Table 3.47.
Key considerations in dental management in Down syndrome (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Bacterial endocarditis; infection |
| Appropriate dental care | 2 | Antibiotic prophylaxis; infection control; oral hygiene education |
| Pain and anxiety control | ||
| – Local anaesthesia | 0 | |
| – Conscious sedation | 1 | Respiratory function/infection |
| – General anaesthesia | 3–5 | Cardiac defects; respiratory disease; difficult intubation; chest infections; anaemia; atlantoaxial subluxation; hepatitis B |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 0 | |
| – Patient positioning | 1 | Avoid neck hyperextension |
| Treatment modification | ||
| – Oral surgery | 1 | |
| – Implantology | 1/5 | Periodontal disease; neglected oral hygiene |
| – Conservative/Endodontics | 1/5 | Severe periodontitis |
| – Fixed prosthetics | 1/5 | Severe periodontitis |
| – Removable prosthetics | 1 | |
| – Non-surgical periodontology | 1 | Periodontitis may progress despite therapy |
| – Surgical periodontology | 1/5 | |
| Hazardous and contraindicated drugs | 1 | Some patients receive platelet aggregation inhibitors |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.