1. Orthodontic Treatment and Down Syndrome: The Art of the Possible Marc Bernard Ackerman, DMD, MBA Assistant Professor Department of Developmental Biology Harvard School of Dental Medicine Director of Orthodontics Children’s Hospital, Boston

2. Review Article Hennequin et al. Significance of oral health in persons with Down Syndrome: a literature review. Developmental Medicine and Child Neurology 1999, 41:275-83.

3. Orthodontic Profile of the Down Syndrome Patient Maxillary anteroposterior hypoplasia (54% of DS patients have Class III-Underbite) Maxillary transverse hypoplasia (65% of DS patients have posterior crossbites) Congenitally missing teeth (20x more frequent than general population) Tooth size discrepancy Open anterior bite Picher ES. Dental care for the patient with Down Syndrome. Downs Syndr Res Pract. 1998;5:111-116.

4. Orthodontic Profile of the Down Syndrome Patient Impacted teeth (10x greater canine impaction than gen. pop.) Transposed teeth Tongue thrust, retained infantile swallow Idiopathic external root resorption Gingival excess, periodontal infection Chewing difficulty, episodic choking Picher ES. Dental care for the patient with Down Syndrome. Downs Syndr Res Pract. 1998;5:111-116.

5. What do these 2 patients have in common?

7. Should we be more interested in how they are different rather than what they have in common?

9. Diagnosis and Treatment Planning in Four Dimensions

10. Assessing an individual’s: Ability to assent to treatment Ability to tolerate the burden of the therapeutic intervention in terms of time, cost, discomfort, disruption to schedule

11. Advances in Orthodontic Technology Direct bond brackets versus banding Quick set, flavored impression materials Shape memory wire (nickel titanium) permitting longer interval between appts Orthognathic surgical technique more predictable Implant supported prosthetic tooth replacement and implant anchorage

24. Ackerman JL, Proffit WR. Communication in orthodontic treatment planning: bioethical and informed consent issues. Angle Orthod 1995;65(4):253-262.

26. TAKE HOME MESSAGE: Orthodontics is the art of the possible and NOT the science of the improbable. Each child with DS deserves to be evaluated for orthodontic treatment but not all problems have simple solutions!!!!