Periodontal disease in Down's syndrome: a review

Cross-sectional as well as longitudinal studies indicate that the prevalence of periodontal disease in persons with Down's syndrome (DS) under the age of 30 years is extremely high. It is even noted in the deciduous dentition. The progression of the disease is rapid, especially in the younger age groups. Severe periodontal breakdown with horizontal bone loss is often present in the lower anteriors. The large amount of plaque and calculus alone cannot explain the severity of periodontal disease in DS persons. Many contributing factors are reported. Abnormal capillary morphology, disorders in connective tissue and anatomical aspects of teeth are some of those considered to be of influence. Alteration in immunological response may also play a role in the progression of the disease process. Disorders in the polymorphonuclear leucocyte function and monocyte function have been reported in persons with DS. T-cell functioning declines after the first 10 years of life. T-cell lymphocyte counts are low and an immature subset of T-lymphocytes is present. This latter effect occurs especially in institutions where the immunological system is under stress. The altered immune response together with higher calculus scores may explain the difference in severity of periodontal disease between institutionalized DS children and those living at home.