Prevalence of Dental Caries and Periodontal Status among Down's Syndrome Population in Riyadh City.

AIM: Aim of the present study was to evaluate the prevalence of dental caries and periodontal status among Down's syndrome population in Riyadh City.
MATERIALS AND METHODS: A total of 81 male Down's syndrome subjects were examined in this study. All subjects were recruited from the Saudi Center for Down Syndrome, Riyadh. Clinical examination was carried out by a single precalibrated examiner. Dental caries experience was counted according to the DMFT (decayed, missing, and filled teeth) indexes. Periodontal status was evaluated by using plaque and gingival indexes. Statistical analysis was performed using SPSS 19 version. Consequently, Pearson chi-square test and Fisher exact test was used to calculate p-value for parametric variables.
RESULTS: In this study 11.1% of the subjects were not having any decayed teeth, 39.5% were not having any missing teeth, and 55.6% were not having any filled teeth. In plaque index, maximum number of subjects in all the age group were in the fair group, and there was a highly significant (P value <0.001) association between the age group and the plaque index groups. In gingival index, maximum number of subjects in all the age group was in the poor group. No significant (P value = 0.697) association between the age group and the gingival index groups was found.
CONCLUSION: The present study concluded that the prevalence of dental caries was high and periodontal status of Down's syndrome subjects was poor.

INTRODUCTION

Down’s syndrome is a genetic disorder caused by the presence of all or part of an extra 21st chromosome. It is named after John Langdon Down, the English physician who initially characterized the appearance and behavior of these patients in 1866, and is one of the most common causes of mental retardation in children. The disorder was later identified as a chromosome 21 trisomy in 1959. The incidence of Down’s syndrome is estimated at 1 in 600–1000 live births, though those statistics are influenced by several factors, in particular, the age of the mother.[12]

Periodontal status of both the primary and the permanent dentitions is affected by a rapidly progressing and severe inflammation in more than 50% of patients with Down’s syndrome. There are defects of chemotaxis of polymorphonuclear and other phagocytes, which explain the high incidence of pocketing and marginal bone loss in these individuals.[3]

There are numerous oral abnormalities and the oral status of these individuals has been well reported. Factors such as dental anomalies, malocclusions, and motor disorders (coordination skills) can make it difficult for a Down’s syndrome person to maintain a good oral hygiene independently, but more complex pathologies such as cardiac diseases, suppressed immunity, and respiratory and hematological problems may also aggravate a dental treatment.[4]

As the life expectancy among this population is increasing, school, work, and community settings are becoming the norm for Down’s syndrome persons. The demand for dental care for this group with special needs is also increasing with this incidence trend, and thus every practitioner should have a clear understanding of Down syndrome’s unique characteristics that would undoubtedly influence their dental care and treatment.[5] The aim of this article was to identify the prevalence of dental caries and periodontal status among Down’s syndrome population in Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study was planned to assess the dental caries and periodontal status of Down’s syndrome subjects in Riyadh. A total of 81 male Down’s syndrome subjects were examined in this study. All subjects were recruited from the Saudi Center for Down Syndrome, Riyadh. Consent was obtained from both the parents and the concerned authority to carry out the study. Subject’s age between 16 and 40 years was considered in the study. The inclusion criteria implemented were as follows: (1) cytogenetic diagnosis of trisomy 21, (2) adequate cooperation from the children, and (3) informed consent from the children’s legal representatives. The exclusion criteria were detrimental systemic diseases, compound disability, and extremely uncooperative children.

Examination

Clinical examination was carried out by a single precalibrated examiner in the respective institutions using artificial light, plain mouth mirror, and periodontal probe. Prior to conducting dental examination, demographic information was obtained from each subject. Information regarding oral hygiene practices, dietary habits, and the parent’s educational background was provided by participants’ parents.

Dental caries assessment

Dental caries experience was counted according to the DMFT (decayed, missing, and filled teeth) indexes.

Periodontal status

Periodontal status was evaluated by Silness and Löe plaque index (PI) (plaque accumulation and the gingival index), which determines the amount and location of dental plaque. A plaque disclosing agent was not used during examination. An examination of plaque was performed visually and using probe.

The scale of assessment was as follows:

0: Excellent

0.1–0.9: Good

1.0–1.9: Fair

2.0–3.0: Poor

Statistical analysis

All the records were coded and statistical analysis was performed using SPSS version 19. Consequently, Pearson chi square test and Fisher exact test was used to calculate P-value for parametric variables. The level of significance was set at P < 0.05; confidence interval = 95%.

RESULTS

Table 1 shows the descriptive analysis of prevalence of dental caries among Down’s syndrome subjects; 11.1% of the subjects were not having any decayed teeth, 39.5% were not having any missing teeth, and 55.6% were not having any filled teeth. Maximum subjects (i.e., 16 subjects) had three decayed teeth. And one subject had 14 decayed teeth. Fourteen subjects (17.3%) had two teeth missing. And 10 subjects had two filled teeth.

Table 1

Descriptive analysis of prevalence of dental caries among Down’s syndrome subjects

Number of teeth affected	Decayed teeth n (%)	Missing teeth n (%)	Filled teeth n (%)
0	9 (11.1)	32 (39.5)	45 (55.6)
1	4 (4.9)	9 (11.1)	7 (8.6)
2	10 (12.3)	14 (17.3)	7 (8.6)
3	16 (19.8)	6 (7.4)	10 (12.3)
4	10 (12.3)	5 (6.2)	3 (3.7)
5	8 (9.9)	4 (4.9)	3 (3.7)
6	11 (13.6)	3 (3.7)	4 (4.9)
7	6 (7.4)	2 (2.5)	1 (1.2)
8	0	2 (2.5)	1 (1.2)
9	2 (2.5)	1 (1.2)	0
10	4 (4.9)	0	0
11	0	2 (2.5)	0
12	0	0	0
13	0	1 (1.2)	0
14	1 (1.2)	0	0

Table 2 shows the association of age group of Down’s syndrome subjects with PI groups. In all the age groups, maximum number of subjects were in the fair group (16–20 years: 41, 21–25 years: 14, 26–30 years: 3, 31–35 years: 2, 36–40 years: 1 subjects). A highly significant (P value <0.001) association between the age group and the PI groups was found.

Table 2

Association of age group of Down’s syndrome subjects with plaque index groups

Plaque index groups	Age groups (years)					χ2	P value
	16–20	21–25	26–30	31–35	36–40
0. Excellent	0	0	1	0	1	32.727	0.001
1. Good	10	0	0	0	0
2. Fair	41	14	3	2	1
3. Poor	5	2	1	0	0

Table 3 shows the association of age group of Down’s syndrome subjects with gingival index groups. In all the age group, maximum number of subjects were in the poor group (16–20 years: 44, 21–25 years: 12, 26–30 years: 5, 31–35 years: 2, 36–40 years: 2 subjects). No significant (P value = 0.697) association between the age group and the gingival index groups was found.

Table 3

Association of age group of Down’s syndrome subjects with gingival index groups

Gingival index groups	Age groups (years)					χ 2	P value
	16–20	21–25	26–30	31–35	36–40
0. Excellent	0	0	0	0	0	5.551	0.697
1. Good	5	0	0	0	0
2. Fair	7	4	0	0	0
3. Poor	44	12	5	2	2

DISCUSSION

Down’s syndrome is characterized by central growth deficiency with delayed mental and physical development ranging from mild to severe. Furthermore, manual dexterity difficulties may lead to oral hygiene problems, which may lead to accumulation of plaque and debris, hence favoring development of dental caries and periodontal disease.[6]

Low caries experience has been reported in Down’s syndrome children in many countries.[78] A number of studies on oral health status of healthy Saudi children have shown a high caries prevalence in Riyadh.[910] The present study also revealed a high caries prevalence and severity among the Down’s syndrome subjects in Riyadh. This is not in agreement with the study on Down’s syndrome patient in other countries that showed a low caries prevalence as well as a high number of caries-free Down’s syndrome patients.[11] The low caries prevalence in Down’s syndrome children appears to be due to immune protection caused by the elevated salivary Streptococcus mutans–specific IgA concentrations and a simpler occlusal morphology.[12] However, it seems that suboptimal oral hygiene status among the study population has neutralized the above-stated advantages.

There are many factors that can aggravate a dental procedure when treating children and especially those with Down’s syndrome. However, common characteristics such as being quiet, passive, natural spontaneity, genuine warmth, loving music, gentleness, tolerance, and honesty can make a treatment approach possible without sedation. Despite the adequacy of low IQ and delayed mental development, Down’s syndrome individuals have different characters as well as different levels of inabilities, where it has been shown that moderate-to-mild mentally retarded individuals are mobile, functional, and can perform well and are highly motivated during workshops.[13]

Gingival status in the present study reveals maximum number of subjects under poor group. Similarly periodontal disease in Down’s syndrome individuals has been first described by Nash, where she reported that 90% of Down’s syndrome patients exhibit some evidence of periodontal disease. The sample that author examined included children below 7 years and she suggested that the gonads hypofunction is the main reason, which is not accepted nowadays.[14] The occurrence of periodontal disease in Down’s syndrome patients is mostly due to defective immune system rather than poor dental hygiene. All of the longitudinal studies along with the cross-sectional studies reported that the prevalence of periodontal disease in Down’s syndrome individuals is very high and can rapidly progress especially in the young age groups.[1415]

CONCLUSION

The present study concluded that the prevalence of dental caries was high and the periodontal status of Down’s syndrome subjects was poor. Oral health promotion programs should be aimed specifically at special needs centers and parents of Down’s syndrome subjects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.