Dental Care Guidance for Caregivers of Patients with Down Syndrome

When it comes to heading to the dentist, there can be feelings of stress and anxiety. For patients with Down syndrome, these feelings can be much more intense. Our dental experts, Dr. Greg Grillo, and Dr. Andrew Jordan, have spent many years working with patients and caregivers on preparing for their dental visits and providing them with tips and care for instilling good oral hygiene habits.

“One of the best ways to help a patient with Down syndrome is to be their resource for excellent daily habits at home. Healthy routines usually mean less dentistry and easier visits, and the dental team can make suggestions for the best home care tools.”

Hablas Español? También tenemos este artículo aquí en Espanol, (Spanish).

Table of Contents

1. Dental Care for Patients with Down Syndrome | Printable Resources
2. The Most Common Dental Problems Seen in Patients with Down Syndrome
3. Dentists for Special Needs Patients
4. Finding the Right Dentist
5. The Question of Sedation
6. Dental Sedation Alternative
7. Preparing for the Appointment
8. Inquiring About Equipment Requirements
9. Making the Experience an Easy One
10. Practicing Proper Oral Hygiene at Home
11. Advocacy Organizations and How They Can Help
12. Down Syndrome and Dental Care
13. Resources

Printable PDF Resources

Dental Care and Down Syndrome – This printable PDF is an excellent guide for you to be able to share all the information we have collected on this page!

Questions to Ask Your Dentist Before an Appointment – Dr. Greg Grillo compiled a list of useful questions that you can print and take with you when you meet with prospective dentists.

The Most Common Dental Problems Seen in Patients With Down Syndrome

When compared to children without Down syndrome, patients are often seen with both baby and permanent teeth coming in at a later time. Delayed eruption is a prime example of the handful of common dental problems that are seen in patients with Down syndrome.

Although, some of the common dental problems are as a result of other factors, such as genetics, for example. This can make it difficult to distinguish what is the result of Down syndrome, genetics, habits, or any other factor.

Listed below are the most common dental problems that are seen in patients with Down syndrome:

1. Malocclusion
2. Malformed teeth or microdontia
3. Congenitally missing teeth
4. Crowding and/or impacted teeth
5. Problems with the jaw and bite
6. Complications with chewing
7. Inefficient natural cleansing action
8. Periodontal disease
9. Cavities
10. Dental caries
11. Gingival hyperplasia

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Dentists for Special Needs Patients

There are numerous dentists out there that care for patients with additional needs. Additional needs dentists are extremely beneficial because they are required to have an additional three years of dental training and know what your loved one needs.

Unfortunately, however, additional needs dentists can be difficult to find. Asking your local dental office for any information that could help you find one is one of the best ways to track one down, but you do have other options such as an advocacy organization for all different types of needs.

Why Going to the Dentist Can Be a Problem

Patients with Down syndrome can have a big fear of going to the dentist because they may not understand what is happening. For example, if they are wary around new people and do not like to be touched, having a stranger’s hands with tools in their mouth can be an overwhelming situation.

With this in mind, it’s important to help dental patients with their fear and anxieties as much as possible to ensure the visit goes as smoothly as possible. Thankfully, however, there are a handful of ways to make the visit easier on everyone.

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Finding the Right Dentist

Finding the right dentist for those with Down syndrome is extremely important. Be diligent in your search and don’t give up until you’ve found someone you’re confident is a good fit for them. There are a number of things to ask when deciding on a dentist that will help you decide who is best for your loved one.

1. Are you comfortable working with someone who has Down syndrome?

The dentist you choose should be comfortable working with patients with additional needs. If the patient is a child, start by searching for pediatric dentists. They have 2-3 years of extra schooling and may be able to accommodate better for their visit.

2. What experience do you have working with patients who have Down syndrome?

When asking a potential dentist this question it’s best to listen for specific examples of when they worked with patients with additional needs. Dentist with previous experience will be more comfortable overall in how to ensure a visit runs smoothly and that your loved one is at ease.

3. Can any special accommodations be made?

A good dentist should answer yes to this question. It should be their goal to make the patient as comfortable as possible and ensure their visit goes smoothly. Some accommodations that you may want to request are if you can stay near them throughout their visit, or if they can have a specific flavor of toothpaste. These may seem small but can make a difference in their overall dental experience.

“If you’re helping a loved one with their dental care, remember that you know them best. Be sure to share any tips with the dental team to help them provide the best care possible.”

These are just a few questions to get you started as you begin your search for a dentist. Remember, as a caretaker, you are in charge of the dental visit and no question you ask will be a bad one. The more information you have, the better the dental appointment will go.

You can look into finding the right dentist by first making contact with the local practices within your surrounding area. If none of them are a good fit, try using the ADA’s Find A Dentist search and directory. They may have options in your area that you didn’t find or already look into.

Asking your friends, family, doctor, or someone you know with a loved one with additional needs for recommendations. What’s more, your dental insurance provider may have some great choices for you as well. You may find the perfect dentist by asking around this way.

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The Question of Sedation

Patients with additional needs can sometimes benefit from being sedated with general anesthesia during the appointment. Sedation is sometimes necessary if they must have dental work done because their health is at risk and they do not want to cooperate with the dentist.

A lot of patients, in general, opt for sedation dentistry, so having it done for a patient with Down syndrome is not uncommon at all. Sedation dentistry, or “sleep dentistry”, helps to keep the patient calm and in a relaxed state. This type of sedation is not the same as being put under. Our services can help match you with a dentist that offers sedation methods.

There are a few different types of sedation that may be available at your dentist. They include:

• Inhaled minimal sedation: Breathing in nitrous oxide combined with oxygen to help relax. Your dentist is in complete control of sedation that is given.
• Oral sedation: Can range from minimal to moderate. This type of sedation is most commonly associated with sedation dentistry. The pill makes will make the patient drowsy while a more moderate dose may make the patient fall asleep.
• IV moderate sedation: A sedation drug is given through a vein and works more quickly. Your dentist will be able to continually adjust the sedation levels.
• Deep sedation & general anesthesia: Medication is given that will make the patient nearly or totally unconscious. While under general anesthesia you cannot easily be awakened until the effects of the medication wear off or are reversed.

“If sedation sounds like a good option, check for a dentist that provides sleep dentistry. Not only do they offer the right techniques, they often have the most experience dealing with anxious patients.”

If someone with Down syndrome suffers from severe behavioral issues, sleep apnea, Gastroesophageal Reflux Disease, Atlantoaxial/Atlanto Occipital Instability, or other diseases, you will have to take some necessary precautions before choosing sedation. It’s important to make sure that dental sedation is the safest option for the patient. This can be particularly important for major dental surgeries, pay particular attention to sedation options in these cases.

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Dental Sedation Alternative

If dental sedation will not be possible for your loved one with Down syndrome, there are luckily safe alternatives to allow them to receive the care that they need.

If your child has any tooth decay it can be treated safely with Silver Diamine Fluoride (SDF). This liquid can be brushed on teeth to help stop tooth decay and doesn’t involve any needles or drills. While this can help repair the tooth and stop the decay more dental work may be needed.

However, this is a great alternative, especially for children with Down syndrome if dental sedation will not be possible. Also, since sensory elements at the dentist can be more difficult for patients with special needs SDF is a quick and non-invasive treatment which makes it a great alternative to help them receive the care they need.

The average cost of SDF is rather affordable costing around $75 for treatment. If you’re worried about paying for this treatment for your child, SDF may be covered by certain health insurance plans as well as Medicaid. You can also speak with your dentist about working out payment plans as well.

Note that if you’re child is allergic to silver that this treatment will not be possible. If you are interested in learning more about SDF treatment for your child, talk with your dentist to discuss a plan for treatment.

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Preparing for the Appointment

Once you’ve chosen a dentist and scheduled an appointment, it will be time to prepare for the appointment. It is important to prepare ahead of time so your loved one has an idea of what to expect during their visit. There are a number of things you can do before their appointment to help them feel comfortable and prepared.

1. Find ways to visualize what happens at the dentist

Using visuals are a great way to see what happens at the dentist. This can be done with stories or videos and gives the future patient a way to make a connection between the visual and their dental appointment.

2. Visit the dentist early

Visiting the dentist prior to the visit can be beneficial because it allows patients to familiarize themselves with the environment such as seeing the lights and hearing the sounds. You and your loved one can meet the office and staff members and go over any accommodations that may need to be made.

When preparing for a dental visit, be sure to present it as a positive experience and focus on how important it is to take care of your mouth and teeth.

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Inquiring About Equipment Requirements

If your family member has equipment requirements that must be accommodated for their visit, make sure you inquire about them while making the appointment. For example, if they are in a wheelchair, you will want to make sure that the office has accommodations, such as a ramp outside to access the door before you book the appointment.

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Making the Experience an Easy One

Making the experience an easy one is a lot more simple than you may initially think. Bringing movies, toys or any other items that the patient loves is a great way to make uneasy feelings go away.

Asking for split treatments is also a great way to ease the stress and the anxiety of the appointment, as well. Split treatments are usually for patients who need to have quite a bit of work done, and are extremely beneficial for patients with additional needs. They help to ensure that the experience won’t be as prolonged or as stressful.

“If you are preparing your child with Down syndrome for their first dental visit, it may be helpful to schedule your regular cleaning on the same day as your child’s. This allows them to observe you in the chair, receiving dental care and gives them a sense of understanding and trust in the process.”

Practicing Proper Oral Hygiene at Home

The best way to avoid trips to an urgent care dentist center or (worse) an emergency room, it’s best to begin practicing good oral hygiene habits at home. Instilling habits from a young age is the best time to start, but for teenagers, young adults, or elderly individuals with Down syndrome, it’s never too late to start practicing good dental hygiene. Here are some important habits to start incorporating at home:

• Brushing twice a day

Brushing your teeth is important when it comes to overall dental hygiene. Brushing twice a day, once in the morning and once at night, is the best way to remove plaque and bacteria in the mouth. Try finding a fun toothbrush and a tasty flavor of toothpaste to make brushing an enjoyable experience. There are also interactive apps that sing and talk as you brush your teeth.

• Flossing

Flossing is so important but unfortunately many miss this step in their dental care routine. Flossing once a day at bedtime is the best way of removing any food or other particles that may have gotten stuck in your teeth throughout the day. You may need to help your loved one with flossing, as it can be more difficult. You can also purchase colorful floss picks that make it an easier, fun task.

• Eating healthy

Maintaining a healthy diet rich in vitamins and nutrients is key to having good oral hygiene. Fruits and vegetables are the best sources for the nutrients needed in having strong, healthy teeth and gums. It’s also important to avoid candy, juice, soda, and other foods high in sugar. While they can be enjoyed in limited quantities, they can cause cavities and tooth decay by wearing down your teeth’s enamel. For picky eaters, try working together to find healthy foods that they enjoy and encourage them to try new things.

Practicing oral hygiene at home is vital to having strong teeth and gums. It’s never too late to start a new healthy habit so always be encouraging and remind the patient of the importance of taking care of their mouth.

As Patients Age

As a patient with Down syndrome gets older these dental issues and complications may cause a higher rate of tooth loss than the average dental patient.

Dentures are a common practice in dentistry and it’s relatively easy to find denture specialists that work with patients with special needs. Just search, “denture labs near me” in Google or use our 24-hour service to find a denturist for your loved one.

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Advocacy Organizations and How They Can Help

Advocacy organizations provide caregivers a lot of beneficial information, especially where dental health is concerned. The National Down Syndrome Society has a number of resources available, including a database of health care providers. Also for Australian citizens please use http://www.downsyndrome.org.au/.

Advocacy organizations for different needs have helpful information, representatives you can ask for help, and a number of other relevant resources that can help you give them the proper care that they need and deserve in any instance.

Down Syndrome and Dental Care

Finding the proper resources that can help make their oral health regime and routines as easy as possible for them can be a bit of a challenge, but once the ball starts rolling you’ll find they’ll grow to learn and enjoy it as much as you do!
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Resources

http://www.ndss.org/Resources/Health-Care/Associated-Conditions/Dental-Issues-Down-Syndrome/
The National Down Syndrome Society is a wonderful advocacy organization for caregivers of someone with Down syndrome. They have advice, resources, etc.

http://dentaloncentral.com/dental-hygiene-for-special-needs-kids/
This website has beneficial information regarding proper oral hygiene for those who have a young child with additional needs.

http://www.colgate.com/en/us/oc/oral-health/conditions/developmental-disabilities/article/oral-care-for-patients-with-disabilities
This website has useful information for caregivers of someone with additional needs who need advice and “what to expect” for appointments at a dental office.

Finding a Dentist for Patients with Special Needs or finding a dentist for Autistic Patients.
Local directory and service for finding a dentist in your local community who specializes in serving patients with additional needs. There are a very limited number of dentists who truly do have the experience needed to help in this way.

http://www.downsyndrome.org.au/
Australia based website for advocacy and information surrounding Down syndrome.

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