Down Syndrome Flashcards

1
Q

What is Down syndrome?

A

trisomy 21, genetic disorder in which their is an extra full set of chromosome 21

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2
Q

What are the risk factors for having a child with Down syndrome?

A
  • increased maternal age
    • over 35 years old
  • parental translocation
    • parent carries rearrangement of genes
  • prior child with Down syndrome
    • familial Down syndrome
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3
Q

What are the three different types of Down syndrome?

A
  • trisomy 21
  • mosaic trisomy
  • translocation trisomy
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4
Q

How can it be determined in utero whether a baby will have Down syndrome?

A
  • amniotic fluid and blood test
    • 20 weeks
  • ultrasounds
    • nasal bones
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5
Q

What conditions might a child with Down syndrome live with and how can these affect dental treatment?

A
  • intellectual disability
    • highly variable
    • dental implications
      • difficulty understanding OHI
      • difficulty understanding importance
  • hypotonia
    • poor motor skills
    • dental implications
      • challenging to use a toothbrush
  • congenital heart defects
    • most commonly VSD
    • tetralogy of fallot and valvular defects
    • dental implications
      • increased risk of infective endocarditis
  • dementia/Alzheimer’s
    • more common at an early age
    • dental implications
      • guardianship and consent issues
      • special care involvement
  • diabets
    • dental implications
      • bidirectional with periodontal disease
  • obesity
    • associated with diabetes
    • poor diet/highsugar intake
    • dental considerations
      • weight capacity of dental chair
      • risk of general anaesthetic increased
  • hearing loss
    • variable severity
      • 1 or both ears
      • hearing aids may berequired
    • dental implications
      • turn of hearing aid for high speed
      • determine preferred communication
  • gastrointestinal issues
    • GORD
    • increased risk of coeliac disease
  • leukaemia
    • increased risk
    • immunocompromised during treatment
      • bleeding and infection risk high
    • dental implications
      • presents in the mouth
      • linear gingival erythema
      • no obvious plaque related cause
      • gingival hypertrophy
      • palpation of nodes
  • instability of cervical spine
    • dental implications
      • move chair carefully
      • consideration for GA
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6
Q

What are the common oral manifestations associated with Down syndrome?

A
  • macroglossia
    • large tongue
    • difficult for moisture control
    • difficult for oral hygiene
  • microdontia
    • small teeth
  • delayed tooth eruption
  • hypodontia
    • congenitally absent teeth
  • malocclusion
    • most commonly class III
      • skeletal and dental
    • anterior open bite
  • gingival hyperplasia
  • enamel hypoplasia/hypomineralisation
  • oral hypersensitivity
  • cleft lip/palate
    • seen within cleft-service
    • many appointments and procedures
    • prevention vital
      • provide ortho with all possible options
  • bifid uvula
  • high arched palate
    • omega shaped
  • small roots
    • increased risk of tooth loss
      • periodontal disease
  • hypersalivation
    • drooling
    • good for buffering
    • family often do not like it
      • hyoscine patches can be used
  • increased caries risk
    • difficulty performing oral hygiene
    • difficulty understanding importance
  • fissured tongue
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7
Q

What can cause cracking and bleeding of the lower lip in patients with Down syndrome?

A
  • hypersalivation
    • slanted commissures lead to saliva pooling
  • hypotonia
    • poor oral seal
      • mouth breathing

-malocclusion
- class III
- anterior open bite

  • management
    • vaseline application
      • regularly
      • before toothbrushing or dental exam
    • regular hydration
    • angular cheilitis treatment
      • miconazole
        • candida
        • gram positive cocci (streptococci)
        • avoid with warfarin and statins
      • fusidic acid based produce
    • local measures to stop progression
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8
Q

What is the caries risk for a patient with Down syndrome and how should this be managed?

A
  • high caries risk
  • enhanced prevention pathway
    • 3 monthly appointments
    • personalised OHI
      • bring own toothbrush and toothpaste
    • flavourless toothpaste
      • oronurse
        • 1,000 or 1,450ppmF
        • non-foaming
        • SLS free
    • high fluoride toothpaste
      • 2,800 Duraphat
    • fluoride varnish
      • every 3 months
      • consider contraindications
    • fissure sealants
      • for caries free teeth
      • challenging in lower due to tongue
      • likely better with GI
    • diet advice
    • regular bitewings
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