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.
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.
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.”
My goal is to provide comprehensive
quality care with a professional and
–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.”
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.
“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.
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).
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.”
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.
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.”
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.”
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.
 Guideline on Management of Dental Patients with Special Health Care Needs, https://www.aapd.org/media/Policies_Guidelines/G_SHCN.pdf
 Down Syndrome Fact Sheet, https://www.ndss.org/about-down-syndrome/down-syndrome-facts/
 Gum disease, and quote: https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-down-syndrome.pdf
 Pilcher, “Dental Care for the Patient with Down Syndrome,” https://library.down-syndrome.org/en-us/research-practice/05/3/dental-care-patient-down-syndrome/
 Cavities and gum disease: “Dental Issues & Down Syndrome,” https://www.ndss.org/resources/dental-issues-syndrome/ Immune system: “The Immune System in Down’s Syndrome” [sic], http://www.intellectualdisability.info/physical-health/articles/the-immune-system-in-downs-syndrome
 Dental Problems in People with Down’s Syndrome, http://www.intellectualdisability.info/physical-health/articles/dental-problems-in-people-with-downs-syndrome
 Pilcher, and “Practical Oral Care for People With Down Syndrome,” https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-down-syndrome.pdf
 “Practical Oral Care for People with Down Syndrome.”
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