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FORUMS > Down Syndrome
Replying to Topic: Teething
Created On 1/19/05 5:57 PM by GamZuLetovah


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GamZuLetovah
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1/19/05 5:57 PM
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I was interested to hear from other DS parents if they had any similar experiences. My son (16 mths ka"h) has been getting his teeth (finally) in a very funny order. First he got his two bottom front teeth (normal), but then all at once he is getting a whole bunch of molars (which is causing him and us many sleepless nights) and he still doesn't have his upper front teeth. I've heard of this happening with non DS children too, but I was wondering if there is any connection with DS and this order of things.


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bmr
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1/21/05 10:20 AM
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I'm not sure what all the following means, but it's from a review of the literature regarding DS and dental issues by Sindoor S. Desai. If my memory serves me correctly, there was an article by her in Exceptional Parent a few years ago. Anyway, there's a paragraph in here regarding eruption of teeth. My son's certainly came in at strange times in a strange order...

Dental anomalies
Microdontia. Thirty five percent to fifty five percent of Down syndrome individuals present with microdontia in both the primary and secondary dentition.22 Clinical crowns are frequently conical, shorter and smaller than normal. Spitzer (1963) described them as "stunted with short, small crowns and roots." Kissling (1966) examined tooth diameters and found that all teeth, except the upper first molars and lower incisors were reduced in size, but that the root formation was always complete.22 Root and crown ratios of central and lateral incisors were related to age. It was considered that short roots and unfavorable crown/root ratio of incisor teeth may contribute to mobility and subsequent tooth loss.23 The mandibular bicuspid is decreased in size but it shows normal shape. Peg shaped lateral incisors and shovel incisors are seen occasionally.20 The crown size reduction in the Down syndrome individual is considered of less relative magnitude than is the reduction in body size (stature).23 Spacing is common because of microdontia and can be corrected either by restorations or orthodontic intervention.
Hypoplasia. Hypoplasia and hypocalcification are common.20 Johnson et.al. (1965) found the incremental lines exaggerated in Down syndrome population.20 Tetracycline staining may occur as a result of the frequent necessity for antimicrobial chemotherapy in early life.20 Infants show generalized or localized congenital dental malformation ranging from intrinsic discolorations which are smooth to overt defects that are easily detected by a dental instrument.24 Hypoplastic defects are frequently the result of significant illnesses or prolonged fevers.24 Hypocalcified teeth should be under observation for early onset of decay. Depending on the degree of hypoplasia general recommendations would vary from sealants to smooth rough defects to bonding or restorations to full crown coverage. Topical fluoride application should be considered as a preventive measure.
Partial anodontia. Congenitally missing teeth are more common among individuals with Down syndrome (50%) when compared to the general population (2%), though the distribution of missing teeth is similar in both populations.22 Genetic modes of transmission are responsible for this condition. A relationship between partial anodontia and other ectodermal defects (mucous membrane, hair, skin) has been suggested.19 Further research indicated that this "Trisomic insult" will greatly increase the susceptibility of the host to partial anodontia, while not affecting specific tooth buds.22 The most frequently missing teeth in descending order are third molars, second bicuspids, lateral incisors, and mandibular incisors. The only teeth not missing are first molars.22 Sometimes the primary tooth will not be resorbed or will be resorbed so slowly that it can be retained well into adulthood.24 Treatment decisions should be made after reviewing the radiographs with concern for space maintenance. In the general population, the incidence of supernumerary primary teeth is approximately 0.3% while in the Down syndrome population the incidence is increased but the frequency is less than congenitally absent teeth.24 Crowding is not uncommon and seen more in the maxillary arch than the mandibular arch.24 Spacing is often seen.9
Tooth Agenesis. Agenesis is 10 times higher in Down syndrome patients than in the general population with a higher frequency in males than in females; higher in the mandible than in the maxilla, and higher on the left side than on the right.28 The teeth most affected by agenesis are mandibular central incisors, followed by maxillary lateral incisors, second premolars and mandibular second premolars. Canines and first molars are rarely affected. Agenesis of cannies and second molars has been seen in both the maxilla and the mandible whereas agenesis of the first molar has been seen only in the mandible.28 The pattern of agenesis may be related to the peripheral nervous system, which either branches differently in Down syndrome patients or which contains fewer branches, or nerves that do not grow peripherally to the same extent as in the normal population.28 Localized chondral components may also be a contributing factor because of the presence of abnormal cartilaginous tissue.28 It is important to correctly identify each tooth by clinical examination, especially mandibular central incisors, thus preventing mistakes in tooth identification due to early mesial drifting of the second incisors.
Dental caries. Low prevalence of dental caries in Down syndrome patients is a favorable factor in the clinical management of these individuals. Orner's study29 of the dental caries experience on Down syndrome contrasted with that of their unaffected siblings, showed that Down syndrome individuals had a caries experience less than one-third that of their siblings. Shapira et al.30 found that Down syndrome adults who were caries free had significantly, lower Streptococcus mutans counts compared with the patients with dental caries. Several factors are considered responsible for the low prevalence of dental decay. Delayed eruption, reduced time of exposure to a cariogenic environment, congenitally missing teeth, higher salivary pH and bicarbonate levels (providing better buffering action), microdontia, spaced dentition, and shallow fissures of the teeth all contribute to this lower risk of dental caries.31
Eruption of deciduous dentition. Tooth eruption is delayed in timing and sequence, particularly in maxillary and mandibular anterior teeth and first molars. Central incisors still erupt first and second molars usually last, but in between there is great deal of variation in the sequence of eruption.24 The first eruption is usually at age of 12 to 14 months but can be delayed up to 24 months.24 By the time the primary dentition is completed the child may be 4-5 years of age. Parental concern about anodontia can be relieved by simply palpating the mucosal tissue over an alveolar ridge. This will produce a blanching of the tissue in the shape of the underlying tooth.
Eruption of the permanent dentition. Like the primary dentition, first eruption in the permanent dentition is delayed. Six year old molars and mandibular incisors may not erupt till age of 8-9 years. It is not uncommon for a succedaneous tooth to erupt without the primary tooth being shed. This is usually true for anterior maxillary and mandibular teeth from canine to canine.24 The dentist may need to extract the retained teeth. The chronological sequence of eruption in Down syndrome is not much different from the general population. The least affected teeth are upper and lower first molars and central and lateral incisors.32 Asymmetries between sides of the jaw mainly affect the canines and premolars. Alteration in eruption sequence timing and asymmetry seem to be less frequent between 7-9 years of age and more frequent between 10-14 years of age. Despite this, children with Down syndrome maintain a certain similarity in sequence and symmetry in comparison to normal children.32

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momofds
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2/2/05 7:30 PM
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All of the children that I have met to date with DS (including my 3 year old son with DS) have a very funny tooth eruption pattern. They all got their molars in first!!! My son was almost 3 when he got his front teeth in. When he got his front teeth in, he also got a lot of teeth at one time (approx 6-8 teeth). B"H having teeth has helped him greatly with his oral motor abilities, and he can now CHEW some foods. Just give motrin or tylenol and orjel for the pain.
Hatzlacha!
 
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GamZuLetovah
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2/3/05 9:53 AM
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Thank you!


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GamZuLetovah
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2/3/05 9:55 AM
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BMR,

If someone could only translate this to English


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bmr
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2/3/05 8:37 PM
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A translation into plain English would be nice...Any dentists reading this?
What I understood is that which I have seen in my own son: microdontia - the strange size and shape of his teeth, fewer dental cavities (something good!), and again the strange time and order of eruption. My son just lost his last baby tooth - at almost 15 years old. Whatever it all means, it certainly takes effort to oversee that he's brushing well - a couple of teeth are literally one behind the other. I'm pushing off orthodontics until he's older. I think he'll handle it better the more mature he gets. (I know this sounds a bit far off if you're dealing with a 16 month old, but time does fly!!)
Kol tuv
 
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bmr
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2/3/05 9:09 PM
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One more thing...
for all those parents of kids with Downs - there's loads of medical info (whether it's dental issues, RSV, cardiac issues - whatever's been coming up here and loads more) to be found at ds-health.com
It's a website by a pediatrician who is also a parent of a kid with DS. And, most of it is in plain English!!
 
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