist visits are especially important for individuals with Down syndrome because of their weakened immune systems. 

Oral health, particularly gum health, has a direct connection to the different systems, tissues, and organs in the body.

When plaque bacteria start to build up in the mouth, it can begin to irritate the gums and cause gingivitis (early-stage gum disease). For people with a robust immune system, this may cause only mild problems for a continued period of time, such as slight swelling or occasional bleeding. Eventually, it may advance to more serious gum disease (periodontitis). 

But for individuals with a compromised immune system, including those with Down syndrome, the process of advancing from a mild gum concern (due to a lack of proper brushing or a weakened immune response to normal plaque buildup) to a serious gum disease issue can happen very quickly. If the body’s immune response can’t fight off the toxins from the plaque bacteria, oral infections may grow aggressively. 

If left uncontrolled, plaque bacteria can also spread — through the bloodstream and respiratory tract — to other parts of the body, including the lungs. This is of high concern to individuals with Down syndrome, as they are already prone to chronic respiratory problems.

The spread of plaque bacteria throughout the body causes inflammation, a major source of infection and disease. Gum disease may be linked to diabetes, stroke, and heart problems.

Dental care tips for people with Down syndrome & their caretakers

  • Establishing a good daily dental care routine as early as possible will help to make effective dental care an important part of everyday life. If you are just starting a dental hygiene schedule, persistence and encouragement can be key to long-term success.

  • Brushing at least twice a day is vital to dental hygiene. If needed, consider an adaptive toothbrush to make this easier and just as effective.

  • Experiment with different toothpastes. Finding one that’s enjoyable can make a huge difference in a daily dental hygiene routine.

  • Flossing may require challenging dexterity and precision. Consider a floss holder or more modern flossing aids, like floss picks or interdental brushes.

  • Limiting the number of sugary or carb-based snacks can help in avoiding decay and gum problems.

  • Talk to your dentist about the daily use of antimicrobial chlorhexidine (available in a rinse or spray), which can help prevent gum disease.

Dental visits for individuals with down syndrome

Regular dental visits are vital for individuals with Down syndrome in order to maintain oral health and prevent long-term problems. Because of a weakened immune system, even minor issues (like gum irritation), can quickly develop into serious problems. With regular visits, a dentist will be able to identify and aggressively treat these issues before they have time to develop or worsen. 

A trusted dentist can become a valuable resource to the individual or caretaker, helping to design an oral health care plan that will help to prevent future dental problems or treat necessary issues. They may be able to recommend products to make daily oral hygiene easier or recommend in-office treatments for gum disease prevention or orthodontic concerns.

If you are choosing a new dentist or preparing for a first-time visit, talk to your regular doctor about any health concerns you have about the dental appointment, such as seizures, the need for antibiotics, or any heart problems, and convey these issues to your new dentist as well. When setting up the appointment, be clear about what the office can do to help ensure a positive and successful visit

Preparation can help make the visit as stress-free as possible. Consider choosing a time that will work best for your schedule and let the office know the visit may take longer than usual. Bring a list of all medical conditions and medications taken as well as a list of any questions you have.


Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.