Radiographic assessment of periodontitis in African-Americans with Down syndrome

Down syndrome (DS) is a neurodevelopmental genetic disorder affecting millions of Americans. Previous studies, mainly in Caucasians, have shown periodontitis to be a major oral health problem among DS patients. Other research has shown that African-Americans (AA) are more susceptible to periodontitis than Caucasians. Our objective was to determine if DS negatively affects the already impaired periodontal status of AAs.

Radiographic alveolar bone levels were used to determine periodontal status. Full-mouth series of intraoral periapical (PA) radiographs of 25 AA DS patients (age range 18-64 years, 36% males) were randomly selected from a special care dental center for the handicapped. PA radiographs of 25 AA mentally challenged (MC) non-Down patients were also selected from the same center. MC patients were matched to DS patients on variables of race, age, sex, socioeconomic status and institutionalized care. All periapical radiographs were taken with a long cone paralleling technique under normal clinical practice conditions. Under standardized viewing conditions, the distance from the cementoenamel junction to the interproximal alveolar crest on both the mesial and distal surfaces of each fully erupted permanent tooth present was measured. A paired samples t-test was used to compare the radiographic bone levels of DS and MC subjects.

All subjects showed sites with bone loss > or = 3 mm. Whole mouth mean (SD) bone level for DS subjects was 3.0 (1.5) mm and for MC subjects it was 1.9 (1.1) mm, p = 0.001. This finding was replicated in the various regions in the mouth where DS patients showed greater bone loss than MC patients in anterior regions (incisors and canines, p = 0.001), in posterior regions (molars and premolars, p = 0.007), in maxillary regions (p = 0.001) and in mandibular regions (p = 0.005).

Periodontitis is a problem in AA patients. Adding the genetic disorder of DS to AA race imposes additional risks for periodontitis.