Oral Health Status and Tooth WearEtiology and Management in a Group ofChildren with Down Syndrome

Abstract

The present study consisted of two studies. At first a cross- sectional study was carried out to assess oral health status and prevalence of tooth wear in a group of Down syndrome (DS) children and matched healthy controls. The second study was a clinical trial study where different management strategies were implemented to control tooth wear in DS children. Assessment of these strategies was carried out for 1 year, thereafter. The study was conducted on a total of 200 children that were divided into two groups. One hundred children with cytogenically confirmed DS constituted the study group (Group I). Matched systemically healthy children constituted the control group (Group II). The present study comprised a questionnaire that included social, medical , and dental history. An extraoral examination and intraoral examination were carried out, dental caries experience was determined in both groups using the deft index in the primary dentition and DMFT index in the permanent dentition. In the mixed dentition, the deft and DMFT scores were recorded and summed separately[117].Oral hygiene and gingival assessment were done using OHI-S and GI respectively[118,119]. Recording tooth wearwas carried out by takingan alginate impression from which dental models were made as well as intraoral photographs. Tooth wear severity was assessed and recorded at base line using tooth wear index by Smith and Knight[88].A seven days diet history sheet was provided for children in both groups to assess the erosive potential of diet. At the end of clinical examination , all patients were counseled about the importance of maintaining good oral hygiene, healthy diet and its effect on the oral health status and levels of tooth wear.All children with dental needs were referred to the outpatient clinic of the Pediatric Dentistry Department, Ain Shams University.Children with DS (Group I) that were diagnosed with TW, were further classified into 3 subgroups according to the etiology of tooth wear, and different management strategies were implemented.Monitoring the progression of tooth wear was undertaken by means of periodic examinations every 6 months for 1 year to assess the effect of management on tooth wear severity in different subgroups. In these examinations, tooth wear was recorded, using TWI. Impressions were taken to make good quality study casts, and a putty index was made. A higher incidence of GERD and CHDoccurring in association with DSwere found in the present study. Developmental oral abnormalities such as high arched palate, congenitally missing teeth, geographic and fissured tongue, peg-shaped lateral incisors,enamel defects, as well as delayed eruption were significantly higher in DS group than the control group.Bruxism and mouth breathing were also significantly more common in DS than in control children. The present study provides further evidence that caries prevalence is low in DS children as both deft and DMFT scores were significantly lower than controls. Poor oral hygiene and gingival inflammation were found in DS group, suggesting an increased need for oral health instruction for these patients. Results of the present study also showed that DS group had statistically significant higher percentage of children with TW than control group.Statistical analysis revealed that DS group showed a higher statistically significant percentage of children with different tooth wear etiology compared to the control group. Assessment of progression of TW in the different subgroups ( attrition, erosion, multifactorial) after management and 12 months follow up revealed that stationary tooth wear was significantly more prevalent than progressive tooth wear in all subgroups. Statistical analysis showed that children with DS who consume diet with high risk of erosion had significantly higher TWI scoresand progressive tooth wear after 1 year.