Dental management strategies for patients with Down’s syndrome

We have all studied about Down’s syndrome in our dental curriculum. We all know it’s a chromosomal disorder with an extra chromosome (trisomy21). We are aware of its prevalence, oral manifestations, and even the treatment. But how confident are we to treat a patient when they enter our practice? Is it possible to miss some life-threatening conditions? In this article, I would like to stress upon some factors which are important and probably we might give it a miss.


  1. Know what to expect

It’s important to know what oral manifestation to expect when a Downs syndrome patient walks in our practice. Early onset of periodontal problems, delayed eruption, congenitally missing permanent teeth, hypodontia, microdontia, macroglossia, tongue thrusting, clenching, mouth breathing are some of the usual findings in a Down’s syndrome patient.


  1. Don’t ignore the underlying medical condition

The patient might have a history of epilepsy, cardiac disorders, fragility of cervical vertebrae/spinal cord, compromised immune system, hypothyroidism, increased risk of leukemia or even hearing or vision loss. Take a detailed medical history and informed consent. Consider taking a medical consultation before initiating therapy. Prophylactic antibiotics may be considered in patients with cardiac abnormalities. Know the management of epilepsy. Be aware of status epilepticus which can be potentially life-threatening.  Use pillows to comfort patients with atlantoaxial instability.


  1. Behavioral management is the key

Plan a prior appointment with the parent or caregiver to understand the special needs of the patient. It’s important to determine the intellectual need so that you can talk at a level that the patient understands. Schedule early morning appointments. Use Tell-Show-Do approach when introducing new instruments and procedures. Use short clear instructions. Reward cooperative behavior with positive verbal reinforcement.

By knowing these strategies before treating patients with Downs syndrome, we clinicians will be better prepared to make a positive difference not only in their oral health but on their quality of life as well.


About the author:

Dr. Paresh Lotlekar is the Founder and CEO at Studio32 Dental Care Pvt. Ltd. He has completed his BDS from Goa Dental College and Hospital and MDS from the prestigious KLE University, Belgaum. He offers passionate insight and smart advice on oral health and wellness through his blogs. Connect with him at

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