DOWN SYNDROME & MALOCCLUSION
Down syndrome is a disease which is usually observed in the newborn. The disease arises as a result of some genetic disorder which reflects itself as trisomy of the chromosome number 21. This is one of the commonest chromosomal disorders observed among the human beings. Almost 1 or 2 children out of 1000 live births are born with this disease. The children born with this disease present with mental and physical impairment. These children also develop multiple oral problems like caries, malocclusion, periodontal diseases, loss of tooth and so on. Among all these abnormalities, malocclusion is a phenomenon that affects the individual in a much negative way. It affects the functions of the children in their daily lives, like difficulty in swallowing, speech, and chewing. Moreover, the fact that these children appear different in their physical features when compared to other children of their age group makes things more difficult for them. The patients present with features like abnormally positioned tongue, craniofacial deformities, and alterations in the number, shape and size of teeth. These abnormalities make occlusion difficult, leading to improper vertical or transverse occlusion. However, the exact correlation between malocclusion and Down syndrome is yet to be discovered. Many researchers have worked on this issue to gain knowledge regarding the association between these two conditions.
A study was conducted which aimed at determining if there was actually any correlation between malocclusion and Down syndrome. It also tried to determine the exact cause of such association. The study was conducted taking into account 120 individuals among which 60 were diagnosed cases of Down Syndrome and the other 60 were apparently normal individuals with no deformities. Data were gathered depending on the results of the oral examination, interviews, medical charts and other analyses. The criteria of Dental Aesthetic Index were used for the diagnosis of malocclusion. The two groups showed drastic differences in their teething patterns. Some particular characteristics were observed which showed increased prevalence of malocclusion; these were Down syndrome, premature birth, and long face. In particular, the individuals with Down syndrome showed increased chances of malocclusion as compared to the other individuals (MARQUES, ALCÂNTARA, PEREIRA & RAMOS-JORGE, 2015).
Another study which was conducted with the objective of understanding the frequency and right – left symmetry of hypodontia in the permanent dentition of 8 to 9 years Norwegian children affected with Down Syndrome. The study consisted of 29 children with Down Syndrome, this section represented 57 per cent children who were born with Down Syndrome in Norway in the year 2002. The assessment of hypodontia was done with the help of panoramic or dental radiographs. The results showed that most of the children of Down Syndrome had one or more permanent teeth missing. Normally unilateral hypodontia is more common in the healthy population, but in the children of Down Syndrome bilateral hypodontia was more prevalent (Andersson et al., 2013).
A third study was performed with two individuals suffering with Down Syndrome. They were examined for their skeletal facial patterns and dental X- rays. On examination, it was seen that both the individuals demonstrated peculiar skeletal patterns but there were significant differences between the two of them (de Faria et al, 2013).
The commonest cause of malocclusion in the children suffering with Down Syndrome is the delay in the eruption of the tooth in these children. these children suffer from multiple developmental abnormalities and delayed dentition is a part of that. The permanent teeth erupt at a later age and the maxilla remains underdeveloped. An underdeveloped or a small maxilla often leads to an open bite which increases the chances of periodontal diseases and other dental caries (National Institute of Dental & Craniofacial Research, 2016).
The severity of the malocclusion may vary from patient to patient but the presence of malocclusion symptoms is almost unavoidable among the patients of Down syndrome. To make it clearer it can be said that a patient of Down syndrome will have malocclusion, but a person presenting with malocclusion may not be a patient of Down syndrome. To verify this statement, more researchers have put in their laborious efforts. They took a sample population of patients with Down syndrome having malocclusion and people having malocclusion without Down Syndrome. On the basis of an extensive study, they reached to a conclusion that malocclusion and its symptoms are more severe in the patients of Down syndrome as compared to those without the disease.
Thus, it can be concluded that malocclusion is an integral part of the disease Down syndrome. Almost every patient who is born with this chromosomal abnormality probably has to face the condition in later life. Along with the problems related to dental caries, periodontal diseases, speech, swallowing and chewing, the patients have to face an inferiority complex that arises as a result of facial disfigurement arising due to the condition. The patients need adequate care and love and support of their family members to cope with the stress due to this disease condition.
Andersson, E., Axelsson, S., Austeng, M., Overland, B., Valen, I., Jensen, T., & Akre, H. (2013). Bilateral hypodontia is more common than unilateral hypodontia in children with Down syndrome: a prospective population-based study. The European Journal Of Orthodontics, 36(4), 414-418. http://dx.doi.org/10.1093/ejo/cjt063
de FARIA, Fernanda Gumes, LAURIA, Roberta Andrade, & BITTENCOURT, Marcos Alan Vieira. (2013). Dental and skeletal characteristics of patients with Down Syndrome.RGO.Revista Gaúcha de Odontologia (Online), 61(1), 121-126. Retrieved February 05, 2016, from http://revodonto.bvsalud.org/scielo.php?script=sci_arttext&pid=S1981-86372013000100016&lng=en&tlng=en
MARQUES, L., ALCÂNTARA, C., PEREIRA, L., & RAMOS-JORGE, M. (2015). Down syndrome: a risk factor for malocclusion severity?. Braz. Oral. Res., 29(1), 1-7. http://dx.doi.org/10.1590/1807-3107bor-2015.vol29.0044
National Institute of Dental & Craniofacial Research,. (2016). Practical Oral Care for People With Down Syndrome - Mobile Version- National Institute of Dental and Craniofacial Research. Retrieved 5 February 2016, from http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/PracticalOralCarePeopleDownSyndrome_mobile.htm#Malocclusion