Long term effects of the palatal plate therapy for the orofacial regulation in children with Down syndrome

Orofacial findings and orthodontic treatment conditions in patients with down syndrome - a retrospective investigation

INTRODUCTION

The most common chromosomal anomaly is Down syndrome/Trisomy 21, which can be associated with varying degrees of intellectual disability and physical malformation. Specific orofacial characteristics regarding orthodontic treatment options and features are described on the basis of a patient collective from the Witten/Herdecke University, Germany.

METHODS

Data of 20 patients (14 boys and 6 girls, mean age: 11.69 ± 3.94 years) who underwent orthodontic treatment between July 2011 and May 2022 were analyzed. Baseline skeletal and dental conditions were assessed, as well as the presence of hypodontia, displacements, and treatment-related root resorptions. The treatment need was evaluated based on the main findings according to the German KIG classification. In addition, treatment success was determined in relation to patient compliance.

RESULTS

The patient group was characterized predominantly by a class III relationship (ΔANB: -2.07 ± 3.90°; ΔWITS: -3.91 ± 4.33 mm) and a brachyfacial cranial configuration (ΔML-NL: -4.38 ± 7.05°, ΔArGoMe: - 8.45 ± 10.06°). The transversal discrepancy of the dental arch width from maxilla to mandible was -0.91 ± 3.44 mm anteriorly and -4.4 ± 4.12 mm posteriorly. Considering the orthodontic indication groups, the most frequent initial finding and treatment indication represented hypodontia (85%), followed by frontal (75%) and unilateral lateral (35%) crossbite. In 55% of the cases, the teeth had a regular shape, but in 35% a generalized and in 15% an isolated hypoplasia. Only 25% of the patients could be treated with a fixed multiband appliance due to sufficient cooperation. In each of these patients, varying degrees of root resorptions were detected during treatment, and 45% of all treatments had to be terminated prematurely due to a lack of cooperation by patients or parents.

CONCLUSION

The extent of dental and skeletal malformations and the high rate of findings requiring treatment in patients with Down syndrome represent a significant indication for orthodontic therapy, which can be well illustrated by the KIG classification. However, this is in contrast to the eventually increased risk of root resorption, with significantly reduced patient cooperation. A compromised treatment outcome and process must be expected. Consequently, the orthodontic treatment must be simple and realistic to achieve fast and therapeutically satisfactory treatment result.

Vowel Production in Children and Adults With Down Syndrome: Fundamental and Formant Frequencies of the Corner Vowels

PURPOSE

Atypical vowel production contributes to reduced speech intelligibility in children and adults with Down syndrome (DS). This study compares the acoustic data of the corner vowels /i/, /u/, /æ/, and /ɑ/ from speakers with DS against typically developing/developed (TD) speakers.

METHOD

Measurements of the fundamental frequency (f o) and first four formant frequencies (F1-F4) were obtained from single word recordings containing the target vowels from 81 participants with DS (ages 3-54 years) and 293 TD speakers (ages 4-92 years), all native speakers of English. The data were used to construct developmental trajectories and to determine interspeaker and intraspeaker variability.

RESULTS

Trajectories for DS differed from TD based on age and sex, but the groups were similar with the striking change in f o and F1-F4 frequencies around age 10 years. Findings confirm higher f o in DS, and vowel-specific differences between DS and TD in F1 and F2 frequencies, but not F3 and F4. The measure of F2 differences of front-versus-back vowels was more sensitive of compression than reduced vowel space area/centralization across age and sex. Low vowels had more pronounced F2 compression as related to reduced speech intelligibility. Intraspeaker variability was significantly greater for DS than TD for nearly all frequency values across age.

DISCUSSION

Vowel production differences between DS and TD are age- and sex-specific, which helps explain contradictory results in previous studies. Increased intraspeaker variability across age in DS confirms the presence of a persisting motor speech disorder. Atypical vowel production in DS is common and related to dysmorphology, delayed development, and disordered motor control.

Effects of using the stimulating palatal plate in combination with orofacial stimulation on the habitual tongue and lip posture in children with trisomy 21: an integrative literature review

ABSTRACT Purpose: to verify, in the literature, the effects of using the stimulating palatal plate on lip and tongue posture in children with trisomy 21. Methods: a search was conducted in Medline, LILACS, CINAHL, EMBASE, Scopus, Web of Science, and Cochrane. Original articles designed as clinical trials, longitudinal studies, or case-control studies, approaching stimulating palatal plate in the treatment of children with trisomy 21 and assessing habitual lip and tongue posture as an outcome, were included. Literature Review: a total of 376 studies were found, of which 10 met the selection criteria. They were published between 1996 and 2007 and carried out mostly in Europe, with small samples. The age when they began wearing the plate ranged from 1 month to 5 years, and intervention lasted from 4 to 58 months; in most cases, it was combined with orofacial muscle stimulation. Use frequency ranged from two to four times a day, each period lasting from 30 minutes to 2 hours. The children’s tongue and lip posture improved in most pieces of research. Conclusion: studies suggest that using the stimulating palatal plate in combination with orofacial muscle stimulation brings benefits to tongue and lip posture in children presented with trisomy 21.

Efeitos da placa palatina de memória associada à estimulação orofacial na postura habitual de língua e de lábios de crianças com Trissomia do 21: revisão integrativa da literatura

RESUMO Objetivo: verificar na literatura os efeitos da placa palatina de memória na postura de lábios e língua de crianças com Trissomia do 21. Métodos: foi realizada busca nas bases de dados Medline, Lilacs, CINAHL, Embase, Scopus, Web of Science e Cochrane, com inclusão de artigos originais com delineamentos dos tipos ensaios clínicos, estudos longitudinais ou caso-controle, que abordaram a placa palatina de memória no tratamento de crianças com Trissomia do 21 e avaliaram, como desfechos, a postura habitual de língua e de lábios. Revisão da Literatura: foram encontrados 376 estudos, dos quais dez contemplaram os critérios de seleção. Estes foram publicados entre 1996 e 2007, conduzidos principalmente na Europa, com amostras reduzidas. A idade de instalação da placa variou de um mês a cinco anos e a duração da intervenção de quatro a 58 meses, estando, na maioria, associada à estimulação da musculatura orofacial. A frequência de uso variou de dois a quatro períodos diários de 30 minutos a duas horas. Houve melhora na postura de língua e lábios das crianças na maioria das pesquisas. Conclusão: os estudos sugerem que a placa palatina de memória, associada à estimulação da musculatura orofacial, proporciona benefícios para postura de lábios e língua de crianças com Trissomia do 21.

Oral Sensory-Motor Intervention for Children and Adolescents (3-18 Years) With Dysphagia or Impaired Saliva Control Secondary to Congenital or Early-Acquired Disabilities: A Review of the Literature, 2000 to 2016

OBJECTIVES:

Dysphagia and impaired saliva control are common in children and adolescents with congenital and developmental disabilities. The aim of the present review was to investigate the evidence base for oral sensory-motor interventions in children and adolescents with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities and to make recommendations regarding methods for intervention.

METHODS:

A review of the literature from 2000 to 2016, including oral sensory-motor intervention studies for children and adolescents (3-18 years of age) with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities, was performed. The literature search included the PubMed, CINAHL, Medline, SpeechBITE, OVID, ERIC, Cochrane, and Google Scholar databases. Primary studies were evaluated on a 4-grade scale using the Grading of Recommendations Assessment, Development and Evaluation.

RESULTS:

Twenty primary studies of oral sensory-motor interventions for dysphagia and 6 studies for the treatment of impaired saliva control fulfilled the inclusion criteria. Of these, 3 were randomized, controlled trials. Five systematic reviews and 16 narrative reviews were also included. Limited and moderately strong recommendations were made on the basis of the grading results from the primary studies. The studies reported good results, but study design was often insufficient, and the study groups were small. The systematic reviews confirmed the lack of high scientific support for oral sensory-motor interventions in children and adolescents with congenital and developmental disabilities.

CONCLUSIONS:

There is an urgent need for high-quality studies that could serve as the basis for strong recommendations relating to oral sensory-motor interventions for children with dysphagia and impaired saliva control.

Sublingual administration of atropine eyedrops in children with excessive drooling - a pilot study

BACKGROUND

Drooling can be a severe disability and have high impact on daily life. Reversible treatment is preferable.

AIM

To analyse whether sublingual administration of atropine eyedrops is a useful reversible treatment option for severe drooling in children with disabilities.

DESIGN

The study had a prospective, single-system research design. The participants served as their own controls. The study period was 3 weeks without treatment, 4 weeks with atropine eyedrop solution 10 mg/mL one drop a day followed by 4 weeks of one drop twice a day. Parents' rating of their child's drooling was assessed on a 100-mm VAS, and unstimulated salivary secretion rate measurement was performed together with notations about side effects and practicality.

RESULTS

Parents' VAS assessment of drooling decreased from a median (range) of 74 (40-98) at baseline to 48 (18-88) (P = 0.05) and 32 (12-85) (P = 0.004) after 4 weeks of atropine once a day and another 4 weeks of atropine twice a day, respectively (n = 11). Unstimulated salivary secretion rates decreased from baseline to end of study (P = 0.032). Several parents complained about difficult administration. No irreversible side effects were noted.

CONCLUSIONS

Sublingual atropine eyedrops may be an alternative for treatment of severe drooling in children with disabilities.

Treatment of obstructive sleep apnea in infants with trisomy 21 using oral appliances

Objective : To perform a retrospective study to evaluate the effect of oral appliances, aimed at increasing the pharyngeal space, on obstructive sleep apnea (OSA) in infants with trisomy 21 (TS21). Design and Setting : Retrospective study in a tertiary referral center. Intervention : We analyzed data from 51 consecutive infants (mean age, 2.7 months) who underwent polysomnography (PSG) and were offered our treatment concept. Primary study variable was the mixed-obstructive apnea index (MOAI); OSA was defined as a MOAI ≥ 1. Results : Twenty-seven infants (53%) had OSA. Their median MOAI improved from 2.3 (1 to 13) to 0 (0 to 0.2; P < .05). Seven of these infants were treated with an appliance that included some type of velar extension to move the tongue base forward. Of the 24 infants without OSA at admission, follow-up PSG results were available for 13. Three infants from this group had developed OSA by the time of a repeat PSG. Conclusion : In patients with TS21, OSA may already develop in infancy. Early treatment may improve OSA. Oral appliances with some type of velar extension may be considered as an alternative to other treatment procedures.

Factors associated with malocclusions in children and adolescents with Down syndrome

INTRODUCTION

Our aims in this study were to determine the prevalence of malocclusion stemming from vertical or transversal occlusal alterations in subjects with Down syndrome (DS) and the associations with individual, socioeconomic, and behavioral factors.

METHODS

A cross-sectional study was carried out with 112 pairs of mothers and their children with DS between 3 and 18 years of age attending a genetics clinic at a public hospital in Rio de Janeiro, Brazil. Data were collected with a questionnaire given to the mothers and a clinical examination of the child or adolescent. Univariate, bivariate, and multiple logistic regression (backward stepwise) analyses were conducted.

RESULTS

The results showed a prevalence of malocclusion in 74% of the sample. After the adjustment of the logistic regression model, these variables--age, nail or finger biting habit, mouth posture, and cold or sore-throat episodes in the previous 6 months--were associated with the prevalence of malocclusions in these subjects.

CONCLUSIONS

The data demonstrate a high prevalence of malocclusions stemming from vertical or transversal occlusal alterations in children and adolescents with DS. Age, nail or finger biting, mouth posture, and upper airway infections were related to malocclusions in these patients.

Children with Down syndrome: oral development and morphology after use of palatal plates between 6 and 48 months of age

OBJECTIVE

The aim of this study was to describe the number of erupted teeth, sucking habits, tongue morphology, facial expression and speech in children with Down syndrome (DS) aged 48 +/- 6 months and treated from 6 months of age with palatal plates in combination with speech and language therapy.

METHODS

The research took the form of a multicentre, multidisciplinary, longitudinal study of children with DS followed from the age of 6 months. A total of 37 children with DS were included. One child could not cooperate at all and was excluded from the evaluations. In combination with speech and language intervention provided by speech and language therapists, the children used palatal plates provided by dentists from 6 months of age. In the evaluation, the children in the sample (n = 36) were compared with two similarly aged control groups: one group of children with DS who never had used palatal plates (n = 31) and one group of children with normal development (n = 36). The evaluation of oral parameters was performed by dentists after calibration. Registration of facial expression and speech was done by a speech and language therapist, and the evaluation was done by two speech and language therapists and one phonetician who were calibrated in joint discussions.

RESULTS

In contrast to the children with DS in the control group, the subjects in the study were found to have as many erupted teeth as the children with normal development. The prevalence of sucking habits did not differ between the three groups. Only children with DS sucked their tongue, a toy or other things in addition to a thumb or dummy. The prevalence of tongue diastase in the study group with DS was of the same magnitude as in the evaluation at the age of 18 +/- 3 months. The palatal plates were used by 57-65% of the children without any larger problems. In the study sample, the possible beneficial effects of palatal plate therapy were a lower prevalence of posterior cross-bite, a higher prevalence of frontal cusp-to-cusp relation and a lower prevalence of frontal open bite. Evaluation of facial expression and speech showed a higher score for facial expression and a better communicative capacity in the children in the study group than in the control children with DS.

CONCLUSIONS

In children with DS, palatal plate therapy between 6 and 48 months of age in connection with speech and language intervention had a positive effect on occlusion, oral motor function, facial expression and speech. No harmful effects were observed. Although this is a valuable method, however, it must be emphasized that palatal plate therapy puts additional demands on already burdened children and their caretakers.

Cephalometric Evaluation of Children with Down Syndrome After Early Intervention with the Stimulating Plate

The aim of stimulating plate therapy in patients with trisomy 21 is to correct orofacial dysfunctions and prevent the establishment of subsequent morphological characteristics such as protrusion of the incisors and pseudoprognathia. This study investigated the effectiveness of this type of therapy in improving skeletal traits of patients with Down syndrome. The lateral cephalograms of 22 consecutive juveniles with Down syndrome, whose orofacial dysfunctions had been successfully treated with a stimulating plate according to Castillo Morales in infancy (17 months +/- 24 months), were examined 136 months on average (minimum of 78 months, maximum of 231 months) after initiation of treatment. In 16 of the 22 patients, the anomaly-typical bialveolar protrusion of the anterior teeth was diagnosed. The cephalometric results indicated larger values of cephalometric parameters concerning cranial base and maxilla, and markedly larger mandibular cephalometric values when compared to untreated children with Down syndrome. These results show that a stimulating plate may not always be indicated in patients with Down syndrome with a skeletal Class III pattern and minor orofacial findings.