Type A Behavior: Its Diagnosis and Treatment (Prevention in Practice Library)

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This may be difficult to achieve with the intellectual impairment and decreased manual dexterity seen in Down syndrome. Flossing may be very hard for these patients and instruction in the use of a floss holder may be helpful. New mechanical tooth brushing and flossing aids on the market may also be of help. It is important to be sure that the patient's family or caregiver is educated in proper home care as well. Parents need to realise the importance of proper daily home care because the child with Down syndrome may be resistant to tooth brushing. Treatment objectives for any population with developmental disabilities should be the same as that of normal patients.

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Type a Behavior: Its Diagnosis and Treatment by Meyer Friedman

Treatment plans may need to be adapted as necessary due to each individual's condition, but the overall goal should be to provide as comprehensive treatment as possible. Areas of dental care such as cosmetic dentistry, orthodontics, prosthodontics, and reconstructive oral surgery should not be ruled out simply because the patient has Down syndrome. With the numbers of persons with Down syndrome working and living out in the community, there may be many who desire and can handle some of the more extensive dental treatment options available today.

Good behavior in the dental office is learned. In a population with delayed learning, this can be a challenge for the dentist and staff. Dental treatment for children with Down syndrome may not be sought out at an early age. There may be more pressing medical problems, financial considerations or parents may want to wait until the child seems mature enough to handle a visit to the dentist. Unfortunately this makes it more difficult to teach proper home care and to develop a relationship with the child that will result in co-operative behavior during dental treatment.

Determining the level of communication is very important in developing a co-operative relationship with your patient with Down syndrome. The level of receptive vs. The patient's family or caregiver will be able to guide the dental staff as to what level of communication is appropriate.

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It is important that the dentist communicate directly with the patient whenever possible in order to build a level of trust. It may be advantageous to have a parent in the operatory during some early childhood visits.

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Finding out what motivates the child with Down syndrome is also important. Something as simple as receiving a pair of gloves and a mask at the end of the appointment may be all it takes to ensure co-operation. However, most patients with Down syndrome can handle routine dental care with just a little more time and attention given during the appointment.

Scheduling appointments early in the day is beneficial as both patient and operator are more rested. First appointments should be for orientation only, and subsequent appointments may require a little more time than what is usually allowed. The patient's medical history should be obtained prior to the first appointment.

This allows for medical consultation if necessary before any treatment begins. Treating the older patient with Down syndrome may present a different set of problems. There appears to be a high incidence of early onset Alzheimer's disease in persons with Down syndrome. These patients will require a great deal of understanding and their level of co-operation may decrease as the disease progresses. It is important that the dental health provider be aware of the incidence of sleep apnea in the Down syndrome population. The decreased airway size combined with lowered muscle tone predisposes these patients to obstructive sleep apnea.

Left untreated, obstructive sleep apnea can further increase developmental delay and lead to pulmonary hypotension and congestive heart failure. Symptoms of obstructive sleep apnea include snoring, restless sleep and unusual sleeping positions.

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If a patient's family or caregiver reports these symptoms, then referral to a sleep disorders clinic is indicated. Dental care for the patient with Down syndrome can be achieved in the general practitioner's office in most instances with minor adaptations. Although this population has some unique dental care needs, few patients require special facilities in order to receive dental treatment.

Adequate dental health care for persons with developmental disabilities is a major unmet health need. It is hoped that the information contained in this review will encourage general practitioners to be willing to provide comprehensive dental care to their patients with Down syndrome. Elizabeth S. Tel: , Fax: , E-mail: pilchees musc. Stay up to date with everything we are doing to improve education for children with Down syndrome. DSE works to improve education and early intervention for children with Down syndrome.

Our research and evidence-based services and resources are helping thousands of young people with Down syndrome to achieve more than ever before. With your support, we can accelerate research, develop new services and resources, and provide support and advice to more families and professionals everywhere. Cookies on DSE sites - We use cookies to provide essential functionality and to analyse how our sites are used. Learn More Accept. It is not an index of all resources; items are selected for their quality, authority of authorship, uniqueness, and appropriateness.

Agency for Healthcare Research and Quality AHRQ Digital forum that provides health professionals and researchers the opportunity to share, learn about, and ultimately adopt evidence-based innovations and tools suitable for a range of health care settings and populations. Includes searchable profiles of successful and attempted service delivery and policy innovations, practical tools, articles, and reports. Gordon, Jr.

Electronic Preventive Services Selector ePSS Agency for Healthcare Research and Quality AHRQ A quick, hands-on tool designed to help primary care clinicians and health care teams identify, prioritize, and deliver the screening, counseling, and preventive medication services that are appropriate for their patients. In undergraduate dental training there is usually little or no exposure to treating patients with disabilities, and general practitioners may be hesitant to treat these patients with confidence. This paper will attempt to summarise the unique characteristics associated with Down syndrome that influence the dental care and treatment of this population.

There is however, an abnormally large percentage who develop mitral valve prolapse MVP by adulthood.

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One third of these adults with MVP do not have ausculitory findings, requiring diagnosis of the MVP by echocardiogram. Patients with Down syndrome, or their caregivers may not be aware of the need for diagnostic echocardiology in adulthood. A compromised immune system with a corresponding decrease in number of T cells is characteristic of most individuals with Down syndrome This contributes to a higher rate of infections and is also a contributing factor in the extremely high incidence of periodontal disease.

Children with Down syndrome often have chronic upper respiratory infections URIs. These contribute to mouth breathing with its associated effects of xerostomia dry mouth and fissuring of the tongue and lips. There is also a greater incidence of apthous ulcers, oral candida infections and ANUG. A reduced degree of muscle tone hypotonia is generally found in Down syndrome. This affects the musculature of the head and oral cavity as well as the large skeletal muscles. The reduced muscle tone in the lips and cheeks contribute to an imbalance of forces on the teeth with the force of the tongue being a greater influence.

This contributes to the open bite often seen in Down syndrome.

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Additionally, reduced muscle tone causes less efficient chewing and natural cleansing of the teeth. More food may remain on the teeth after eating due to this inefficient chewing. Associated with the low muscle tone seen in Down syndrome is a ligamentous laxity seen throughout the body. This causes hyperflexibility of the joints and it is theorised that the ligaments around teeth may be influenced as well Southern Assoc.

A condition related to ligamentous laxity is that of Atlanto Axial Instability. If a patient has this instability, careful positioning in the dental chair is required to avoid any potential harm to the spinal cord. Persons with Down syndrome vary widely as to their degree of intellectual impairment.


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Most have IQs in the mild to moderate range and are able to be treated in a normal setting. There is often a relatively severe delay in language development. The patient with Down syndrome will probably understand more than their apparent level of verbal skills. The assistance of the patient's family or caregiver will be necessary in conveying to the dentist and staff what level of communication should be used with the patient.

It may take a little extra appointment time to explain procedures to the patient with Down syndrome, but once a level of trust is achieved they are likely to be very co-operative patients. Down syndrome is frequently seen in conjunction with other medical problems. There is a higher incidence of epilepsy, diabetes, leukemia, hypothyroidism and other conditions. Alzheimer's disease and Down syndrome appear to have a strong connection to one another. The importance of a thorough medical history including a work-up by a physician cannot be over emphasized. The primary skeletal abnormality affecting the orofacial structures in Down syndrome is an underdevelopment or hypoplasia of the midfacial region.

The bridge of the nose, bones of the midface and maxilla are relatively smaller in size. Absence or reduction in size of the frontal and maxillary sinuses is common. The incidence of mouth breathing is very high due to a small nasal airway.


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  7. The tongue may protrude and appear to be too large. True macroglossia is rare, rather a relative macroglossia is found where the tongue is of normal size but the oral cavity is decreased in size due to the underdevelopment of the mid-face. Upon examination the palate in a person with Down syndrome appears to be narrow with a high vault.

    In actuality the vault is of normal height but the sides of the hard palate are abnormally thick. This creates less space in the oral cavity for the tongue affecting both speech and mastication. Speech pathologists can be of help in teaching correct tongue positioning and increasing the tone of the orofacial musculature. With age, both the tongue and the lips in people with Down syndrome tend to develop cracks and fissures. This is a result of chronic mouth breathing. Fissuring of the tongue can become severe and be a contributing factor in halitosis.

    Patients should be instructed to brush their tongue when they brush their teeth. Another result of chronic mouth breathing may be a decrease in saliva with a dry mouth.