Down Syndrome: a paediatnc oral health promotion project

OBJECTIVES Down Syndrome (DS) is the most frequent and known among chromosomal anomalies: it is characterized by a numerical aberration of chromosome 21 which leads to systemic diseases, such as congenital heart anomalies, and intellectual disability.In DS, dental anomalies, periodontal diseases and orthopedic-orthodontic anomalies are frequent. In addition, marginal gingivitis is common, and in young-adults the acute necrotizing ulcerative gingivitis represents a frequent finding; adults present an early onset of periodontitis, affecting lower incisors firstly.The main objective of this study is to promote healthy oral habits in children with Down Syndrome (DS), enrolling them in a personalized motivational information care plan.The second objective is to examine whether acquiring new skills regarding healthy oral habits may positively influence self-esteem and affect rapport with others, especially within the family.MATERIALS AND METHODS Thirty-six children were included, age ranged from 6-16 with a mean value of 11. Silness and Loe Plaque Index (PI) and decay -missing-filed-teeth for primary dentition (dmft) and Decay-Missing -Filed-Teeth for permanent dentition (DMFT) dental caries indexes were scored. After the first check-up visit, children and parents were accompanied to a separate room where an ad hoc prepared colleague promoted healthy oral habits using a specifically designed PowerPoint presentation, a plastic mouth model and a toothbrush. The PowerPoint presentation mentions the child by name on numerous occasions. Personalization was used to increase the children's attention and involvement, with the aim of increasing their level of learning. Interactions between the characters and the animations were used to promote the child's involvement. Parents were given the FIS (Fami-ly Impact Scale) questionnaire to evaluate the impact of the child's oral health status on family's lifestyle (activities, emotions, conflicts, economic expenses) and the P-CPQ (Parental-Caregiver Perceptions Questionnaire) to evaluate the correlation between oral symptoms and functions with the child's emotional and social well-being. In addition, the following were distributed: a brochure with the information provided to the child; a weekly chart for the child to register positive oral health habits; a kit with a toothbrush, toothpaste and hourglass; and the "Guidelines for children's oral health" for parents. At 3 and 6 months, oral health habits and motivation were clinically reevaluated and FIS e P-CPQ questionnaires were redistributed to parents. Statistical significance of the data was evaluated using Pearson chi-squared test. Quantitative variables (DMFT and PI scores) were analyzed at 0, 3 and 6 months respectively using Friedman and Wilcoxon tests. RESULTS Plaque index showed a significant reduction from 1,80 & PLUSMN;0,92 (T0) to 1,15 & PLUSMN;0,74 (T1) and to 0,41 & PLUSMN;0,53 (T2) (p = 0.001). FIS e P-CPQ questionnaires showed a significant reduction of irritability, difficulty communication with other children and attention-seeking attitude towards parents, also during the night.CONCLUSIONS Results confirm that the use of a tailor-made prevention program for pediatric patients affected by DS has a positive effect on overall oral health as well as individual and family quality of life. CLINICAL SIGNIFICANCE The positive relationship established between the pediatric dentist and the child with DS through frequent dental recalls, as proposed by the oral health promotion project, improves child's oral hygiene level and the quality of life of the family.