Title Periodontal Disease Prevalence Is Significantly Higher In Patients With Down Syndrome Compared To Age Matched Patients In The General Population.
Clinical Question In patients with Down Syndrome, is there a higher prevalence of periodontal disease than in the general population, as measured by clinical markers?
Clinical Bottom Line Patients living with Down Syndrome and other intellectual disabilities have an increased prevalence of periodontal disease as measured by clinical markers. This is supported by a systematic review that shows greater and earlier prevalence of periodontal disease among patients with intellectual disabilities. As well as a case control study that demonstrates more severe periodontal disease in several age groups of patients with Down Syndrome.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
20500706Anders/2010Adult patients with intellectual diabilitiesSystematic Review
Key results27 studies that were assessed for strength of evidence were reviewed. Twenty-five of 27 studies found that people with intellectual disabilities (IDs) “have poorer oral hygiene than the general population.” “The evidence also strongly supports that people with ID have a higher prevalence and greater severity of periodontal disease.” Down Syndrome patients were one of the two subgroups “at especially high risk for oral health problems,” the other being patients unable to manage routine dental care. Although wide variation was found in the quality of the studies, in quantity all studies “reported significant findings, providing evidence of adequate power.” Consistency of evidence in the studies reviewed was high even though they varied in size and in country where they were conducted.
15882231Sakellari/200570 patients with Down Syndrome, 121 age-matched healthy patients, and 76 with cerebral palsyCross - sectional case-control study
Key resultsClinical markers of periodontal disease (attachment loss, BOP, and pocket depth) were exhibited in a much higher level in patients with Down Syndrome in all age subgroups. Their level of oral hygiene was also worse. Probing attachment levels in DS patients displayed statistically significant higher percentages of 4-6mm and >6mm, than the matched healthy patients. This study also concluded, using the chi-squared test, that DS patients have a higher prevalence of microfloral associated with periodontal disease, including A. actinomycetemcomitans and P. gingivalis.
Evidence Search (("down syndrome"[MeSH Terms] OR ("down"[All Fields] AND "syndrome"[All Fields]) OR "down syndrome"[All Fields]) AND ("periodontal diseases"[MeSH Terms] OR ("periodontal"[All Fields] AND "diseases"[All Fields]) OR "periodontal diseases"[All Fields] OR ("periodontal"[All Fields] AND "disease"[All Fields]) OR "periodontal disease"[All Fields])) AND systematic[sb] sakellari[All Fields] AND 2005[All Fields] AND ("down syndrome"[MeSH Terms] OR ("down"[All Fields]
Comments on
The Evidence
The systematic review is the highest level of evidence available. Studies included in the review varied widely in methods of assessment, data collection, periodontal status, sample size, age ranges, and location. The quality of the studies varied widely from 3-9 on a scale of 10 of inclusion criteria. The case-control study is weaker in the evidence pyramid, but still demonstrated clinically significant findings, increasing its importance. They established clear diagnostic benchmarks such as levels of attachment loss, bleeding on probing, pocket depths, and plaque samples. Alongside the clear criteria the age matched sub groups lend to the validity of the study.
Applicability Clinicians may assume to see a higher prevalence of periodontal disease in patients with Down Syndrome due to poor oral hygiene, low compliance to treatment plans, or even increased presence of oral bacteria. Management the disease and restoration of periodontal health in this patient population may be limited by involvement and compliance of not only the patient, but also the caregiver or social context of the patients living situation.
Specialty (Public Health) (General Dentistry) (Periodontics) (Dental Hygiene) (Behavioral Science)
Keywords Down Syndrome, Periodontal Disease
ID# 2726
Date of submission 05/06/2014
E-mail stewartma@livemail.uthscsa.edu
Author Marissa Stewart
Co-author(s) e-mail
Faculty mentor Kelly C. Lemke, DDS
Faculty mentor e-mail lemkek@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available