Dental Healthcare and Muscular Dystrophy

Muscular dystrophy is a group of degenerative diseases that cause weakness and the loss of muscle mass. It occurs mainly in boys, and can appear as early as age three. Patients who are not treated are usually unable to walk by the time they’re about ten. While advances in medicine have extended the lifespans of some patients, muscular dystrophy is often fatal by the late teens because of respiratory or heart problems.[1]

Special Needs Dentistry
Interested in more Special Needs

Dentistry posts from CDA? Click here.

The term muscular dystrophy (MD) refers to more than thirty conditions, the most common of which is Duchenne muscular dystrophy (DMD). It isn’t known how common other forms are, in part because symptoms can vary so much from one patient to the next. This article mainly describes Duchenne MD, but also considers Becker (BMD). BMD is similar to DMD, but the symptoms are not as severe, and it progresses more slowly.[2]

Muscular dystrophy brings on a host of life challenges, including proper dental care. The Center for Dental Anesthesia in Alexandria is equipped to treat patients with MD and other special needs.

A Cruel Disease

Muscular dystrophy is a particularly cruel disease. Children who are diagnosed with it gradually lose their ability to walk, move their arms and hands, and even to breathe easily. In about a third of all cases there is no family history of the disease. While medication and physical therapy can slow its progress there is currently no cure, nor can it be prevented or reversed.[3]

Suzan Norton’s son Mike was diagnosed with DMD when he was four years old, and the news devastated her. “I spent the next six months in chronic sorrow,” she recalls. “But one day I woke up and knew we could be OK.” She and her family got involved with the Muscular Dystrophy Association and learned to have hope. “MDA and all its resources are there to help.”[4]

In 1986, research supported by MDA identified a gene on the X chromosome that, if it mutates, leads to DMD. Women are DMD carriers, but carriers don’t usually have any signs or symptoms.[5]

MD and Dentistry

MD patients and their loved ones face challenges every single day, and the disease remains a grim subject. “I can fight with it,” one MD patient said bluntly, “but I can’t beat it.”[6]

The effects of MD do not spare the muscles of the face and mouth. Consequently, it can have a major impact on dental health, leading to these common issues:

  • Chewing difficulties
  • Swallowing difficulties
  • High rates of malocclusion (improper bite alignment)[7]

People with DMD are also more likely to have poor dental hygiene. Even with help from caregivers, it may be difficult for the patient to open his jaw or move his tongue out of the way. It is common to find higher than ordinary rates of tooth decay, plaque buildup, poor gum health, and poor dentition.[8]

At home, most patients will eventually need help brushing and flossing their teeth. Whoever has this responsibility must understand that patience and skill are necessary so that their efforts are successful. In order to maintain the patient’s dental health, caregivers should make sure that:

  • Teeth are brushed daily
  • Teeth are flossed daily
  • The patient has regular dental checkups[9]

Many of the issues that make everyday life a challenge for MD patients are present in the dentist’s office. Since many are in a wheelchair by the age of ten, just getting into the office may be a challenge. The Center for Dental Anesthesia is fully wheelchair accessible, and many dental practices throughout the United States follow that example. Some patients, of course, are able to walk but may be more likely to fall. Dental professionals should take appropriate precautions.[10]

Never Give Up Hope

New and better treatments for DMD and other forms of muscular dystrophy are developed all the time, and Suzan Norton tells people like herself, whose loved ones have the disease, to remain optimistic. “Surround yourself with inspirational and positive people,” she advises. “Let your love for your child give you strength. Never give up your hopes and dreams.” Her son has graduated from high school and has many friends, including a girlfriend. “He’s taught me more than I’ve taught him.”[11]

Dr. Mady is always here to provide
honest and gentle dental care … and
would be happy to speak with you
soon and help you design a treatment
plan that’s right for you.

Caregivers and the loved ones of people with MD must be proactive in the management of their dental care. The combined effects of the progression of the disease and the weakening of the facial muscles means there must be constant vigilance.

No matter your age or physical condition, good dental health is important. It should never be viewed as some kind of bonus. At the Center for Dental Anesthesia in Alexandria, we believe that no one should be without quality dental care because of a physical limitation. Our entire facility is wheelchair accessible and provides specialized dental chairs and equipment. Each team member is familiar with relevant protocols, and has years of experience in providing dental healthcare to patients with DMD and other special needs. Please call our office to schedule an appointment.

For anyone with a loved one facing the challenges of muscular dystrophy, you can read about the latest in medical management, and find other useful information, on the Muscular Dystrophy Association website.



[1] Mayo Clinic website. Referred to hereafter as Mayo Clinic.

Lifespans: “Patients living longer with Duchenne muscular dystrophy pose new challenge for caregivers,” Science Daily website. Referred to hereafter as “Lifespans.”

[2] “Muscular Dystrophy.”

More than thirty forms: “All About Muscular Dystrophy,” Referred to hereafter as All About.

[3] Mayo Clinic.

[4] “Facts About Duchenne & Becker Muscular Dystrophies.” referred to hereafter as Facts.

[5] “Duchenne Muscular Dystrophy (DMD).” Referred to hereafter as DMD.

[6] Quote: “21 Truths People With Muscular Dystrophy Wish Others Understood.”

[7] Parent Project Muscular Dystrophy, referred to hereafter as Parent Project.

[8] Parent Project. Note: since most MD patients are male, this article forgoes gender-neutral language.

[9] Dental Care Every Day: A Caregiver’s Guide.

[10] Muscular Dystrophy – CDHO (College of Dental Hygienists of Ontario).

[11] Facts.


Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia

Aging and Dental Health

Not so long ago it was taken for granted that serious memory impairment was a normal part of aging. While some memory loss is common as people get older, and while we can joke about “senior moments,” the notion that mental decline is inevitable is just plain wrong.[1]

Special Needs Dentistry
Interested in more Special Needs

Dentistry posts from CDA? Click here.

Yet mental decline does happen, and far too often the effects of aging have a negative impact on a person’s dental health. While the reasons for this are varied, the team at the Center for Dental Anesthesia in Alexandria believes that advancing age does not have to mean poor dental health.

A lot of people aren’t even sure how to refer to mental decline. They call it dementia, or even the outdated “senility.” But dementia is really a general term that describes a group of symptoms like reduced attention span, impaired learning ability, and – yes – memory. It is only when these symptoms begin to interfere with daily life that they become an issue. This article uses the term dementia in its broadest sense and acknowledges that it is an imprecise term.[2]

Regardless of what it’s called, dementia is a major disorder with many implications. “As dementia progresses … oral care can be forgotten,” wrote the authors of a paper on aging and dental care. “There can be a disinterest by the individual affected by dementia in dental maintenance and a reduction in the physical ability of the individual to maintain their oral health and communicate dental problems.”[3]

The Center for Dental Anesthesia specializes in Special Needs Dentistry and treats patients who are coping with declining cognitive ability due to the effects of aging.

Frightening Matters

Dementia is caused by damage to brain cells, which hinders their ability to communicate. This in turn affects thinking and behavior. While dementia is a generic term, Alzheimer’s disease accounts for sixty to eighty percent of dementia cases in older citizens. Nearly five and a half million Americans, in fact, are living with Alzheimer’s disease.[4]

Other forms of dementia include:

  • Huntington’s disease
  • Creutzfeldt-Jakob disease
  • Mixed Dementia.[5]

What all forms have in common is that they are progressive, meaning that symptoms become more pronounced as time goes by.[6]

Our team provides outstanding
care for special needs patients,
including geriatrics … Dr. Zeyad
Mady and Dr. James Geren are
dentists with comprehensive training
and expertise, so you can expect a
comfortable and safe experience
every time.

These are frightening matters. Most of us have witnessed a loved one gradually succumb to dementia. It is only small comfort that the symptoms of dementia are, in some cases, reversible. These include vitamin deficiencies and thyroid problems. Most progressive dementias, however, are not reversible and cannot be cured.[7]

There are many factors that increase the risk of developing dementia. Some of these, like aging, are beyond our control. Others, such as smoking and heavy alcohol use, are within our influence.[8]

Oral Care

Because dementia is a progressive condition, the risk of other health issues stemming from it increase as time goes by. Balance problems, for example, can result in a greater risk of falling. It is therefore important to establish a good dental hygiene routine in someone who has been diagnosed with dementia.

Anyone who has been diagnosed should not be living alone. During the early stages, they should for taking care of their teeth and gums, and should be in control for as long as it is possible. They might, however, need some supervision, or need to be reminded to brush and floss.[9]

It may be up to a caregiver to not only remind the person to brush. They may also need to give them the brush and toothpaste, and even show them what they need to do. If there are coordination issues, it may be easier for the person to use an electric toothbrush. At the Center for Dental Anesthesia, we have a lot of experience with dementia patients, and can provide advice on the best approaches for oral care.[10]

The person with dementia may be a denture wearer. In such cases, it may be necessary to remind them to put them in; they may also need some assistance inserting them. They may also need help keeping the dentures clean. Some caregivers have found it helpful to mark the dentures, because people with dementia sometimes lose them.[11]

Later Stages

As the person’s dementia progresses, there may be a decline in oral health. They may lose the ability to brush and floss on their own, or the understanding of how important it is. If that happens, it may be up to a caretaker to do it for them.

It is also possible that the person with dementia has discomfort with their teeth or gums but is unable to articulate the problem. Their caregiver or loved ones should be on the lookout for signs such as:

  • Not wearing dentures
  • Disrupted sleep
  • Loss of appetite
  • Pulling at the face or mouth

If you observe any of these behaviors, bring the person in to the CDA for an examination as soon as possible.

Help Is Nearby

The rate of dementia among Americans is increasing. During the next fifty years, the number of people affected by Alzheimer’s disease alone is projected to triple. That means that more and more people will be need the services of dental professionals who are equipped to treat dementia patients.[12]

No matter your age or condition, good dental health is important. No one should be deprived of quality dental care because of a disability. At the Center for Dental Anesthesia in Alexandria, we have years of experience in designing treatment plans for patients with all sorts of special needs. If you or a loved one is coping with dementia, please call us to schedule an appointment.

For anyone coping with dementia in a family member or loved one, an excellent resource is alz connected, an online support community.



[1] “The Connection Between Alzheimer’s Disease and Dental Health” Referred to hereafter as “Connection.”

[2] Dementia is general term: “What Is Dementia?”, and “Dementia,”

The word “senility” has largely fallen into disuse. See

[3] Quote: “Dental problems and their management in patients with dementia,” p 4.

[4] Number of people living with Alzheimer’s: “Connection.”

[5] Other forms: “Types of Dementia”, referred to hereafter as “Types of Dementia.”

[6] “Types of Dementia”

[7] “What Is Dementia?”

[8] “Dementia.”

[9] “Dental Care and Oral Health, Factsheet 448LP. Referred to hereafter as “Factsheet.”

[10] Factsheet.

[11] Factsheet.

[12] Rates of dementia cases: “Treating Patients With Alzheimer’s Disease.”


Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


Dentistry and ADHD

Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) are the most common neurobehavioral conditions in school-aged children. Nationally, anywhere from two to eighteen percent of people are affected. The total number of Americans diagnosed with ADHD has risen steadily since 2003.[1]

Special Needs Dentistry
Interested in more Special Needs

Dentistry posts from CDA? Click here.

ADHD is characterized by inattention, impulsivity, and overactivity, and usually begins during childhood. “It is a developmental disorder of self-control or the ability to regulate behavior,” said Lisa Dowst-Mayo, a dental hygiene program director at Concorde Career College in San Antonio. “Children with ADHD have a significant impairment in their ability to inhibit behavior that affects daily life. Working with these patients in the dental office can be a challenge.”[2]

A friendlier term for ADHD is spirited. It is more common in boys than in girls, is a lifelong condition, and is not preventable. Providing dental care for ADHD patients and others with special needs may be a challenge, but it is the specialty of the Center for Dental Anesthesia in Alexandria.[3]

A Brief History

ADHD was identified more than one hundred years ago. At first it was named “brain-injured child syndrome.” Fortunately that name did not stick, and it became known as “minimal brain dysfunction.” This term remained in use until 1970, when it was renamed “hyperactive child syndrome,” and then “attention deficit disorder.” Only in 1987 did the current term, Attention Deficit Hyperactivity Disorder, come into use.[4]

ADD, incidentally, is a type of ADHD. The two are not the same thing, since the latter involves a lot of movement and fidgeting. However, since 1994 all forms of the disorder have been referred to as ADHD. This article primarily addresses the hyperactive form, but readers should bear the distinctions in mind.[5]

Dr. Zeyad Mady has
dedicated his practice as a
save haven for all of his
patients, especially for
those who need additional
attention or who have had
poor experiences with
dentistry in the past.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), patients with ADHD cope with the following:

  1. Difficulty with sustaining attention and increased distractibility
  2. Impulse control or inhibition
  3. Excessive activity
  4. Difficulty following rules and instructions
  5. Excessive variability in their responses to situations

Compulsivity and excessive energy, of course, are hallmarks of most children. The DSM-5 lists nine ADHD personality traits. To be diagnosed with the condition, a patient must possess at least six of them.[6]

Sensory Overload

Raising a child is seldom easy, but the parents of children with ADHD – or any special needs condition – face additional challenges.

Kids with ADHD tend to have poor oral hygiene, and thus a greater potential for tooth decay. There are also higher rates of bruxism (teeth grinding), and a higher risk for dental/oral trauma than in other children.[7]

Many experts contend that children and adults with ADHD can be treated in a general dental setting, but this is not always practical. Young ADHD patients in particular tend to have more behavior management issues during dental appointments than do those kids without it. Just sitting through a checkup can be challenging for children with ADHD. The dental environment – its sights, smells, and sounds – can be enough to trigger an adverse reaction.[8]

Lisa Dowst-Mayo calls this sensory overload, and advises dentists not to make too much of these reactions. “In the dental chair, it is best to simply ignore behaviors that may seem inappropriate, because they are usually unintentional,” she says. Fidgeting, for example, may seem excessive, but can help ADHD children feel more relaxed. She also urges patience, because so many ADHD kids need extra time to process directions, such as “Open wide.”[9]

Parents can do a lot to help make things go smoother. Schedule appointments in the morning, because most ADHD kids tend to do better earlier in the day. Bring a favorite toy or game to keep them occupied, and keep them informed about what is going on and what is expected. Rewards and positive reinforcement for cooperative behavior can also be effective.[10]


A diagnosis of ADHD may set someone apart from the crowd, and it can be challenging for those who live with it every day. But by no means does it limit what one can achieve in life.

Matt Curry was diagnosed with ADHD in seventh grade. After graduating from high school he began working in automotive stores and discovered his passion; today he owns one of the largest independent auto-repair chains in the Washington, D.C. area. Behavioral strategies enable him to focus, and he attributes his business success to his condition. “ADHD is my superpower,” Curry says. “I’m successful because of it, not in spite of it.”[11]

For dental professionals and other health care providers, the keys are empathy and compassion. “Treating a dental patient with ADHD does not have to be a painful, strenuous experience,” Lisa Dowst-Mayo says. She recommends dental professionals abide by strategies summarized by the acronym, UNCAPPED:

U. Understanding for your patient
N. Non-judgmental attitude
C. Calm. Stay calm and relaxed
A. Attitude. Keep a positive attitude
P. Praise. Be generous with positive praise
P. Patient. Be patient with your client’s needs
E. Empathy
D. Directness

An excellent resource for information on ADHD is the Children and Adults with Attention Deficit Hyperactivity Disorder website ( CHADD is a national non-profit providing information, advocacy, and support for people with ADHD.

The Center for Dental Anesthesia in Alexandria has always recognized the importance and necessity of special needs dentistry, and welcomes patients with ADHD, Down syndrome, and serious illnesses. CDA is committed to excellence in dentistry, and to being a safe haven for all of our patients, regardless of extenuating special needs.



Number of Americans with ADHD: “ADHD, By the Numbers.” See also, “Pharmacologic Behavior Management of Pediatric Dental Patients Diagnosed with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder.”

[2] Quote: “How to work effectively with patients who have ADHD,” by Lisa Dowst-Mayo, RDH, DSDH, p. 2. Hereafter referred to as “How to work effectively…”

More common in boys: “Attention Deficit Hyperactivity Disorder: Implications for Dental Practice.” (Author not listed.) Lifelong condition, not preventable: “10 Key Questions About Attention Deficit Hyperactivity Disorder (ADHD).”

“How to work effectively…” p. 2.

“ADD v. ADHD.”

“How to work effectively…” p. 2.

“Oral Health Fact Sheet for Dental Professionals: Children with Attention Deficit Hyperactivity Disorder.” Referred to hereafter as “Oral Health Fact Sheet…”

“How to work effectively…” p. 5.

“How to work effectively…” p. 5.

“How to work effectively…” p. 5.

“Born This Way: Personal Stories of Life with ADHD,” by Eileen Baily.

Quote, and UNCAPPED: “How to work effectively…” p. 6.


Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia

Dentistry and Dental Phobia

Dental phobia is a condition that leaves people terrified of going to the dentist. Most of those who have it are perfectly aware that their fears are irrational, but are still unable to do anything about it. With the right help, like what is available at the Center for Dental Anesthesia in Alexandria, people with dental phobia can still get the care they need.

Fear of the dentist is common, but dental phobia is in a category all its own. It is more than feeling stressed while a cavity is filled, or your teeth are cleaned. It is an emotion so intense, people may avoid the dentist altogether.[1]

The terms “dental anxiety” and “dental phobia” are sometimes confused, or used interchangeably. Researchers who study the phenomenon say dental phobia is more than anxiety, and place it at the far end of a continuum of fear. In its most extreme form, people with dental phobia may only go to the dentist when they absolutely must – when their dental pain has become unbearable.

“Many times these fears are not taken very seriously by friends and family,” said Markus Schulte, a Swiss dentist and oral surgeon. “They are even made fun of.” Even some dentists, he said, are not sympathetic enough to those with dental phobia. Because of that, people with the condition may end up feeling isolated and helpless, and with ever-declining dental health.[2]

“If you have dental phobia,
we want you to know that
our first priority is making
you feel safe and comfortable
–Dr. Zeyad Mady, Center
for Dental Anesthesia

Why Does It Happen?
There is no single explanation for why some people develop dental phobia, yet many who share the condition have certain things in common. Most often, dental phobia is attributed to traumatic or painful dental experiences, usually early in life. Dr. Schulte says that about a third of his patients report having had some kind of negative experience with a dentist when they were young. It usually involved physical pain. Even worse, insensitive or brutal behavior by a dentist has contributed to their phobia.[3]

Other people trace their dental phobia to frightening stories they heard about dentists when they were growing up – how painful an extraction or root canal was, for example. Often, these scary stories came from their parents.[4]

Still others with dental phobia cannot identify any particular cause.

Hard to Forget
Among those who could name a cause for their dental phobia, nearly half said it was the result of pain. Most of us are able to remember particularly painful events, even years after they happened. “Our brains are wired for this, with a strong emotional component,” wrote Dr. Ben Bobrow, “which makes some pain literally ‘hard to forget.’” These memories, he says, can lead to avoidance behavior, such as dental phobia.[5]

Other reasons people have dental phobia include:

  • Fear of injections, like a local anesthetic
  • Fear that an injection won’t work
  • Fear of the side effects of anesthesia
  • A sense of helplessness

Not everyone with dental phobia avoids going to the dentist. But they still cope with a range of symptoms, such as:

  • Crying, or feeling sick just thinking about a dental appointment
  • Sleeplessness the night before an appointment
  • Elevated blood pressure
  • Mounting tension while in a dentist’s waiting room
  • Intense unease when dental tools are put in their mouths
  • Fainting
  • The urge to gag or vomit

What to Do
First and foremost, dental phobia must be met with empathy on the part of the dentist. Advising a patient to find their backbone, or keep a stiff upper lip, simply will not work and is inappropriate.

New patients to any dental practice are usually asked to fill out a registration form. This is a standard procedure, and Dr. Schulte says it’s the perfect time to ask specific questions about whether the patient has any fear of dentists. If the patient answers yes, how strong is it, on a scale of one to ten?

Fortunately, more and more dental professionals are becoming aware that dental phobia is a very real condition that deserves the same understanding and respect that other conditions receive. This includes the team at the Center for Dental Anesthesia in Alexandria, which has always made dental phobia a priority.

“Studies show that up to 75% of Americans experience some level of dental-related fear,” says the CDA’s Dr. Zeyad Mady. “If you have dental phobia, we want you to know that our first priority is making you feel safe and comfortable here.”

At the Center for Dental Anesthesia, Dr. Mady begins with an initial consultation that takes place in a neutral environment. Using rooms that don’t contain any dental equipment removes emotional triggers – the sights, sounds, and smells we associate with dentistry. Patients tend to be more relaxed, and better able to describe their conditions and concerns, as well as learn of the options available to them. At these consultations, Dr. Mady gives each patient his undivided attention, and begins to build the trust needed to overcome dental phobia.

Our Top Priority
The available options include sedation dentistry. This is an umbrella term encompassing every type of sedation available in modern dentistry.

The lightest and most common type of sedation is nitrous oxide, also known as laughing gas. Administered as a mixture of nitrous and oxygen, it is safe and effective, and has been used in dentistry for more than a hundred years.

Nitrous oxide is extremely effective, but it may not be enough for some patients with dental phobia. The Center for Dental Anesthesia offers a full range of sedation options. Dr. Mady and the entire CDA staff have received advanced sedation training and are certified to administer the highest levels of dental anesthesia. This includes IV sedation, sometimes called “twilight dentistry,” and general anesthesia, which puts the patient completely under.

At the Center for Dental Anesthesia in Alexandria VA, we offer special needs dentistry for people with dental phobia. The safety, comfort, and dental health of each of our patients is always our top priority. It is possible to have quality dental care that is safe and pain-free, and we are committed to bringing that to each of our patients, regardless of their history. If you are coping with dental phobia, don’t put your dental health at risk. We urge you to call us to schedule a consultation.


[1] “Why Are People Afraid of the Dentist?” by Laura Beaton, Ruth Freeman and Gerry Humprhis., p. 296.
See also “Dental Phobia: The Fear of Dentists,” by Dr. Markus Schulte, (cited hereafter as Schulte).

[2] Schulte, p. 5 (“Impacts of dental phobia”).

[3] Schulte, and “Prevalence Of Dental Phobia Among Patients At Dental Clinics In UAE,” by Syeda Sheema, Safa Khan, Zaid Muayad, Ali Thaier, Meera Obaid, Hossam A. Eid.

[4] Schulte.

[5] Ben Bobrow, MD, “Reducing Pain by Learning How to Not Fear Pain.”

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


Dentistry and Down Syndrome

People with Special Health Care Needs (SHCN) have to go to the dentist, just like anyone else. But they can have unique differences that require special attention. While not essential, SHCN patients as a group tend to do better with dentists who have had special training and are equipped to accommodate them, like the team at the Center for Dental Anesthesia in Alexandria.

The term “Special Health Care Needs” is recognized by the American Academy of Pediatric Dentistry and other professional associations. It refers to a group of physical, developmental, cognitive, and emotional conditions that require specialized services and programs. These conditions pose distinct challenges in life activities and personal care, such as oral health. People with SHCN are, all too often, at a greater risk for oral diseases. This is important, because good oral health is essential to a person’s overall health.[1]

An estimated 36.3 million Americans are categorized SHCN, and about 12.5 million of them are children, according to the U.S. Census Bureau. This article focuses on people with Down syndrome, a congenital disorder that happens when someone has a full or partial extra copy of chromosome 21. The National Down Syndrome Society says that about one of every seven hundred babies born in the United States each year has Down syndrome.[2]

People with Down syndrome are, of course, susceptible to the same dental problems as the general population. Some research suggests they are less at risk for cavities. But they also tend to be at higher risk for certain conditions, like gum disease. The National Institute of Dental and Craniofacial Research states flatly that gum disease “is the most significant oral health problem in people with Down syndrome.”[3]

My goal is to provide comprehensive
quality care with a professional and
personal touch.
–Dr. Zeyad Mady, DDS, FAGD, FICOI

Some readers may find these assertions surprising. The apparent low rates of tooth decay may, in fact, be misleading, according to Elizabeth S. Pilcher of the Medical University of South Carolina, who says the finding is based on older, flawed studies. “These groups may not have had the exposure to cariogenic foods at the rate of today’s children with Down syndrome who are growing up at home.”[4]

Higher rates of gum disease, meanwhile, may be attributable to compromised immune systems. There is no consensus on this in the medical community, but people with Down syndrome may have higher rates of immune system abnormalities compared to the general population.[5]

“Obviously, good home care is essential in the management of periodontal disease of this type,” notes Dr. Pilcher, who is both a dentist and the parent of a child with Down syndrome. “This may be difficult to achieve with the intellectual impairment and decreased manual dexterity seen in Down syndrome.” Using dental floss, for example, can be difficult, although floss holders can be helpful.[6]

In addition to gum disease, dental issues in people with Down syndrome include:

  • Delayed eruption. Both baby teeth and adult teeth may come in later than in people without Down syndrome. (This may help to explain statistically lower rates of tooth decay.)
  • Malocclusion. This is a common condition, resulting from delayed eruption of permanent teeth, and underdevelopment of the jaws.
  • Small and missing teeth. People with Down syndrome often have smaller than average teeth. It is also common to have missing teeth (hypodontia).[7]


The Dentist Appointment

I believe that it is all about listening
to the patient, knowing them and
understanding their concerns.
–Dr. Zeyad Mady, DDS, FAGD, FICOI

It’s important for dentists treating patients with Down syndrome to establish a trusting relationship, especially in their younger patients. General dentists are advised, during appointments, to listen closely to their patients with Down syndrome, who may find speaking difficult. They should take care not to confuse underdeveloped language ability with intellectual impairment. “The patient with Down syndrome,” says Dr. Pilcher, “will probably understand more than their apparent level of verbal skills.”[8]

People with Down syndrome tend to be well-behaved, although there are exceptions, as with any other identifiable group. But behavior management is not usually an issue in a general dentist’s office. Since they often have challenges that may compromise oral care, however, dentists should review the patient’s medical history beforehand. This includes consulting with physicians, family members, and caregivers to get an accurate medical history.[9]

Ideally, a visit to the dentist is about the same for people with Down syndrome as it is for anyone else. “Most dental treatment for persons with Down syndrome can take place in a general dentist office with relatively minor adaptations,” says Dr. Pilcher. She says it really comes down to individual dentists, and his or her background and education. “In undergraduate dental training there is usually little or no exposure to treating patients with disabilities, and general practitioners may be hesitant to treat these patients with confidence.”[10]

At the Center for Dental Anesthesia in Alexandria, Dr. Zeyad Mady and Dr. James Geren have comprehensive training and expertise that equips them to treat patients with Special Health Care Needs. Dr. Mady says that successful treatment of special needs patients comes down to being a good listener. “It’s important to spend enough time with each patient to properly devise solutions that fit their desires,” he says. “My goal is to provide comprehensive quality care with a professional and personal touch.”

The team at the Center for Dental Anesthesia has provided special needs dentistry for many years, and are proud to have earned the trust of countless patients and their families. “My deep appreciation for all you and your fine staff’s efforts in connection with my intellectually disabled adult daughter Danna’s recent experience at the Center for Dental Anesthesia,” said the father of one patient. “It was the first time Danna was being treated by both of you. I cannot say enough about how pleased I am with your efforts in Danna’s behalf.”[11]

The Center for Dental Anesthesia in Alexandria treats patients with many different special needs, including Down syndrome, diseases like Parkinson’s or Alzheimer’s, patients with medical problems like diabetes or cancer, and patients with dental anxiety and/or dental phobia. We also treat people who are otherwise healthy, but have a history of bad reactions to local anesthetics.


Source Notes

[1] Guideline on Management of Dental Patients with Special Health Care Needs,

[2] Down Syndrome Fact Sheet,

[3] Gum disease, and quote:

[4] Pilcher, “Dental Care for the Patient with Down Syndrome,”

[5] Cavities and gum disease: “Dental Issues & Down Syndrome,” Immune system: “The Immune System in Down’s Syndrome” [sic],

[6] Pilcher.

[7] Dental Problems in People with Down’s Syndrome,

[8] Pilcher, and “Practical Oral Care for People With Down Syndrome,”

[9] “Practical Oral Care for People with Down Syndrome.”

[10] Pilcher.

[11] Patient review,

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


Special Needs and Dental Health

People from all over the Washington, DC and Virginia area turn to the Center for Dental Anesthesia in Alexandria for special needs dentistry, which our  team has provided for many years.

We treat patients with disabilities and diseases, such as Parkinson’s, Alzheimer’s, or Down Syndrome; patients with medical problems like diabetes, or who are in  treatment or recovery from cancer.

We also treat those who are healthy but have dental anxiety, or are not able to sit still for an appointment for different reasons, like age or a physical condition.

People with special needs need good dental health, like anyone else. Many practices might be able to accommodate special needs patients, but we offer an unusual level of compassion and understanding, and our patients benefit from our level of care.

In addition to special needs dentistry, the Center for Dental Anesthesia in Alexandria provides family and cosmetic dentistry to patients of all ages. Schedule your next appointment with us  today.

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia