Dental Issues

Dental care is important for everybody, but people with Down syndrome can have a number of differences that require special attention.

What is Different About the Teeth of People With Down Syndrome?

Delayed Eruption

The teeth of people with Down syndrome, both baby teeth and permanent teeth, may come in late compared to children without Down syndrome. On average, babies with Down syndrome get their first teeth at 12 – 14 months, but it may be as late as 24 months of age. Babies without Down syndrome typically get their first teeth between 6 – 12 months. A child with Down syndrome may not get all 20 baby teeth until he or she is 4 -5 years of age, rather than 2 – 3 years of age, which is typical for children without Down syndrome. The front permanent teeth and permanent 6 year old molars may not erupt until 8 – 9 years of age. It is also common for the teeth of children with Down syndrome to erupt in a different order than they do in children without Down syndrome.

Small and Missing Teeth

Frequently, people with Down syndrome have smaller than average teeth and missing teeth. It is also common for their teeth to have roots that are shorter than average.

Large Tongues

People with Down syndrome may have large tongues or they may have an average size tongue and a small upper jaw that makes their tongue too large for their mouth. It is also common for people with Down syndrome to have grooves and fissures on their tongues.

Problems With Bite

People with Down syndrome may have small teeth, which can cause spacing between the teeth. They also tend to have a small upper jaw. This may cause crowding of the teeth and may result in the permanent teeth being “impacted” because there is no room in the mouth for them to come in. The small upper jaw may create a situation where the top teeth do not go over the bottom teeth the way they are meant to. Instead the bottom teeth may be out further than the top teeth in the back of the jaw, the front of the jaw, or both. It is also common that the front teeth of people with Down syndrome do not touch.

Orthodontics (braces) may be able to improve some of these issues. Orthodontics require a lot of cooperation and make the teeth even more difficult to keep clean, so it may not be possible in all people. It may be a good idea to wait until a child is older and able to tolerate it a bit better. Having orthodontic appliances in the mouth can also pose challenges to speech. Children without Down syndrome typically adapt their speech quickly but a child with Down syndrome may experience more difficulty doing so. Therefore, it may be a good idea to delay orthodontic treatment until a child is older and his or her speech is further along.

Gum Disease

People with Down syndrome are at increased risk for gum disease (periodontal disease). Even when individuals with Down syndrome do not have a lot of plaque and tartar, they get periodontal disease more frequently than others. This is because they have an impaired immune system and do not have some of the natural protections against the disease that people without Down syndrome have. To prevent gum disease, they must brush twice daily, focusing the bristles along the gum line, floss daily and be sure to visit the dentist regularly to have gum health monitored and to take X-rays to monitor bone levels. If the gums bleed, they are inflamed. Brushing and flossing should not be stopped because of this. In fact, brushing and flossing will keep the gums clean and help to minimize the inflammation.


Some research says that people with Down syndrome are at less risk for cavities. However, much of that research was done when people with Down syndrome lived in institutions and had very restricted diets. People with Down syndrome do get cavities, so brushing with fluoride toothpaste, flossing between any teeth that touch, and limiting the amount and frequency of sugar and refined carbohydrates will help to prevent cavities.

Do People With Down Syndrome Need to Take Antibiotics Before Going to the Dentist?

People who have, or have had, certain kinds of heart defects need to take antibiotics before their dental appointment. The patient’s physician or cardiologist must determine whether antibiotics are needed and the dentist should ask about all health conditions, including heart issues.



The information featured in this section is reproduced via an exclusive arrangement with National Down Syndrome Society [ONLINE] Available at