[Groping in the dark: unheard pain 2]. / Tasten in het duister: niet gehoorde pijnklachten 2.

For a very severely mentally disabled, deaf and blind man, it was always very difficult to carry out dental check-ups, diagnosis and treatment, even with pharmacologic support. The man cannot communicate pain. When caries and calculus were diagnosed, the man was treated under general anaesthesia. During this treatment session he was also found to have severe periodontal disease and peri-apical problems. The legal representative of the patient was unavailable for consultation on changes to the pre-prepared preliminary treatment plan. This created a dilemma for the dental treatment team. This case study was presented during the conference 'State of the art' on March 17, 2017, that was organised by the Society for the Promotion of Dental Health Care for People with Disabilities (VBTGG). In this second part of the case, the treatment that was ultimately chosen is described, considered and discussed.

[Groping in the dark: pain that goes unheard 1]. / Tasten in het duister: niet gehoorde pijnklachten 1.

Even with pharmalogical support, it is always very difficult to carry out dental check-ups on a deaf-blind man with profound intellectual disabilities. The man cannot communicate pain. Further diagnostic measures and treatment are impossible while using only oral sedation. When caries and calculus are diagnosed, the man is treated under general anaesthesia. In this treatment session severe periodontal disease and peri-apical problems are also diagnosed. The legal representative of the patient is unavailable for consultation on changes to the pre-prepared preliminary treatment plan during the treatment session. This creates a dilemma for the dental treatment §team. This case study will be presented during the conference 'State of the art' on 17 March 2017, by the Society for the Promotion of Dental Health Care for People with Disabilities (VBTGG). This case can be read before the conference exclusively by the readers of the Dutch Journal of Dentistry (NTvT). The chosen treatment will be published in the edition of April 2017.

Dental development in Down syndrome and healthy children: a comparative study using the Demirjian method.

OBJECTIVE: In children with Down syndrome, the timing of dental eruption is important for orthodontics treatment planning. Aim of this study was to determine whether tooth eruption and development of the dentition in children with Down syndrome are impaired. MATERIAL AND METHODS: Dental development was scored on orthopantomograms (OPTs) of 95 children with Down syndrome. The dental age was determined at the left mandibular side according to the Demirjian method and by converting the assigned scores to the dental maturity score. Dental development scores of control children and DS children were compared with a mixed model linear regression analysis. RESULTS: The model showed statistically significant changes relating to increasing age (P<0.001) and gender (P<0.05). In this comparison, the total DS group (with and without hypodontia) was not statistically significantly different from the control group. There was also no significant difference between the total sample of DS children and the control group after using the Nyström imputation (with and without hypodontia). CONCLUSION: The findings showed that dental development in DS children is similar to the development of control children and that a relationship exists between hypodontia and dental development. The clinically observed late eruption is probably not due to late dental development but due to the other processes that take place during eruption, such as the possible impaired processes at the apical side and the occlusal side of an erupting element.

The relationship between craniofacial development and hypodontia in patients with Down syndrome.

BACKGROUND/OBJECTIVE: Hypodontia is often seen in people with Down syndrome (DS). In the normal population, persons with hypodontia have a shorter cranial base and a hypoplastic maxilla, leading to a skeletal Class III tendency and a reduced face height. The purpose of this study was to examine craniofacial morphology in patients with DS at different ages and the influence of hypodontia on their craniofacial morphology. MATERIALS AND METHODS: A comparative cross-sectional study was conducted in 63 children with DS (6-19 years old; 28 males and 35 females) at a Centre for Special Care Dentistry in Rotterdam, the Netherlands (CBT Rijnmond). Digital lateral cephalograms were obtained from all subjects and a cephalometric analysis was performed. The subjects were divided into a group with hypodontia (13 males and 25 females) and a group without hypodontia (15 males and 10 females). RESULTS: Significant results included a decrease in antero-posterior relationship of upper and lower jaw (ANB angle -0.331° per year, P = 0.044) and a decrease in vertical dimension (S-N_Go-Gn angle -0.72° per year, P = 0.039) over the years in subjects with hypodontia compared to subjects without hypodontia. CONCLUSION: The process of growth in DS patients is towards a reversed overjet. Hypodontia seems to have an additional effect on this development. The management of hypodontia as part of the complete treatment of dental development in DS children is important because it strongly influences the jaw relationship.