contributory factor in this supposed reduction in dental disease prevalence.
Periodontal disease
The periodontal status of children who are intellectually impaired may be
compromised by their inability to comprehend and thus comply with oral hygiene
measures. In these children periodontal disease is more prevalent, possibly as a result
of an altered immune state (1124HChapter 11.). Almost universally, plaque and gingivitis
indices scores are higher in children with impairments.
Malocclusion
There are no studies that deal specifically with the problems of malocclusion in
intellectually impaired children. However, in published data on general dental health,
the number of orthodontic anomalies is frequently higher because many remain
untreated. In Down syndrome the relative mid-face hypoplasia contributes to the
pseudoskeletal class III relationship and this, in combination with the narrow, high-
vaulted palate produces buccal cross-bites (1125HFig. 17.2).
Other oral defects
One feature of note is the prevalence of enamel defects often caused by the
aetiological agent that produced the impairment. It is possible that dentists could play
a part not only in the diagnosis of some disabilities, for example, coeliac disease (1126HFig.
17.5), but also in the timing of the insult that led to the impairment. Teeth provide a
good chronological record of the timing of severe systemic upsets (1127HChapter 13).
1128H
Fig. 17.5 Chronological hypoplasia in a
child with coeliac disease.17.2.3 Operative procedures
Children who are intellectually impaired may be able to co-operate for dental
treatment, but their ability to accept specific procedures such as the use of local
anaesthetic and high speed instruments will depend on their degree of understanding
and level of maturity. Isolation may be difficult due to a large tongue and poor control
of movement, and in these situations it may be necessary to compromise on the
treatment approach. In fissure sealing it may be more practicable to use a glass
ionomer cement, protected by occlusal adjustment wax or a gloved finger during the
setting phase, rather than to struggle with all the stages of applying a conventional
resin sealant (1129HFig. 17.6). Human clinical trials are now underway in both the United