[Down syndrome--2. Orofacial aspects]

Because of the higher life expectancy and the ambulant care facilities, the general dentist will be more and more confronted with patients suffering from Down's syndrome. Of major importance are the associated heart and vascular diseases and hypothyroidism, accentuating even more the retarded growth. These patients also show a decrease in resistance, which frequently (50%) results into periodontal disease. Apart from the typical bone "growth" changes, the hypotonicity of the masticatory musculature and the tongue are key factors determining the typical expression. The eruption time and, to a lesser extent, the age of the final teeth is slowed down. When in addition hypothyroidism is observed, this results in a typical radiographic image of the mandible (apices against bottom corticalis). When merely considering the microdontics, the agenesis and the more favourable composition of saliva, caries should be less frequent. However, for techno-hygienic reasons this is often not the case. When the gingiva is affected by a rapidly progressing periodontal disease, it should be frequently cleaned, supported by a chemical plaque treatment. The author emphasizes that on no account prevention can be left to the patient. The patients always need to be helped. Finally the logopaedic purpose of the Castillo-Moralis palatal plate, as well as the functional use of the surgical tongue reduction, are discussed.