Down syndrome

Down syndrome changes the dental plan in two ways at once: the mouth tends to carry more periodontal disease earlier, and the person carries several conditions that bear directly on sedation and general anaesthesia. Pooled observational studies of medium and low quality associate the syndrome with periodontitis at roughly four-fold odds on a wide interval, small and largely indirect evidence points to an immune contribution rather than hygiene alone, and a small meta-analysis found conventional cleaning reduced pocket depth by a fraction of a millimetre less than in people without the syndrome. About half of people with Down syndrome have congenital heart disease, but antibiotic prophylaxis follows the specific cardiac lesion under the American Heart Association categories, not the syndrome. Atlantoaxial instability is common on imaging and rarely symptomatic, and routine radiographs in symptom-free children have been de-emphasised, yet a review of rare, severe neurological injuries in children around anaesthesia, sedation, positioning or restraint found no intraoperative precautions reported for any of them; the airway is narrower under sedation, sleep apnoea is very common in children, and in paediatric series anaesthesia brought more bradycardia, airway obstruction and post-intubation croup than in other children — which argues for planning the venue, while also showing that the hospital is a different set of risks rather than none. Alzheimer's pathology is nearly universal by forty and about 70% are diagnosed with dementia by their mid-fifties, which makes the timing and scope of complete care a decision that cannot be postponed indefinitely.