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Am Fam Physician. 2015;92(1):8

Original Article: Role of the Family Physician in the Care of Children with Down Syndrome

Issue Date: December 15, 2014

to the editor: I appreciated the comprehensive article on caring for children with Down syndrome and the inclusion of hypodontia and delayed dental eruption in Table 4. Dental care is the leading unmet health care need among children with Down syndrome.1 Rapid destructive periodontal disease, leading to the loss of permanent anterior teeth in the early teens, is the most significant oral health problem in this population.2 Contributing factors include poor oral hygiene, malocclusion, bruxism, conical-shaped tooth roots, and abnormal host response because of a compromised immune system. Because of the difficulty distinguishing missing teeth from delayed eruption (as late as 24 months), as well as an increased incidence of malformed teeth, it is imperative that children with Down syndrome be referred to a dentist within six months of the eruption of the first tooth or by one year of age.3

Preventive advice for parents should include twice-daily supervised brushing and flossing, low-cariogenic snacks, and regular systemic and topical fluoride. The dentist may advise chlorhexidine rinses for better periodontal health. Because there is more malocclusion and crowding, orthodontics may be more common as well.

Resources for family physicians include the American Academy of Pediatric Dentistry to help find dentists who are comfortable treating children with special needs ( and the National Institute of Dental and Craniofacial Research for practical information for health professionals and parents ( Family physicians can also access free online training covering general pediatric oral health issues on the Smiles for Life website (

in reply: We appreciate Dr. Silk's letter highlighting several key factors about oral health care in children with Down syndrome. Dental care should never be overlooked, and we agree that early referral to an oral health professional is essential.

Dr. Silk's letter also addresses the importance of dialogue between clinicians, parents, and other health professionals. Parents should be empowered to ask questions and seek necessary referrals. The resources provided by Dr. Silk can help facilitate access to appropriate care.

Email letter submissions to Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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