*Marta Ziętek, Urszula Kaczmarek
Oral hygiene and periodontal status in children and adolescents with Down syndrome
Stan higieny jamy ustnej i przyzębia u dzieci i młodzieży z zespołem Downa
Department of Conservative and Paediatric Dentistry, Wroclaw Medical University
Head of Department: Professor Urszula Kaczmarek, PhD, MD
Streszczenie
Wstęp. Zespół Downa, najczęściej spotykana aberracja chromosomowa, jest zespołem wad wrodzonych spowodowany obecnością dodatkowego chromosomu 21. Cechom dysmorficznym i wadom układowym w całym organizmie towarzyszy różnego stopnia niepełnosprawność umysłowa. Wady zgryzu, dysproporcja między rozwojem narządu żucia a językiem, a także nieprawidłowy tor oddechowy, gorsza higiena oraz słabsze samooczyszczanie (zmniejszona sekrecja śliny) implikują rozwój chorób przyzębia u osób z zespołem Downa.
Cel. Określenie stanu higieny jamy ustnej oraz stanu przyzębia u dzieci i młodzieży z zespołem Downa w odniesieniu do osób zdrowych.
Materiał i metody. Badaniem objęto 150 osób obojga płci w wieku od 5 do 21 lat, w tym 75 chorych z zespołem Downa (grupa badawcza) i 75 ogólnie zdrowych (grupa kontrolna). U wszystkich badanych przeprowadzono badanie kliniczne jamy ustnej oceniające poziom higieny (uproszczony wskaźniki OHI-S i aproksymalny wskaźnik płytki – API) i stan przyzębia (wskaźnik dziąsłowy GI wg Löe i Sillness’a i zmodyfikowany wskaźnik krwawienia z kieszonki dziąsłowej – mSBI).
Wyniki. Frekwencja zapaleń przyzębia u chorych z zespołem Downa wynosiła 100%. Chorych w porównaniu ze zdrowymi cechował gorszy stan przyzębia – zarówno wartości wskaźnika GI, jak i mSBI były istotnie wyższe (0,90 ± 0,56 vs. 0,39 ± 0,53; 70,99% ± 27,65% vs. 26,69% ± 34,94%; p < 0,001). Zanotowano istotnie wyższą niż u zdrowych wartość wskaźnika OHI-S 1,68 ± 0,68 (vs. 1,32 ± 0,76) oraz wskaźnika API (86,66% ± 17,78%; vs. 66,34% ± 34,33%; p < 0,001).
Wnioski. U chorych z zespołem Downa w porównaniu ze zdrowymi stwierdzono istotnie gorszy stan higieny jamy ustnej i gorszy kliniczny stan przyzębia.
Summary
Background. Down syndrome, the most common chromosomal aberration, is a congenital disorder caused by having an extra 21st chromosome.
Dysmorphic features and characteristic systemic defects are accompanied by mental disability of varying degree. Malocclusions, disproportion between the development of masticatory system and the tongue, abnormal respiratory tract, poor oral hygiene, and reduced salivary secretion contribute to the development of periodontal diseases in patients with Down syndrome.
Aim. The aim of the study was to assess oral hygiene and gingival health status in children and adolescents with Down syndrome compared to generally healthy subjects.
Materials and methods. The study included 150 subjects of both genders, aged between 5 and 21 years. The research group comprised of children and adolescents with Down syndrome (n = 75) and a control group with generally healthy individuals (n = 75).
Oral hygiene status was assessed using the oral Hygiene Index -Simplified (OHI-S) and the Aproximal Aproximal Plaque Index (API). Periodontal status was assessed using the Gingival Index (GI) and the Sulcus Bleeding Index (SBI).
Results. The prevalence of periodontitis among patients with Down syndrome reached 100%. GI and SBI values were significantly higher in Down syndrome group compared to control group (0.90 ± 0.56 vs . 0.39 ± 0.53; 70.99% ± 27.65% vs 26.69% ± 34.94%, respectively; p < 0.001). OHI-S and API values were also significantly higher in Down syndrome patients compared to healthy individuals (1.68 ± 0.68 vs 1.32 ± 0.76, p < 0.01; 86.66% ± 17.78 vs 66.34% ± 34.33, p < 0.001).
Conclusions. Patients with Down syndrome had significantly poorer oral hygiene and worse periodontal health status compared to healthy individuals.
Introduction
Down syndrome (DNS) is the most common autosomal chromosome abnormality in humans, covering a spectrum of characteristic traits. In 1959, DNS was found by Lejeune to be caused by the presence of an extra copy of chromosome 21 (1).
Chromosome 21 is the smallest human chromosome. It is classified as belonging to the G group of chromosomes responsible for the somatic development of reproductive organs, pelvis, heart, epicanthic folds, iris, lens, paranasal sinuses, phalanges and metacarpus, palmar and plantar dermatoglyphics, as well as muscle tone, cartilage and tendon elasticity, proportion between limbs and the trunk, and cranial proportions. The chromosome also determines the auricular shape, quality and quantity of hair, size of teeth, thickness of neurocranial bones, and intelligence and intellectual development (2, 3). The presence of an additional copy of chromosome 21 (or its long arms) causes metabolic disorders, internal organ defects, tissue dimorphism, and characteristic phenotypic features with varying degrees of mental retardation (3-7).
Oral cavity abnormalities such as malocclusion and disproportion in growth between the masticatory system and the tongue – as well as abnormal breathing patterns, poorer hygiene due to impaired manual skills and lower self-cleaning ability (reduced secretion of saliva) – imply the development of caries and periodontal diseases in patients with Down syndrome (8).
In addition to topical factors, an important role in the development of periodontal diseases is attributed to generalized factors including impaired circulation leading to tissue hypoxia, reduced immunity, and propensity to infections, as well as systemic endocrine dysfunction. The first symptoms of periodontal diseases occur as early as between 6 and 15 years of age. The disorders may take the form of marginal gingivitis, acute or subacute necrotizing gingivitis, advanced periodontitis, gingival recessions as well as vertical and horizontal bone atrophy. A factor predisposing to the development of periodontitis is the presence of specific bacterial flora including Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, forming the so-called “red complex” (9-14).
Aim
The aim of the study was to determine the oral hygiene and periodontal status in children and adolescents with Down syndrome compared to healthy individuals.
Material and methods
A total of 150 subjects of both sexes (66 boys and 84 girls) aged between 5 and 21 years were selected for the study. The study group comprised children and adolescents with Down syndrome (n = 75), pupils of the Special School and Educational Centre No. 8 and 9, and the Special School and Educational Centre No. 10 in Wroclaw. The control group consisted of generally healthy children and adolescents (n = 75), age- and gender-matched to the study group, receiving dental treatment at Stomatologiczne Centrum Transferu Technologii Sp. z o.o., NZOZ Akademicka Poliklinika Stomatologiczna (University Dental Polyclinic) in Wroclaw.
The clinical oral examination evaluating the level of oral hygiene and periodontal status was carried out at the University Dental Polyclinic under artificial light, using a standard mouth mirror and a WHO-621 probe. The results of the examination were recorded in a specially prepared study sheet. The parents/carers were requested to fill in a questionnaire containing questions about the hygiene habits of the study patients. Questions asked in the survey included whether the child brushes his/her teeth, whether he/she performs this activity on his/her own or with the help of parents, when the child last brushed his/her teeth, whether the child cleans his/her teeth with a manual or electric toothbrush, and whether he/she uses dental floss, interdental brushes, toothpicks, and chewing gum.
Oral hygiene was evaluated using the Oral Hygiene Index-Simplified (OHI-S) of Greene and Vermillion, and the Approximal Plaque Index (API). The periodontal status was assessed using the Gingival Index (GI) of Löe and Sillness, and the modified Sulcus Bleeding Index (mSBI).
The results were analyzed statisically using the chi-square test, Pearson correlation coefficient and analysis of variance. The level of significance was p ≤ 0.05.
The study was approved by the Bioethics Committee at Wroclaw Medical University (approval no. KB – 71/2014).
Results
The prevalence of periodontitis in patients with Down syndrome was 100% and was thus 14.7% higher than in the healthy controls (100.0 vs. 85.3%; p < 0.001) (fig. 1).
Fig. 1. Frequency of periodontitis
The DNS patients had a poorer periodontal status compared to the healthy controls, as evidenced by significantly higher GI and mSBI values (p < 0.001). However, even though the GI level was approximately 3 times higher in the DNS patients than in healthy controls (0.90 ± 0.56 vs. 0.39 ± 0.53), the values obtained in both groups were in the range of 0.1-1.0, indicating mild gingivitis.
The mSBI value, which was equal to 70.99% ± 27.65 in the DNS patients, indicates severe generalized gingivitis, while the value of the index in the healthy subjects (26.69% ± 34.94) suggests mild gingivitis (tab. 1).
Tab. 1. Periodontal status
| | Study group | Control group | Significance of differences |
| Indices | x ± SD | x ± SD | |
| mSBI (%) | 70.9 ± 27.65 | 26.69 ± 34.94 | p < 0.001 |
| GI | 0.90 ± 0.56 | 0.39 ± 0.53 | p < 0.001 |
Oral hygiene was worse in the DNS patients than in the healthy individuals, too. The mean OHI-S score was 1.68 ± 0.68 including the Debris Index (DI-S) of 1.58 ± 0.65 and the Calculus Index (CI-S) of 0.10 ± 0.14. The values of the Debris Index (DI-S) were found to be significantly higher (p < 0.01) in the DNS patients compared to the healthy controls, contributing to significantly higher values of the Oral Hygiene Index (OHI-S). There were no significant differences between the values of the Calculus Index (CI-S).
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