Orthodontic Treatment
and
Down Syndrome:
The Art of the Possible
Marc Bernard Ackerman, DMD, MBA
Director of Orthodontics
Children’s Hospital, Boston
Assistant Professor
Department of Developmental Biology
Harvard School of Dental Medicine
Review Article
• Hennequin et al. Significance of oral
health in persons with Down Syndrome:
a literature review. Developmental
Medicine and Child Neurology 1999,
41:275-83.
Orthodontic Profile of the
Down Syndrome Patient
• Maxillary anteroposterior hypoplasia
(54% of DS patients have Class III-Underbite)
• Maxillary transverse hypoplasia
(65% of DS patients have posterior crossbites)
• Congenitally missing teeth
(20x more frequent than general population)
• Tooth size discrepancy
• Open anterior bite
Picher ES. Dental care for the patient with Down Syndrome. Downs Syndr Res Pract.
1998;5:111-116.
Orthodontic Profile of the
Down Syndrome Patient
• Impacted teeth
(10x greater canine impaction than gen. pop.)
•
•
•
•
•
Transposed teeth
Tongue thrust, retained infantile swallow
Idiopathic external root resorption
Gingival excess, periodontal infection
Chewing difficulty, episodic choking
Picher ES. Dental care for the patient with Down Syndrome. Downs Syndr Res Pract.
1998;5:111-116.
What do these 2 patients have
in common?
Should we be more interested in
how they are different rather than
what they have in common?
Diagnosis and Treatment Planning
in Four Dimensions
Assessing an individual’s:
• Ability to assent to treatment
• Ability to tolerate the burden of the
therapeutic intervention in terms of time,
cost, discomfort, disruption to schedule
Advances in Orthodontic Technology
• Direct bond brackets versus banding
• Quick set, flavored impression materials
• Shape memory wire (nickel titanium)
permitting longer interval between appts
• Orthognathic surgical technique more
predictable
• Implant supported prosthetic tooth
replacement and implant anchorage
Ackerman JL, Proffit WR. Communication in orthodontic treatment planning: bioethical and
informed consent issues. Angle Orthod 1995;65(4):253-262.
TAKE HOME MESSAGE:
• Orthodontics is the art of the possible
and NOT the science of the improbable.
• Each child with DS deserves to be
evaluated for orthodontic treatment but
not all problems have simple
solutions!!!!