Down's syndrome: Does it affect dental development?

I have a 10 month-old son with Down's syndrome and no teeth. I heard that teething may be delayed. Is this true?

Question:

Reports suggest that children with Down's syndrome have delayed eruption of the primary teeth, but this has not been extensively studied. Ondarza et al. (1997) showed that boys with Down's syndrome had significant delay in eruption of six teeth, specifically the upper right central incisor, upper right and left lateral incisors, lower right central incisor and lower right and left canines. Girls with Down's syndrome showed significant delay in eruption of 11 teeth. However, this study showed no difference in the pattern of tooth eruption. I was unable to locate any studies that addressed the average tooth eruption times for children with Down's syndrome.

Down's syndrome can cause other dental concerns. Often, these children have smaller upper jaws. The tongue, which may be larger than average, may protrude. These conditions may lead to problems with the way upper and lower teeth fit together. The teeth are generally smaller and may have more irregularities than the general population. Peretz et al. (1998) studied permanent molars from children with and without Down's syndrome. The children with Down's syndrome had molars that were significantly smaller and altered in shape when compared to the other children. It appears the change in size occurs early in tooth development while the change in shape happens at a later stage.

The incidence of tooth decay appears to be less frequent, but severe periodontal disease can occur in children with Down's syndrome. This may be due to abnormalities in the immune response to the bacteria in the oral cavity. A substance present in many tissues called prostaglandin E-2 (PGE-2) plays a role in inflammation and pain. The level of PGE-2 detected in gum tissue may be increased in children with Down syndrome. Specific bacteria may also be implicated.

Maintaining good oral hygiene is very important. Even though he has no teeth yet, you should keep his gums clean by wiping them with a clean cloth at least once daily. When his teeth erupt, you should begin brushing his teeth and take him to the dentist for an examination. If no teeth have erupted by about 16 to 17 months, you might take him to the dentist to check on the development of the teeth.

References:

Peretz et al., "Modified cuspal relationships of mandibular molar teeth in children with Down's syndrome" Journal of Anatomy (1998) 193(4):529-533.

Ondarza et al., "Sequence of eruption of deciduous dentition in a Chilean sample with Down's syndrome" Archives of Oral Biology (1997) 42(5):p401-406.

Morinushi et al., "The relationship between gingivitis and the serum antibodies to the microbiota associated with periodontal disease in children with Down's syndrome" Journal of Periodontology (1997) 68(7):626-631.

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