1. Gretchen Pierce
AP Lit
Ms. Tillery
Fall 2011
A Different Style in Dentistry
Going to the dentist is a necessity in life. No matter the age, race, or gender, everyone
must visit the dentist in order to achieve the right oral hygiene. Failure to do so can result in a
chronic bacterial infection that affects the gums and bones that support the teeth, also known as
periodontal disease. Plaque is the biggest cause of periodontal disease and is caused by bacteria
that is present in the mouth and found between the teeth and at the gum line. Gingivitis is a mild
form of periodontal disease that is characterized by swelling and bleeding of the gums caused by
the build-up of untreated plaque removal (SAID). Cavities are another result of plaque not being
controlled. Cavities are caused by the softening of the enamel on the teeth creating permanent
holes. 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 with
special 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

2. 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. By
having good oral hygiene, special needs children reduce the risks of oral diseases and have a
good opportunity to have a healthy mouth (Mueller). When treating patients with special needs, a
routine check-up can become very complex. Dentists, if choosing to be able to care for those
with 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 make
it 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 skin
around 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 reason
why it is harder for oral cleansing to take place. Many also have difficulty swallowing and this
can make it challenging when rinsing during oral hygiene care.
Macroglossia, where the tongue is oversized, is a common characteristic with a person
having Down syndrome. This creates cracks all around the oral cavity and could make chewing
inefficient, thus making it very difficult to maintain healthy oral hygiene. There are also several
characteristics regarding their teeth that are common. There can be a delay of baby teeth as well
as permanent teeth coming through the gums. Some patients also never develop some of their
permanent teeth. Many have smaller teeth and large gaps between their teeth causing pockets for
infection to begin. The mid-facial area may be underdeveloped which include areas such as the

3. bride of the nose, the palate and the lips (Pilcher). This can affect the function of the oral cavity
creating additional complications with oral care.
There are many methods dentists use in order to help Down syndrome patients maintain a
healthy 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 you
also 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 treatments
on 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 in
the 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 healthy
mouth and a good smile!
Using oral motor skills is something every human being must learn and adapt to as they
grow 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 a
person 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 comes
down to the oral motor skills. This also may determine how often one should visit the dentist of-

4. fice for a check-up. Those who have trouble cleaning, speaking, and keeping healthy may need
to 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 likely
to have tooth decay than someone without special needs (Pilcher). Decay is normally caused by
a 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 eating
healthy 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 the
means of viewing them has greatly improved over the years. Using a panoramic x-ray often
feels less intimidating than a traditional individual x-ray and allows for one full picture of the
mouth (Ford). The field of orthodontics has also seen improvement over the years. While this is
an option for Down syndrome patients, good daily hygiene is a must for orthodontic care to be a
success. The orthodontic hardware as well has the teeth and gums must stay extremely clean and
maintained. Another advancement in technology is the vast improvement of the comfort and use
of dentures. When a patient is overcome with periodontal disease, extracting all of their teeth
and replacing them with new custom fit dentures is an option. Providing dental implants is also
another option. With advancements in both of these areas, both dentures and implants make for
viable options for permanent tooth replacement.
Dentistry that specializes in Down syndrome has come a long way over the years. There
are many specialty degrees that are offered in the School of Dentistry at many colleges and uni-

5. versities. However, taking simple precautions in order to make it a safe and positive experience
in 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 would
be to listen actively and speak clearly to the patient. A special needs person has a difficult time
communicating with others most times. Talking slowly and going through each step of the
cleaning 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’s
limits, daily habits and the state of mind on the particular day of the visit will also help make the
visit 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 patient
and caregiver are aware to the correct method of care is also beneficial. Consistency with timing
and 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 a
successful office visit. Using body pillows for comforting as well as offering a stuffed animal to
hold are helpful tools. The use of television screens and showing movies as a distraction from
some of the loud and often strange noises in a dentist office that may intimidate patients is also
helpful. All of these simple precautions can make for a positive experience.
Practicing dentistry can be challenging at times, especially when working with children
who have special needs, specifically, Down syndrome. With patience, dedication, and a highly
trained skill level treating these patients can be successful and rewarding (NIDCR). The special
dynamics that a Down syndrome patient present require specific instructions and precautionary
measures to be implemented in the dental office. Technology and additional skills learned allow

6. a dentist to successfully treat these patients and give them the guidance needed to have a healthy
mouth for life!

7. References
Dental 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.html
Dr. 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.pdf
National 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.htm
NIDCR. (2011, March 25). Practical Oral Care for People With Down Syndrome [Basics of
down syndrome dentistry].

8. 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