Children with Down Syndrome: oral development and morphology after use of palatal plates between 6 and 18 months of age

Objectives. The aim of this study was to describe oral development and morphology in 18‐month‐old children with Down syndrome (DS) treated with palatal plates in combination with structured communication and speech training. The aim is further to describe the design of the palatal plates, compliance in their use and to give a brief report of their effect on oral motor function and speech. Sample and methods. Forty‐two children with DS were followed from ≤ 6 months of age until 18 ± 3 months old. In addition to language intervention, and oral motor and sensory stimulation provided by speech therapists for all children with DS in Sweden, palatal plates provided by dentists are included in the training programme. In the evaluation, the children in the project were compared with two control groups of children matched for age; one group of children with DS who had not been treated with palatal plates, and one group of children with normal development. Results. Compared to the children with normal development, both groups of children with DS had fewer teeth erupted and a lower prevalence of sucking habits. Deviant morphology of the tongue in the form of diastase, lingua plicata or a sulcus in the anterior third of the tongue was only seen in children with DS. All children with normal development had positive values for overjet compared to 53% of the children with DS. The palatal plates were used 2–3 times daily for a total mean time of 15 min. Compliance in use of the plates decreased with age, mainly due to eruption of teeth and subsequent loss of retention. Evaluation of oral motor function and speech show that the children with DS in the project had better motor prerequisites for articulation than the control children with DS. Conclusion. Palatal plate therapy did not affect oral parameters, i.e., eruption of teeth, types and prevalence of sucking habits, tongue morphology and symptoms of hypotonia. In combination with oral motor and sensory stimulation, palatal plate therapy had a positive effect on oral motor performance and prerequisites for articulation.     

Three-dimensional palatal development between 3 and 6 years

OBJECTIVE: To measure palatal landmarks of healthy nonpatient children aged 3 to 6 years with a normal deciduous dentition and to evaluate palatal shape independent of size. MATERIALS AND METHODS: Fifty-eight dental casts of children with a normal and complete deciduous dentition were obtained and digitized with a computerized 3D instrument. At all ages, male and female data did not differ (Student's t-test), so the pooled values were considered. Dimensions were compared between ages by analyses of variance. RESULTS: Palatal slope and height increased significantly as a function of age (P < .001). Palatal length did not change with age (average: 23.1 mm). In the frontal plane, the intermolar width increased slightly with age by about 1.8 mm at the second molars, 1.1 mm at the first molars, and 0.9 mm at the canines. Palatal height in the frontal plane did not change in the posterior part of the palate, but decreased anteriorly. The intercanine distance increased by 0.9 mm with age. However, this change did not reach statistical significance. CONCLUSIONS: Between 3 and 6 years of age, palatal shape changed and became proportionally higher in both the frontal and sagittal planes.     

Skeletal age of individuals with Down syndrome

The aim of this study was to assess the skeletal age of Brazilian individuals with Down syndrome (DS) using the method of Greulich and Pyle. Forty subjects with DS between the ages of 6 and 16 years were studied and compared to a control sample of children without DS. The statistical analysis showed that at the age of 7 years the skeletal age (SA) of the individuals with DS was delayed in relation to their chronological age (CA) (SA < CA). On the other hand, at the age of 15 years, their SA was advanced in relation to their CA (SA > CA). An evaluation of the results suggests that the period of adolescent development for individuals with DS was shorter. These individuals reach the completion of bone maturation earlier compared to individuals without DS.     

Long-term effects of palatal plate therapy on oral motor function in children with Down syndrome evaluated by video registration

Oral motor function was evaluated after 4 years of palatal plate therapy in nine children with Down syndrome (DS); 11 children with DS constituted the control group. During the treatment period all children had orofacial physiotherapy with their speech pathologist. An extraoral examination was performed, as was a video registration of the face. Nine different variables showing positions of the lips, tongue, and facial expression were examined. Children in the palatal plate group (n = 9) had significantly more rounding lips during speech (P< 0.05) than children in the control group (n = 11). The active variables describing normal muscle tension were diagnosed to constitute 81.0% +/- 11.0% of the registered video time in the palatal plate group, compared with 68.2% +/- 22.5% in the control group. Statistically significant differences were found between the groups in the summary variables describing an inactive open mouth and inactive tongue protrusion (P< 0.01). The results indicate that palatal plate therapy has a long-term effect on oral motor function.     

A four-year longitudinal study of palatal plate therapy in children with Down syndrome: effects on oral motor function,articulation and communication preferences

The orofacial function in 20 children with Down syndrome was evaluated after 4 years of palatal plate therapy in 9 of the children (PPG); the remaining 11 were untreated age-matched controls (CG). All 20 children had received continuous orofacial physical therapy from their speech therapist during the treatment period. A clinical extra- and intraoral examination was performed, including oral motor function, facial expression, the occurrence of malocclusions, and hypertrophic tonsils. A questionnaire requesting data on breathing patterns, drooling, eating problems, and communicative preferences was answered by the parents. An articulation assessment was performed by two speech and language pathologists blinded to the treatment status of the children in order to find out whether the palatal plate had stimulated to improved oral speech behavior. The results for oral motor function showed significant differences between the groups in favor of the PPG for the summary variables for: visible tongue (P < 0.01), visible tongue during non-speech periods (P < 0.05), and lip-rounding during spontaneous speech (P < 0.01). During non-speech time, the PPG had their mouths open significantly less than the CG (P < 0.05). Expressivity of facial expression on a visual analog scale in the PPG scored 75.6 +/- 13.3 compared to 51.8 +/- 25.7 in the CG (P < 0.05). The intraoral examination showed that 6/9 children in the PPG and 7/11 in the CG had enlarged tonsils, resulting in more than 50% inter-tonsillary space reduction. Despite these findings, and no significant differences between the groups with respect to mouth/ nose breathing, nocturnal snoring was significantly less in the PPG than in the CG (P < 0.05), according to the parental questionnaire. After 4 years of palatal plate therapy, orofacial function had improved significantly in the 9 PPG children and specifically in terms of tongue position and lip activity.     

A four-year longitudinal study of palatal plate therapy in children with Down syndrome: effects on oral motor function,articulation and communication preferences

The orofacial function in 20 children with Down syndrome was evaluated after 4 years of palatal plate therapy in 9 of the children (PPG); the remaining 11 were untreated age-matched controls (CG). All 20 children had received continuous orofacial physical therapy from their speech therapist during the treatment period. A clinical extra- and intraoral examination was performed, including oral motor function, facial expression, the occurrence of malocclusions, and hypertrophic tonsils. A questionnaire requesting data on breathing patterns, drooling, eating problems, and communicative preferences was answered by the parents. An articulation assessment was performed by two speech and language pathologists blinded to the treatment status of the children in order to find out whether the palatal plate had stimulated to improved oral speech behavior. The results for oral motor function showed significant differences between the groups in favor of the PPG for the summary variables for: visible tongue (P < 0.01), visible tongue during non-speech periods (P < 0.05), and lip-rounding during spontaneous speech (P < 0.01). During non-speech time, the PPG had their mouths open significantly less than the CG (P < 0.05). Expressivity of facial expression on a visual analog scale in the PPG scored 75.6 ± 13.3 compared to 51.8 ± 25.7 in the CG (P < 0.05). The intraoral examination showed that 6/9 children in the PPG and 7/11 in the CG had enlarged tonsils, resulting in more than 50% inter-tonsillary space reduction. Despite these findings, and no significant differences between the groups with respect to mouth/nose breathing, nocturnal snoring was significantly less in the PPG than in the CG (P < 0.05), according to the parental questionnaire. After 4 years of palatal plate therapy, orofacial function had improved significantly in the 9 PPG children and specifically in terms of tongue position and lip activity.     

Melanocytic neuroectodermal tumor of infancy: excision and primary palatal repair at 7 months of age

Melanocytic neuroectodermal tumor of infancy is a rare pigmented tumor generally occurring in the head and neck region in children 12 months of age or younger. The true incidence is unknown and fewer than 200 clinical case reports have been reported to date in the literature. The tumor itself is locally aggressive. It does not have a tendency to metastasize but carries a high risk of local recurrence. This report describes one patient's care, including primary palate reconstruction, and provides a review of the literature. A 7-month-old boy was found in a Haitian orphanage with a growing, very large mass originating from his right maxilla.     

Patterns of fluoride mouthrinse and gel use by children 6 to 96 months of age

PURPOSE: The purpose of this paper was to report longitudinally on parental reports of mouthrinse/gel use at home and at preschool/elementary school until age 8. METHODS: A cohort recruited at birth was followed in the Iowa Fluoride Study (IFS). Demographic data were collected at baseline. Pretested questionnaires were sent to participants at 3- to 6-month intervals, from ages 6 to 96 months, concerning many aspects of fluoride exposures and intake--including home use of fluoride mouthrinse/gel and participation in fluoride mouthrinse programs at preschool/elementary school. Summary statistics were computed for each period. Associations between home fluoride mouthrinse/gel use and demographic covariates were assessed. RESULTS: There were 1,388 participants. However, the number of respondents for each study interval varied from 549 to 800. Most participants were white, with about two thirds of parents having some college education. The percentage with use at home/preschool/elementary school during the period increased from less than 1% for 12 months to 3% at 48 months, 11% at 72 months, and 25% at 96 months. Fluoride mouthrinse use at preschool/elementary school was consistently less common than mouthrinse use at home. There were no significant associations between fluoride mouthrinse/gel use and demographic covariates. Patterns of fluoride mouthrinse use among users (N=205) indicated that, when children became older, higher proportions used fluoride mouthrinse and used them more consistently over time. CONCLUSIONS: A relatively small percentage of children used fluoride mouthrinse/gel, and this proportion increased with age.     

The oral health of children with Down syndrome in Ireland

The authors investigated the oral health of a convenience sample of 71 children with Down syndrome. The study group had a lower caries prevalence but similar levels of unmet treatment needs as children at special and mainstream schools. Treatment experience varied with age: 5-year-olds had more extractions and fewer restorations, and 15-year olds had fewer extractions and more restorations. The number of teeth with fissure sealants was comparable to that of other children in Special Needs Schools. Although the study group had poor oral hygiene, a need for advanced periodontal treatment was not evident. Few had evidence of dental trauma. Malocclusion was prevalent. Through a government-funded program, most of the sample had seen a dentist within the previous year, and few parents reported problems accessing dental care.
This study suggests that services targeted toward groups with special needs could generate outcomes comparable to those seen in other service users. A finding that also may hold true for other underserved populations.     

Medical problems and oral care of patients with Down syndrome: a literature review

When planning the dental treatment of patients with Down syndrome (DS), dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach. This article presents a literature review of the primary medical conditions in patients with DS that may affect their general health care and the appropriate clinical delivery of oral health care.     

Comparison between the palatal configurations in complete and incomplete unilateral cleft lip and palate infants under 18 months of age.

OBJECTIVE: The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients. DESIGN: Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally. RESULTS AND CONCLUSIONS: The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.     

Outcome of orthodontic palatal plate therapy for orofacial dysfunction in children with Down syndrome: A systematic review

To evaluate the effects of orthodontic palatal plate therapy (OPPT) in the treatment of orofacial dysfunction in children with Down syndrome (DS). Indexed databases were searched. Clinical trials in DS allocated to test (treatment with palatal plates) versus control group (without palatal plates/special physiotherapy for orofacial stimulation) with follow‐up of any time duration and assessing mouth closure, tongue position, active and inactive muscle function as outcomes. Study designs, subject demographics, frequency and duration of palatal plate therapy, method for assessment, follow‐up period and outcomes were reported according to the PRISMA guidelines. Eight clinical studies were included. The risk of bias was considered high in three studies and moderate in 5 studies. The number of children with DS ranged between 9 and 42. The mean age of children with DS at the start of the study ranged between 2 months and 12 years. The duration of palatal plate therapy ranged between 4 months and 48 months. The follow‐up period in all studies ranged from 12 to 58 months. All studies reported OPPT to be effective in improving orofacial disorders in children with DS. Most of the included studies suggest that palatal plate therapy in combination with physiotherapy/orofacial regulation therapy according to Castillo Morales/speech and language intervention seems to be effective in improving orofacial disorders in children with DS. However, the risk of bias of the included studies was high to moderate. Longitudinal trials with standardized evaluation methods, age of children at treatment initiation, treatment duration and standard orofacial outcomes are recommended.     

Chewing indicators between adults with Down syndrome and controls

Down syndrome induces a neuromotor deficiency that affects the orofacial musculature, and thus could be implicated in the feeding difficulties affecting people with this disease. This study aimed to investigate the differences in chewing indicators between a group of 11 adults with Down syndrome and a group of 12 healthy subjects without Down syndrome. Chewing ability was evaluated by means of video recordings taken during a standardized meal that included 10 natural foods. The variables collected were masticatory time, number of masticatory cycles, chewing frequency, number of open masticatory cycles, and number of food refusals. There were several differences in both directions for masticatory time and number of masticatory cycles between the two groups. In addition, with the exception of purée, the group with Down syndrome had significantly lower mean chewing frequency than the reference group, and was unable to eat all the foods presented.