Possibilities of orthodontic-orthopaedic treatment in patients with Down syndrome, based on review of literature and on own observations

Patients with Down syndrome often suffer from protruding tongue, various dental and occlusal anomalies. Characteristic features of midface hypoplasia in Down syndrome include smaller maxilla, narrower bridge of the nose and presence of “stair” palate. Possibilities of an active orthodontic treatment and its impact on tongue position, oral hygiene, quality of speech and bruxism in patients with Down syndrome, treated orthodontically at the Orthodontic Department Medical University of Lodz. Various types of malocclusions including maxillary hypoplasia, total mesiocclusion, pathological attrition of primary molar due to bruxism, total distocclusion with primary crowdings, persistent infantile type of swallowing were observed. During first phase of treatment, upper plate by Castillo Morales was used; in the second phase patients are currently undergoing active orthodontic treatment with Schwarz plates. The state of oral hygiene was assessed using OHI Index by Green and Vermillon. Glossogram was made in order to assess the tongue position. The state of oral hygiene was sufficient both in the maxilla and in the mandible with OHI values 1.67 and 2.0, respectively. The position of tongue and the pronunciation of polish sounds m,b,p,r. during spontaneous speech improved during orthodontic treatment. In patients with Down syndrome correct speech can be restored and facial aesthetics improved through orthodontic rehabilitation. Nevertheless, the state of oral hygiene proved to be unsatisfactory.