Editing Down syndrome (section)

===Teeth===
People with Down syndrome tend to be more susceptible to [[gingivitis]] as well as early, severe [[Periodontal pathology|periodontal]] disease, [[Acute necrotizing ulcerative gingivitis|necrotising ulcerative gingivitis]], and early [[tooth loss]], especially in the lower front teeth.<ref name="Churchill">{{cite book| vauthors = Cawson RA, Odell EW |title=Cawson's essentials of oral pathology and oral medicine|date=2012|publisher=Churchill Livingstone|location=Edinburgh|isbn=978-0443-10125-0|pages=419–421|edition=8th}}</ref><ref name="Carranza">{{cite book | veditors = Newman MG, Takei HH, Klokkevold PR, Carranza FA |title=Carranza's clinical periodontology|date=2006|publisher=W.B. Saunders Co.|location=Philadelphia|isbn=978-1-4160-2400-2|pages=299, 397, 409, 623|edition=10th}}</ref> While [[Dental plaque|plaque]] and poor [[oral hygiene]] are contributing factors, the severity of these periodontal diseases cannot be explained solely by external factors.<ref name="Carranza"/> Research suggests that the severity is likely a result of a weakened immune system.<ref name="Carranza"/><ref name="Mosby">{{cite book | vauthors = Avery DR, Dean JA, McDonald RE |title=Dentistry for the child and adolescent |date=2004 |publisher=Mosby |isbn=978-0-323-02450-1 |edition=8th |location=St. Louis, Mo |pages=164–168, 190–194, 474}}</ref> The weakened immune system also contributes to increased incidence of [[Candidiasis|yeast infections]] in the mouth (from ''[[Candida albicans]]'').<ref name="Mosby"/>

People with Down syndrome also tend to have a more [[alkaline]] [[saliva]] resulting in a greater resistance to [[tooth decay]], despite decreased quantities of saliva,<ref name="ReferenceA">{{cite book| vauthors = Sapp JP, Eversole LR, Wysocki GP |title=Contemporary oral and maxillofacial pathology|date=2002|publisher=Mosby|location=St. Louis|isbn=978-0-323-01723-7|pages=39–40|edition=2nd}}</ref> less effective oral hygiene habits, and higher plaque indexes.<ref name="Churchill"/><ref name="Mosby"/><ref name="ReferenceA"/><ref name="Saunders">{{cite book| vauthors = Regezi JA, Sciubba JJ, Jordan RC |title=Oral Pathology: Clinical Pathologic Correlations|date=2008|publisher=Saunders Elsevier|location=St Louis, Missouri|isbn=978-1-4557-0262-6 |pages=353–354|edition=5th}}</ref>

Higher rates of tooth wear and [[bruxism]] are also common.<ref name="Mosby"/> Other common oral manifestations of Down syndrome include enlarged hypotonic tongue, crusted and hypotonic lips, [[mouth breathing]], narrow [[palate]] with crowded teeth, class III [[malocclusion]] with an underdeveloped maxilla and posterior [[crossbite]], delayed exfoliation of [[baby teeth]] and delayed eruption of adult teeth, shorter roots on teeth, and often missing and malformed (usually smaller) teeth.<ref name="Churchill" /><ref name="Mosby"/><ref name="ReferenceA"/><ref name="Saunders"/> Less common manifestations include [[cleft lip and palate]] and [[enamel hypocalcification]] (20% prevalence).<ref name="Saunders"/>

[[Taurodontism]], an elongation of the pulp chamber, has a high prevalence in people with DS.<ref>{{cite journal | vauthors = Bell J, Civil CR, Townsend GC, Brown RH | title = The prevalence of taurodontism in Down's syndrome | journal = Journal of Mental Deficiency Research | volume = 33 | issue = 6 | pages = 467–476 | date = December 1989 | pmid = 2533267 | doi = 10.1111/j.1365-2788.1989.tb01502.x }}</ref><ref>{{cite journal | vauthors = Rajić Z, Mestrović SR | title = Taurodontism in Down's syndrome | journal = Collegium Antropologicum | volume = 22 | issue = Suppl | pages = 63–67 | date = December 1998 | pmid = 9951142 | url = https://pubmed.ncbi.nlm.nih.gov/9951142/ }}</ref>