Down syndrome children in UAE have higher rates of tooth decay, study finds

Call for action after study uncovers oral health problem among sample of disabled young people

Dubai, United Arab Emirates - November 6, 2014.  Dr Daniel Mahrous ( General Dentist, Just White Dental Clinic ) is one of the dentist available, at Just White Dental Clinic.  ( Jeffrey E Biteng / The National )  Editor's Note; Rebecca D reports.
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Down syndrome children need more help to access proper dental care, according to dentists who found they had significantly higher rates of tooth decay than their non-disabled peers.

New research, which focused on Down syndrome children aged between four and 18 in Dubai, revealed that those with the disability had on average 65 per cent more decayed adult teeth compared to other children.

A lack of awareness from parents who may be overwhelmed by their children’s other health issues, unhealthy diets including more sugary foods and and drinks a lack of specialist dentists in the UAE were put forward as possible reasons for the disparity.

Researchers said more research was needed to better understand the problem, but called for better parental education and for new, targeted health programmes to be set up.

We have to educate parents but also our medical colleagues, so these patients can be referred to us before other problems develop

“The number of teeth missing, decayed or filled [in Down syndrome children] was significantly higher than healthy children in our sample,” Mawlood Kowash, one of the co-authors of the study, said.

“People with Down syndrome can have a lot of health problems, and the parents or guardians can become overwhelmed with that. Teeth can come at the bottom of the list.

“So we have to raise awareness, we have to educate parents but also our medical colleagues, so these patients can be referred to us and we can treat them before cavities and other problems develop. Awareness is very, very important.”

Dr Kowash, who is associate professor of pediatric dentisty at Hamdan bin Mohammed College of Dental Medicine in Dubai, said that it could often be challenging to treat children with conditions such as Down syndrome, as well as upsetting for parents and their children who can find visiting the dentist traumatic.

He said that some have to be sedated or given general anaesthetic before having dental treatment, which can mean an overnight stay in hospital depending on other medical conditions.

He said that elsewhere in the world a specific discipline, special care dentistry, had evolved to treat patients with intellectual disabilities. However, he said this was yet to develop in the UAE.

Down syndrome causes differences in dental development, including having smaller teeth or a higher likelihood of missing teeth, which can cause problems with biting. They also have an increased risk of gum disease. Experts say this means they need special attention in terms of dental care.

The researchers decided to study the area due to the high rates of Down syndrome in the country, compared to other parts of the world, particularly among UAE nationals. They compared 106 Down syndrome children, with an average age of nine, and 125 non-disabled children, with an average age of 11, all living in Dubai.

The Down syndrome children included in the study had received more dental restorations, the researchers found, suggesting that they generally had access to dental care. The Ministry of Health in Dubai provides free dental treatment for special needs children who are holders of a special needs medical card.

However, while there was no statistically significant difference in rates of decay in milk teeth, damage was found at a “significantly higher” rate in adult teeth.

Overall, the average number of decayed, filled or missing adult teeth was 3.32 each for the Down syndrome children, compared to 2.16 for the other children.

This means the Down syndrome children typically had one extra tooth decayed, filled or missing due to decay, compared to the other children.

When considering only tooth decay, the average Down syndrome child had on average 2.73 adult teeth affected by the problem, compared to 1.65 per child among others.

In addition, the proportion of Down syndrome children with tooth erosion was 34 per cent, compared to 15.3 per cent in the control group.

Rates of more serious erosion, into tooth enamel and dentine, was 12.3 per cent for Down syndrome children but just four per cent among others.

The findings have been published in the Journal of International Society of Preventive and Community Dentistry.

The four authors of the study, which was led by Emirati dentist Batool Ghaith, a specialist in pediatric dentistry at Dubai Health Authority, recommended a new focus on parental awareness programmes stressing the importance of oral health for Down syndrome children.

They also called for the establishment of “proper prevention and community oral healthcare programmes that target special needs children in Dubai” and for a UAE-wide study to be carried out, aimed at developing a better understanding of Down syndrome children’s oral health and treatment needs.