Xerostomia, Halitosis, and Angular Cheilitis

Among individuals with Down syndrome, there is a very high incidence of mouth breathing. This feature is related to the orofacial anomalies seen in the majority of individuals with Down syndrome, as well as the chronic upper respiratory infections experienced by many of these individuals. The oral cavity in persons with Down syndrome is typically small; resulting in insufficient space for the tongue, and thus an open-mouth, tongue-protruding habit is typically adopted. Dry oral mucosa, or xerostomia, and/or angular cheilitis (cracking at the corner of the lips), typically develops in these individuals and may be accompanied by halitosis from subsequent fissuring of the tongue, which may become severe. Xerostomia also may contribute to the development of dental caries, as saliva normally functions as a natural cleanser for the teeth. Recent research indicates that the introduction of Xylitol-containing products, such as chewing gum, wafers, or other snacks, may significantly lower the incidence of dental caries and may even induce some remineralization of dental defects. Researchers continue to disagree as to the exact mechanism by which Xylitol produces its anticariogenic effect; whether by merely increasing salivation, inhibiting bacterial colonization, or a combination of both. Increasing salivation alone may help to reduce some of the discomfort experienced by individuals with chronic xerostomia.

Xerostomia when severe may contribute to the development of oral infections, i.e., bacterial colonization of the oral cavity. Patients exhibiting significant symptoms may benefit from daily use of an alcohol-free oral antimicrobial rinse such as Biotene. If a particular patient cannot safely use a rinse, it is typically just as effective to apply using a toothbrush. Finally, when xerostomia or angular cheilitis is present, it is important to use some type of lip balm or petroleum jelly on the patient's lips to decrease painful splitting during dental treatment.

Kitchens, D.H. (2005). Xylitol in the prevention of oral diseases. Special Care Dentistry, 25(3), 140-44.

NIDCR National Institute of Dental and Craniofacial Research (2005). Behavioral management. Practical oral care for people with Down syndrome. Retrieved online 6/17/05 from http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/
DevelopmentalDisabilitiesAndOralHealth/PracticalOralCareforPeople
WithDownSyndrome.htm

Pischer, E.S. (1997). Behavior management in dental care for the patient with Down syndrome (Paper presented at the 6th World Congress on Down Syndrome, October 1997). Retrieved online 6/17/05 from http://www.altonweb.com/cs/downsyndrome/pilcher.htm