U osoba s Downovim sindromom pronađene su znatne promjene koje zahvaćaju kranioorofacijalno područje. Ovim radom željela se
utvrditi čestoća pojedinih vrsta ortodontskih anomalija u tih ispitanika.
U tu svrhu pregledano je 112 ispitanika s citogenetski potvrđenom dijagnozom Downova sindroma. Svi ispitanici podvrgnuti su potpunom stomatološkom pregledu. Za određivanje ortodontske anomalije uporabljena je sljedeća klasifikacija: kompresije, anomalija preranoga gubitka, progenija, otvoreni zagriz, pokrovni zagriz, jednostrani unakrsni zagriz, te obostrani unakrsni zagriz. U 92% ispitanika postojala je ortodontska anomalija. Najzastupljenija je bila progenija, i to u 43,8% ispitanika. Zbijenost i jednostrani križni zagriz pronađeni su svaki od njih u 17% ispitanika. Obostrani križni zagriz pronađen je u 5,4% ispitanika, anomalija preranoga gubitka samo u 1% ispitanika, a pokrovni zagriz nije pronađen ni u jednome slučaju.Significant alterations of the cranio-orofacial region have been observed in subjects with Down’s syndrome. The aim of this study was to assess the frequency of particular orthodontic malocclusion in these subjects. A group of 112 subjects with cytogenetically confirmed diagnosis of Down’s syndrome was examined. All the subjects underwent a complete dental examination. The following classification was used to determine malocclusion of crowding, premature tooth loss, class III malocclusion, open bite, class II division 2 malocclusion, unilateral cross bite and bilateral cross bite. Clipper language programs were designed for data processing. Malocclusion was found in 92% of the subjects. Class III malocclusion was most frequently observed (43.8%). Crowding and unilateral cross bite were found in 15% of the subjects respectively. Bilateral cross bite was present in 5.4% of the subjects. Premature tooth loss was observed in only 1% of the subjects whereas class II division 2 malocclusion was not recorded in any of the subjects examined

Jadranka Štefanac-Papić

Jasmina Stipetić

Martina Mikšić

Senka Meštrović

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A S CActa Stomatol Croat, Vol. 36, br. 2, 2002. 239Prevalence of Malocclusion inPatients with Down’s SyndromeSummarySignificant alterations of the cranio-orofacial region have beenobserved in subjects with Down’s syndrome. The aim of this study wasto assess the frequency of particular orthodontic malocclusion in thesesubjects. A group of 112 subjects with cytogenetically confirmed diag-nosis of Down’s syndrome was examined. All the subjects underwent acomplete dental examination. The following classification was used todetermine malocclusion of crowding, premature tooth loss, class IIImalocclusion, open bite, class II division 2 malocclusion, unilateralcross bite and bilateral cross bite. Clipper language programs weredesigned for data processing. Malocclusion was found in 92% of thesubjects. Class III malocclusion was most frequently observed (43.8%).Crowding and unilateral cross bite were found in 15% of the subjectsrespectively. Bilateral cross bite was present in 5.4% of the subjects.Premature tooth loss was observed in only 1% of the subjects whereasclass II division 2 malocclusion was not recorded in any of the subjectsexamined.Key words: malocclusion, Down’s syndrome.Senka MeπtroviÊ1Martina MikπiÊ1Jadranka ©tefanac-PapiÊ1Jasmina StipetiÊ21Department of OrthodonticsSchool of Dental MedicineUniversity of Zagreb2Department of ProsthodonticsSchool of Dental MedicineUniversity of ZagrebActa Stomat Croat2002; 239-241ORIGINAL SCIENTIFICPAPERReceived: February 18, 2002Address for correspondence:Senka MeπtroviÊDepartment of OrthodonticsSchool of Dental MedicineGunduliÊeva 5, 10000 ZagrebCroatiaIntroductionAll subjects with a chromosomal disbalance (tri-somy or monosomy) in each individual cell of theirbody, have some feature in common, i.e. theyresemble other subjects with the same genetic dis-turbance, like siblings and differ considerably fromtheir own relatives (1). Genetic disturbances causealterations in the structure and function of the organsand the body as a whole, which make the carrier ofa genetic disbalance differ from his family’s geneticbasis (2). Thus, subjects with Down’s syndrome canreadily be recognized according to the phenotype,as well as to the development and history of thedisease, i.e. a whole array of symptoms (3, 4). Thecranio-orofacial region is involved by considerablealterations. Cohen and Winer recorded dentitiondisturbances in 73% of cases with Down’s syn-drome (5). Deleyed tooth eruption in both deciduousand permanent dentition has been reported by manyauthors (5-18). Tooth malocclusion, most frequentlyin the form of hypodontia and microdontia, isalso characteristic of the disturbance (5, 8, 10,16, 17).A S C Acta Stomatol Croat, Vol. 36, br. 2, 2002.240Senka MeπtroviÊ et al. Prevalenece of MalocclusionEpidemiologic studies have shown that subjectswith Down’s syndrome are predisposed to certaintypes of malocclusion, e.g., class III malocclusion,usually associated with mandibular overjet and openbite. These types of malocclusion are otherwise veryrare in the healthy population (18). Open bite is alsoquite frequent in other mentally retarded subjects,free of Down’s syndrome. In contrast, deep bite andmaxillary prognathism are very rarely observed. Indeciduous dentition, Spee’s curve is slightly deeperas compared to that in the normal population. Dur-ing mixed dentition, the curve tends to decline indepth, and in some subjects it may even becomeinverse. With aging, the depth of Spee’s curve increas-es very slightly once again, most probably due to pre-molar hypodontia, but never reaches the depth foundin the normal population (16). In subjects with Down’s syndrome guidance ofthe mandible into the centric occlusion is absent.The mandible is permanently pushed to the right, tothe left or forward, always reacting with differentocclusion on demand. Therefore, the subjects tendto mandibular prognatism (19). Jensen et al. (16)compared the width, length and perimeter of dentalarches between subjects with Down’s syndrome andthe normal population. In the normal population,the maxillary arch width exceeds the mandibulararch width, in contrast to the subjects with Down’ssyndrome in whom the width of both arches is equalor the mandibular arch is even wider. Of course,this is related to a high frequency of unilateral crossbite and class III malocclusion. The length and perime-ter of the maxillary dental arch are smaller in sub-jects with Down’s syndrome than in the normal pop-ulation, while the size of the mandible is equal inthe two groups of subjects.The aim of the studyThe aim of the study was to assess the frequencyof particular types of malocclusion in subjects withDown’s syndrome.Subjects and methodsIn total, 131 subjects with cytogenetically con-firmed diagnosis of Down’s syndrome, aged 2-36years, were examined. As the number of teeth wasinadequate in 19 subjects, they were excluded fromthe study. Thus, a sample of 112 subjects, 68 (60.7%)males and 44 (39.3%) females, were studied. Allsubjects underwent a complete dental examination,performed in the dental surgery of their home insti-tutions. A WHO 1983 E questionnaire for oral healthand need assessment (CPITN) was used for datarecording. A new item had to be added to the ques-tionnaire for this study, for the finding of malocclu-sion. The following classification was used to desig-nate the malocclusion observed:1. Crowding2. Premature tooth loss3. Class III malocclusion4. Open bite5. Class II division 2 malocclusion6. Unilateral cross bite7. Bilateral cross bite. Programs in the Clipper language were designedfor processing of the data obtained.Results and discussionAmong the 112 subjects examined, malocclusionwas present in 92% (Figure1). This percentage great-ly exceeds those observed by others in a healthy pop-ulation (20-26). Only 8% of the subjects were free ofmalocclusion, which was by almost less than half thefigure reported by ©tefanac in children from Zagreb(21). She found 15% of eugnathic children, 13% and15% of boys and girls, respectively. VrbiË et al. (20)examined children aged 6, 12, 15 and 18 years. Mal-occlusion were found in 45.5% of the cases. Radica(22) examined 1600 children aged 7-14 years in Splitand observed malocclusion in 52.8% of the cases. Intheir study carried out in 366 children aged 12.5-13.5years in the PoreË area, LegoviÊ and CekiÊ (23) foundmalocclusion to be present in 63.7% of the cases.Cipruπ (24) examined children aged 7-14 years on theisland of Rab, reporting 66.8% of cases with mal-occlusion. CeraniÊ (25) studied 990 children aged 7--15 years in the Poæega area. Malocclusion wasobserved in 54.14% of the children. In the examined sample of subjects with Down’ssyndrome (Table 1), class III malocclusion wasmost frequently present, i.e. in 43.8% of the cases,which was considerably different from the resultsreported by authors who examined a healthy popula-tion. Cipruπ (26) found class III malocclusion in8.27%, Radica (22) in 5.8%, LegoviÊ and CekiÊ (23)in 6.44%, and CeraniÊ (25) in 14.34% of the sub-jects examined. Crowding and unilateral cross biteoccupied second place, with 17% each. LegoviÊ(27) found crowding in 33.3%, Cipruπ (26) in56.93%, Radica (22) in 34.67%, LegoviÊ and CekiÊ(23) in 60.5%, and CeraniÊ (25) in 14.34% of thecases. The frequency of open bite was 8%. Cipruπ(26) recorded it in 0.81%, LegoviÊ and CekiÊ (23)in 4.7%, and CeraniÊ (25) in 2.32% of the subjectsexamined. According to Gorlin (7), open bite ispresent in 15% of subjects with Down’s syndrome.Fisher-Brandies (28) reported on open bite in sub-jects with Down’s syndrome to be of a dento-alve-olar nature. According to Weyman (29) and Desai(30) , most subjects with Down’s syndrome have anormally sized tongue, but the size of the oral cavityis reduced, resulting in open bite. In subjects withDown’s syndrome, bilateral cross bite occurred in5.4% of the cases. The malocclusion of prematuretooth loss was less frequent, i.e. in only 0.9% of thecases. Radica (22) found premature tooth loss in13.4%, LegoviÊ and CekiÊ (23) in 19.4%, and Ce-raniÊ (25) in 5.86% of the subjects examined. Mu-retiÊ et al. (31) examined 10 000 orthodonticpatients and found crowding to be the most frequentdiagnosis (60.2%).In our study, none of the subjects examined wasfound to have class II division 2 malocclusion, whichdiffered considerably from the frequency of thismalocclusion in the healthy population. Cipruπ (23),Radica (19), LegoviÊ and CekiÊ (20), and CeraniÊ(22) reported on the frequency of class II division2 malocclusion of 4%, 13.53%, 4.7% and 6.77%,respectively. Class III malocclusion was found tooccur twice as frequently in male subjects than infemale with Down’s syndrome. In contrast, the fre-quency of unilateral and bilateral cross bite infemales was three-fold that found in males. The fre-quency of other malocclusions was equal in bothsexes. In the total number of malocclusions (Table2), class III malocclusion was most frequentlyobserved, i.e. in 47.6% of the cases (in 36.9% and10.7% of the boys and girls, respectively). Cohen(32) considers class III malocclusion in subjectswith Down’s syndrome to be induced by inadequate-ly developed maxilla, and increased by enlargedtongue and its movements. The frequency of crowd-ing and unilateral cross bite was found in 18.5% ofthe cases. Unilateral cross bite was present in 5.8%of the boys, which was by half as low as in the girls,in whom it was found in 12.6% of the cases. The fre-quency of open bite and bilateral cross bite was8.7% and 5.8%, respectively. The malocclusion ofpremature tooth loss was less frequently observed(1%). ConclusionsMalocclusion was observed in 92% of subjectswith Down’s syndrome. Class III malocclusion wasmost frequently observed, i.e. in 43.8% of the cases.Crowding and unilateral cross bite were found in15% of the subjects respectively. Bilateral cross bitewas present in 5.4% of the subjects. Premature toothloss was observed in only 1% of the subjects.A S CActa Stomatol Croat, Vol. 36, br. 2, 2002. 241Senka MeπtroviÊ et al. Prevalenece of Malocclusion

Prevalence of Malocclusion in Patients with Down’s Syndrome

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