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Fast Facts: Perio Edition - Periodontitis as a Manifestation of Systemic Disease - Trisomy 21

Fast Facts

Fast Facts: Perio Edition Episode 59

[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello, and welcome to Fast Facts: Perio Edition. This week's conversation is continuing the dialogue we began a few weeks back in discussing periodontitis as a manifestation of systemic disease. This week we are looking at Trisomy 21. And I want to be very clear when we talk about these diseases and we say that periodontitis as a manifestation of systemic disease is oftentimes linked to relatively rare or obscure diseases, most of us recognize of any of these diseases, Trisomy 21. We understand, for example, Trisomy 21, a chromosomal anomaly in humans, is also termed Down Syndrome. Now, down syndrome, or Trisomy 21, is a genetic condition in which the patient presents with an extra chromosome, so most babies will inherit 23 chromosomes from each parent for a total of 46 chromosomes. However, in babies born with Down Syndrome, these individuals end up with three chromosomes placed at position 21. Thus why we call these Tri somy 21 cases. And we understand while this is a relatively rare disease, in fact, it currently occurs in about one out of every almost 700 births across the United States that this particular disease is oftentimes affiliated with an increased risk for other medical complications.
So oftentimes, patients with Down Syndrome may experience things like congenital heart disease. In fact, in about 30% to 50% of Down Syndrome cases, these patients may experience cardiovascular disease to the point where they might actually be placed on a premedication prior to your dental visit. They may also experience things like gastrointestinal abnormalities, musculoskeletal or movement problems, spinal disorders, endocrine disorders, epilepsy, hearing loss, difficulty making speech sounds, sleep disorders, feeding disorders, or a variety of different types of developmental disabilities. These could be things like learning disabilities, intellectual disabilities, or moving in tandem with autism.
And so the concern, of course, becomes, while we understand these other systemic challenges, how does this specifically relate to periodontal disease? Well, we understand first and foremost that part of this challenge may be in the anatomical structure of the face. Individuals who have Trisomy 21 have a narrow nasopharyngeal region and a widened mouth area. They oftentimes present with malocclusion, oftentimes a class III crossbite. These individuals also may present with macroglossia or enlargement or fissuring of the tongue, high arched palate and present with larger than normal deciduous dentition.
We also frequently observe missing teeth in these individuals. We can see changes in dental abnormalities like shovel-shaped and incisors, missing marginal ridges, and, of course, a wrinkling of the occlusal surface, as seen in Molars. When we talk about periodontal disease, specifically, that explanation for why these patients may experience advanced periodontal destruction is likely due to the challenge around chemotaxis of our neutrophils. So we learned in dental and dental hygiene school that chemotaxis is the means of moving our immune components to a site of infection to a chemical attractant.
And in this case, while we know that these nutrients are important to the first line of defense against infection, that in their absence, this really sets the stage for the presence of disease. So we believe that patients who present with Trisomy 21 present with a significant decrease in neutrophil activity due to that declined chemotaxis. In addition, we see a decrease in phagocytic abilities, the ability for our macrophages to be able to engulf and digest bacteria, and, of course, suspected shortened half life of our neutrophils that our neutrophils, even if we can get them to the site of infection, that their ability to live in this area and continue to provide clean up during the disease process is diminished.
Thank you for your time today as we discussed perio as a manifestation of systemic disease. Join us next week as we continue the conversation around patients who present with any one of multiple rare diseases as contributory factors to perio as a manifestation of systemic disease.
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at We'll see you next week for another Fast Fact!

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