{"id":14904,"date":"2017-06-20T10:20:04","date_gmt":"2017-06-20T10:20:04","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=14904"},"modified":"2019-07-26T09:47:21","modified_gmt":"2019-07-26T09:47:21","slug":"clinical-and-radiographic-evaluation-of-periodontitis-in-downs-syndrome-children-in-south-indian-population","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol10no2\/clinical-and-radiographic-evaluation-of-periodontitis-in-downs-syndrome-children-in-south-indian-population\/","title":{"rendered":"Clinical and Radiographic Evaluation of Periodontitis in Down\u2019s Syndrome Children in South Indian Population"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Down syndrome\u00a0(DS), also known as\u00a0trisomy 21, is one of the most common\u00a0chromosomal abnormalities,\u00a0caused by the presence of all or part of a third copy of\u00a0chromosome 21. The extra chromosome occurs by chance.1<\/sup>\u00a0It is characterized by the whole chromosomal aneuploidy in about 95% of cases. The remaining 5% is in the form of translocations and mosaics.2<\/sup><\/p>\n

DS is one of the most common genetic birth defect, affecting approximately one in 700 live births.3,4,5<\/sup>\u00a0According to National Down Syndrome Society (NDSS),6<\/sup>\u00a0more than 400.000 individuals with DS are living in the United States. Moreover, in the recent decades, their life expectancy has increased dramatically from 25years in 1983 to 60years till date.6<\/sup><\/p>\n

DS individuals present anatomical abnormalities, mental and Orofacial problems that has a large impact in quality of life.7<\/sup>\u00a0They typically have\u00a0poor immune function\u00a0and generally reach\u00a0developmental milestones\u00a0at a later age. They also have an increased risk of infections. Individuals with Down syndrome tend to be more susceptible to\u00a0gingivitis\u00a0as well as early, severe\u00a0periodontal\u00a0disease and early tooth loss that occur frequently under the age of 30years.8<\/sup>\u00a0They are classified by the American Academy of Periodontolgy as a manifestation of systemic diseases associated with genetic disorders.9<\/sup>\u00a0While plaque and poor oral hygiene are contributing factors, the severity of periodontal disease in Down\u2019s syndrome patients, cannot be explained solely by microbial factors. It is suggested that the severity of periodontal breakdown is likely a result of a weakened immune system.10\u201314<\/sup>\u00a0DS individuals present mild to moderate reduction in T and B cell counts, lack of normal lymphocyte expansion in infancy, suboptimal antibody responses to immunizations, decreased immunoglobulin A in saliva and impaired neutrophil chemotaxis.13<\/sup>\u00a0Tanaka in 2012 shows a high level of IFN-\u03b1 and IFN-\u03b3 in children with DS, indicating its importance in the modulation of the inflammatory process in periodontal disease.15<\/sup>\u00a0These inflammatory cytokines presents biological effects in the body and important regulatory roles in immune responses.12<\/sup>\u00a0Zampieri et.al demonstrated the study of altered expression of immune related genes in children with DS, highlighting molecular mechanisms involved in pathology.16<\/sup>\u00a0Periodontal disease in these patients is generalized, severe, with rapid progression and bone loss in addition to periodontal treatment, DS patients must receive attention and management of dental caries,17,18<\/sup>\u00a0malocclusion19<\/sup> and obstructive sleep apnea.20<\/sup><\/p>\n

Preventive approaches and treatment modalities of gingivitis and periodontitis include removal of dental biofilm, surgical and nonsurgical therapy. Preventive reactions involve supervised brushing or stimulation of oral hygiene habits and periodic clinical and radiographic evaluations. Periodontal treatment includes scaling and root planing (surgical or non-surgical), associated with or without local and\/or systemic antibiotics.21\u201323<\/sup>\u00a0Furthermore, participation of parents, caregivers and possibly institutional attendants are fundamental for the maintenance of outcomes.<\/p>\n

Both clinical and radiographic data are essential for diagnosing the presence and extent of periodontal disease. Clinical findings include gingival architecture, bleeding indices, probing depths, etc. Radiographs are essential in evaluation of amount of bone present, condition of the alveolar crests, bone loss in the furcation areas, width of the PDL space.<\/p>\n

Local factors such as calculus which can cause or intensify periodontal diseases, poorly contoured or overhanging restorations, caries, root length and morphology, crown to root ratio, anatomic issues like maxillary sinus, missing, supernumerary and impacted teeth, other pathologies and its contributing factors, apical inflammatory lesions, root resorption etc.<\/p>\n

This study focuses on one of the preventive measures and a diagnostic tool (Ortho pantamograph) which helps in detection of early periodontitis considering the higher prevalence of adult periodontal disease.\u00a0 This evidence is necessary for prevention of periodontal disease in DS population.<\/p>\n

The Aim of our present study was to evaluate the Clinical and Radiographic status of Periodontal Disease in Down\u2019s syndrome children.<\/p>\n

Materials and Methods<\/strong><\/p>\n

20 Down\u2019s Syndrome individuals with chronic periodontitis were included for clinical parameters group and OPG (Figure 1, 2). The ethical clearance was obtained for the study from our institution and informed consent was obtained from the head of the Balavihar school of special children. DS individuals from Balavihar School of special children, kilpauik Chennai, Tamil Nadu, were brought to Thai Moogambigai Dental College and hospital, Maduravoyal, Chennai for OPG (Sirona dental xray inc. corporation) and Case sheet were obtained and all the clinical parameters were recorded. CPITN C probe (Hufriedy) was used to record CPITN index.<\/p>\n

Radiographic Technique<\/strong><\/p>\n

The x-ray beam must be perpendicular to the long axis of the teeth and the plane of the image receptor .The image receptor must be parallel to the long axis of the teeth<\/p>\n

Exposure factors also play a role in increasing the diagnostic yield from the radiographs, By using a higher kVp setting (90kVp), instead of the customary 70 kVp, and reducing the mAs, a radiograph with a wider gray scale will be produced. This allows subtle changes in bone density, as well as soft tissue outlines, to be discerned<\/p>\n

Results <\/strong><\/p>\n

The current study was performed to correlate clinical and radiographic parameters in Down\u2019s Syndrome individuals with Chronic Periodontitis between age group of 12 to 30 years; however in the Downs syndrome group, the patients were younger, with a mean age of 18.65. p < 0.001, by means of One Way ANOVA indicating that the Down\u2019s Syndrome group developed periodontal breakdown, leading to chronic periodontitis at an earlier age. (Table 1)<\/p>\n

Table 1: Comparison of mean Age between the three groups using oneway ANOVA<\/strong><\/p>\n\n\n\n\n\n
Groups<\/strong><\/td>\nN<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\n95% Confidence Interval for Mean<\/strong><\/td>\nMinimum<\/strong><\/td>\nMaximum<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Lower Bound<\/strong><\/td>\nUpper Bound<\/strong><\/td>\n<\/tr>\n
DS+CP<\/td>\n20<\/td>\n18.65<\/td>\n6.99<\/td>\n15.37<\/td>\n21.92<\/td>\n12.00<\/td>\n35.00<\/td>\n<0.001*<\/td>\n<\/tr>\n<\/thead>\n<\/table>\n

*P<0.05 is considered statistically significant<\/p>\n

Plaque Index<\/strong><\/p>\n

To Assess with Plaque index score in DS with chronic periodontitis subjects who have more significant p value <0.001 (Table 2)<\/p>\n

Table 2: Oneway ANOVA<\/strong><\/p>\n\n\n\n\n\n\n\n\n
Groups<\/strong><\/td>\nN<\/strong><\/td>\nMean<\/strong><\/td>\nStd. Deviation<\/strong><\/td>\n95% Confidence Interval for Mean<\/strong><\/td>\nMinimum<\/strong><\/td>\nMaximum<\/strong><\/td>\nF<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Lower Bound<\/strong><\/td>\nUpper Bound<\/strong><\/td>\n<\/tr>\n
DS+CP<\/td>\n20<\/td>\n2.2520<\/td>\n0.65043<\/td>\n1.9476<\/td>\n2.5564<\/td>\n1.00<\/td>\n3.00<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n42.8<\/td>\n<0.001<\/td>\n<\/tr>\n<\/thead>\n
Total<\/td>\n20<\/td>\n1.7132<\/td>\n0.94433<\/td>\n1.4692<\/td>\n1.9571<\/td>\n.00<\/td>\n3.00<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

To further assess the presence of local factors that contribute to periodontal destruction the Oral Hygiene Index \u2013 Simplified was examined. Of the 20 patients , 12 of them (57.1%) fell in to the poor oral hygiene categories which was statistically significant according to Chi Square Test. (Table 3)<\/p>\n

Table 3: OHI-S among all three groups compared using Chisquare test<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\nDS<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
OHI_S<\/strong><\/td>\nGOOD<\/strong><\/td>\nCount<\/strong><\/td>\n5<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
<\/td>\n% within OHI_S<\/td>\n<\/td>\n100.00%<\/td>\n<\/td>\n<\/tr>\n
FAIR<\/td>\nCount<\/td>\n<\/td>\n3<\/td>\n<\/td>\n<\/tr>\n
% within OHI_S<\/td>\n<\/td>\n8.80%<\/td>\n<0.001*<\/td>\n<\/tr>\n
POOR<\/td>\nCount<\/td>\n<\/td>\n12<\/td>\n<\/td>\n<\/tr>\n
% within OHI_S<\/td>\n<\/td>\n57.10%<\/td>\n<\/td>\n<\/tr>\n
Total Count<\/td>\n<\/td>\n20<\/td>\n<\/td>\n<\/tr>\n
% within OHI_S<\/td>\n<\/td>\n33.30%<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*P<0.05 is considered statistically significant<\/p>\n

To understand the periodontal health of the patients, the Community Periodontal Index of Treatment Needs (CPITN) \u00a0was performed.\u00a0 Nine Ds, children had a score of (TN 3) which means colored area of probe remains partly visible in the deepest probing depth in the sextant suggesting chronic periodontitis, which was statistically significant.(Table 4)<\/p>\n

Table 4: CPITN in all three groups compared using Chisquare test<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/td>\nGroup<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nDS<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
No Rx<\/td>\n0<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n0.00%<\/td>\n<\/td>\n<\/tr>\n
TN 1<\/td>\n3<\/td>\n<0.001*<\/td>\n<\/tr>\n
CPITN<\/td>\n17.60%<\/td>\n<\/td>\n<\/tr>\n
TN 2A\/B<\/td>\n8<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n38.10%<\/td>\n<\/td>\n<\/tr>\n
TN 3<\/td>\n9<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n64.30%<\/td>\n<\/td>\n<\/tr>\n
Total<\/td>\n20<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n33.30%<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Radiographic Assessment<\/strong><\/p>\n

All 20 patients were asked to take digital OPG. \u00a0All 20 patients were having horizontal bone loss. Of the 20 patients, 8 patients had angular bone loss and, out of these, 9 patients showed arch shape bone loss which is a classical sign of Localized aggressive periodontitis. Some of those teeth also showed bone loss extending to the apical third and 3 of the patients had pulpo periodontal lesion. It was also noted that three patients had furcation involvement in multiple teeth, two patients exhibited root stumps and two of the patients had retained deciduous teeth. It was also noted that 2 of the patients had bilateral pneumatisation of sinus this may be due to early loss of teeth.<\/p>\n

Discussion<\/strong><\/p>\n

Down syndrome (DS) is one of the most common genetic abnormalities, and has a highly variable prognosis. Individuals with DS have specific orofacial characteristics associated with the syndrome. The most common oral disorders include periodontal disease, malocclusion, mouth breathing, macroglossia, delayed teeth eruption, missing and malformed teeth, microdontia, diastema and bruxism.29-34<\/sup><\/p>\n

Literature on Down syndrome has exaggerated the homogeneity of this population. There has been enduring belief that people with Down syndrome reach a plateau in adolescence, beyond which further developmental change is not possible.23<\/sup><\/p>\n

It is well documented that individuals with Down syndrome are also at increased risk for developing destructive forms of periodontal disease,25,26<\/sup>\u00a0with the majority affected early in life with extensive gingival tissue inflammation, bleeding on probing, increased probing depths, loss of periodontal attachment, and alveolar bone loss.25,26<\/sup>\u00a0In our study, the clinical and radiographic findings demonstrated periodontitis in Down\u2019s syndrome subjects, exhibiting greater periodontal pathology. These results have concordance with study done by Hennequin M<\/p>\n

In our study demographic data was analyzed the Down\u2019s syndrome group, the patients were younger, with a mean age of 18.65. p < 0.001, by means of One Way ANOVA indicating that the Down\u2019s Syndrome group developed periodontal breakdown, leading to chronic periodontitis at an earlier age.<\/p>\n

Further Plaque index score and CPITN score confirmed highly significant value in Down\u2019s syndrome with periodontitis p < 0.001. These results were compared with our previous study 28<\/sup> where only plaque score and OHI, CPITN was taken and\u00a0 \u00a0concluded that most of the patients had chronic periodontitis. No radiographic evidence was provided in that study ,to overcome that shortcoming in this study we have taken OPG for all the patients. We have found that most of the patients have evidence of bone loss.<\/p>\n

Radiographic evaluation also confirms that these patients are prone for periodontitis at the younger age itself. This could be due to the lack of awareness and lack of maintenance of the caretakers of these children.<\/p>\n

Conclusion<\/strong><\/p>\n

Down\u2019s syndrome subjects are very brilliant in learning new skills. Either caretakers should be motivated to teach these children or they can help these children in maintaining their oral hygiene status which will prevent the future periodontal breakdown.<\/p>\n

References<\/strong><\/p>\n

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    Introduction Down syndrome\u00a0(DS), also known as\u00a0trisomy 21, is one of […]<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[49],"tags":[],"class_list":["post-14904","post","type-post","status-publish","format-standard","hentry","category-vol10no2"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/14904","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=14904"}],"version-history":[{"count":6,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/14904\/revisions"}],"predecessor-version":[{"id":28269,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/14904\/revisions\/28269"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=14904"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=14904"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=14904"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}