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Clinic Seminar IV Leslie Bebber
Spring 2010
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Vital Statistics 34yr male
Ethnicity: Caucasian
Vitals: BP131/85, R16, P85
Height: 5ft
Unemployed
SES lower middle class
Lives with mother
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Family Past History
PaternalDiabetesHeart Disease Arthritis
MaternalCancer
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Medical History Frequent Headaches
Hearing Impairment
Hypothyroidism Blood Transfusions
Brain tumor removed in 1990
Down s Syndrome
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Medications Synthroid: thyroid
Desmopressin: urinary control Advair: Asthma
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Psychosocial Implications Dependent on family coping
mechanisms
Requires successful emotional adjustment by thefamily
The degree to which the family adapts to theillness will
determine the coping strategies andpsychological adjustment of both
child andfamily members
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Description of Condition Chromosomal disorder caused by the
presence of
all or part of an extra 21 st chromosome
Named after John Langdon Down in 1866
Associated with cognitive disabilities, andphysical growth
impairment
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Incidence and Prevalence 1 per 800 to 1,ooo births More common
with older mothers
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Etiology of Downs Syndrome
Most common cause of mental retardation & malformation in
anewborns Extra chromosome, number 21 Effects psychomotor,
cognitive and language development Short or truncated stature,
short fingers, toes, limbs and neck,
distinct facial features including small skull, slanting,
almondshaped eyes, flat-bridged nose and small oral cavity Tendency
to be overweigh Inability to ever reach normal growth development
Possibility of poor hearing, heart conditions, faster aging
Tendency to develop diseases of aging like Alzheimers at an
early
age Strabismus (crossed eyes)
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Simian Crease
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Oral Manifestation
Large, fissured tongue Mouth Breathing with anterior open bite
Short constricted palate Underdeveloped maxilla
Malocclusion Delayed exfoliation and eruption Small cone-shaped
teeth Hypoplastic enamel Rapidly progressive and aggressive
periodontal disease Cleft lip and/or palate in 5% Frequent
occurrences of NUG
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Radiographs
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Dental Management Short appointments with care giver
present Frequent breaks Distractions (areas of interest) Patient
may be on multiple medication for
various conditions as a result of the
Downs Syndrome Ultrasonic not contraindicated if patient will
tolerate
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Plan of Treatment Prophy
Fluoride Varnish
Floss
Polish
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Ethical and Legal Considerations
Patient may say he/she understands justto agree
It is vitally important to have the legalguardian sign any
medical/legaldocuments
Treat the patient with the same respectand thoroughness as any
other patient
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Prognosis Expected life span is 50 to 60 dependent
on severity and complications of condition
Dental: Fair (poor in lower anteriors)
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References Arron JR, Winslow MM, PolleriA (2006). NFAT
deregulation by
increased dosage of DSCR1 and DYRK1A on chromosome 21. Nature
441 (7093): 595-600.
Epstein CJ (June 2006). Downs syndrome: Critical genes in
acritical region. Nature 441 (7093): 582-3.
Nelson DL, Gibbs RA (2204). Genetics. The critical region
intrisomy21. Science Journal (5696): 619-21.
Underwood, J.C.E. (2004). General and Systematic Pathology(4 th
ed.). Edinburgh: Churchill Livingstone.
