Periodontal treatment and prevention in Down syndrome patients

Down syndrome (DS) is a common genetic birth defects, affecting approximately one in 700 live births. Recent decades have seen a dramatic improvement in life expectancy since the 1980s. DS patients are prone to periodontal disease and it is often severe and generalised.

Preventive methods and conventional periodontal treatments are thought to present disappointing outcomes in this group of patients, requiring specific approaches. The aim of this review was to evaluate which type of approach preventive programs and different periodontal therapies improve periodontal outcomes for DS patients.

Methods

Searches were conducted in the Medline, Embase CENTRAL and OpenGREY databases supplemented by hand searches of the Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research and Special Care in Dentistry.

Longitudinal and observational studies, controlled clinical trials, randomised clinical trials and case series; studies reporting different methods of periodontal preventive care and periodontal treatment in DS patients  were considered. Two reviewers independently selected studies and abstracted data. Study quality was assesses using the Cochrane Risk of bias tool or Newcastle-Ottawa scale as appropriate for the study design.

Results

9 studies involving a total of 279 patients were included. There were 4 clinical trials, 4 longitudinal studies, and a prospective case series.
Of the 4 trails, 2 were crossover studies, 1 a split-mouth study and 1 controlled trial. Two of the trials were considered to be at high risk of bias and 2 at unclear risk.
Of the 5 observational studies 4 were considered to be of medium quality and 1 of low quality.
There was substantial variation in the participants, methodology, periodontal prevention approaches, treatment and outcomes assessed so a narrative summary was presented.
3 studies evaluated outcomes after sessions of scaling and root planing.
1 study compared surgical and non-surgical periodontal therapies.
1 study evaluated the effect of a supervised toothbrushing program.
6 studies considered different forms and uses of chlorhexidine (CHX).
Participation of parents, caregivers and institutional attenders and DS patients’ motivation were encouraged in all.

Conclusions

The authors concluded: –

This systematic review demonstrated the importance to early introduce DS patients into preventive programs and periodontal therapy. Thus, the participation of parents, caregivers or institutional attendants in supervising/performing oral hygiene is essential for prevention and control of the periodontal disease. In addition, frequency of attendance and association with chemical adjuvants (independently of the periodontal treatment adopted) seems to improve periodontal outcomes in preventive and periodontal treatment of DS patients. More clinical trials about preventive and periodontal treatment in DS patients are needed, including antimicrobial agents and other adjuvant treatments.

Comments

This review has involved a detailed search of multiple databases and journals and also used broad inclusion criteria. However it has only identified a small number of small studies addressing this clinical problem. The largest study involved 112 patients and the smallest just five. The durations of studies also varied from 3 weeks to 30 months. The quality of the included studies is limited and while the conclusions are pragmatic as the authors note significantly higher quality research needs to be undertaken on the best way of managing periodontal disease in DS individual considering its high prevalence and severity in this group.

Links

Primary paper

Ferreira R, Michel RC, Greghi SL, Resende ML, Sant’Ana AC, Damante CA, Zangrando MS. Prevention and Periodontal Treatment in Down Syndrome Patients: A Systematic Review. PLoS One. 2016 Jun 29;11(6):e0158339. doi: 10.1371/journal.pone.0158339. eCollection 2016. PubMed PMID: 27355338.