Subgingival microbial changes in Down Syndrome adults with periodontitis after chlorhexidine adjunct non-surgical therapy and monthly recalls-A 12-month case series study.

OBJECTIVES: Down Syndrome (DS) adults are at risk for periodontitis. Previous reports indicated difficulties in periodontopathogen reduction or eradication in DS individuals after periodontal treatment. This case series follows the subgingival microbial changes in adult DS individuals with periodontitis who received chlorhexidine adjunct non-surgical therapy plus 12-month recalls. METHODS: Twenty periodontitis DS participants (7 females; 25.5 ± 5.6 years of age; 3 with generalized periodontitis) partook in a study involving non-surgical mechanical periodontal therapy, twice daily chlorhexidine gel toothbrushing, chlorhexidine mouthwash, and monthly recalls. The subgingival microbiota profile was followed at baseline, 6-, and 12-months post-operation. RESULTS: Desulfobulbus, Saccharibacteria (TM7), Tannerella, and Porphyromonas were the major subgingival genera in this DS cohort. Favorable chlorhexidine adjunct non-surgical treatment outcomes were observed, with the relative abundance of Desulfobulbus sp. HMT 041, Saccharibacteria (TM7) [G-1] bacterium HMT 346 or 349, and Tannerella forsythia significantly reduced at the end of the study, but no significant reduction of Porphyromonas gingivalis or Aggregatibacter actinomycetemcomitans could be observed. Relative abundance of Desulfobulbus sp. HMT 041 and T. forsythia were also found to be significantly associated with plaque, bleeding on probing, and probing pocket depth (PPD, in mm) at a site level, while the relative abundance of Halomonas pacifica was negatively associated with PPD. CONCLUSIONS: Successful chlorhexidine adjunct non-surgical treatment with hygiene care was accompanied by a subgingival microbial shift involving certain periodontopathogenic species, except P. gingivalis and A. actinomycetemcomitans. Further investigations are required to clarify the mechanism underpinning the unchanged relative abundance of the above two pathogens despite favorable clinical responses. CLINICAL SIGNIFICANCE: DS adults face challenges achieving optimal home care or hygiene for periodontal healing and disease prevention. Chemical adjunct mechanical periodontal therapy plus regular recalls appeared promising clinically and microbiologically, with subgingival periodontopathogenic species reduction. The persistence of A. actinomycetemcomitans and P. gingivalis in subgingival niches post-treatment warrants further investigation.

Non-surgical periodontal therapy with adjunctive chlorhexidine use in adults with down syndrome: a prospective case series.

BACKGROUND: Subjects with Down syndrome (DS) experience a high prevalence of periodontal disease, and the management of this disease in subjects with DS is a challenge for oral health care providers. The purpose of this case series was to follow the periodontal healing response changes over a 12-month period after non-surgical mechanical periodontal therapy with the adjunctive use of chlorhexidine and monthly recalls in adults with DS who presented initially with chronic periodontitis. METHODS: Twenty-one subjects with DS (14 males and seven females; 25.3 +/- 5.5 years of age) with reported mild-to-moderate learning disabilities and chronic periodontitis were recruited and treated by non-surgical mechanical periodontal therapy (followed by monthly recalls) and the adjunctive use of chlorhexidine gel for toothbrushing and chlorhexidine mouthwash twice daily. Clinical data were recorded. RESULTS: After 12 months of non-surgical mechanical periodontal therapy, the mean percentage of sites with plaque decreased from 84.1% to 23.6%, and the mean number of sites with bleeding on probing decreased from 82.1% to 29.5%. Mean probing depth decreased from 3.2 to 1.8 mm, with a mean clinical attachment level gain of 0.6 mm. CONCLUSIONS: Satisfactory healing responses were achieved following non-surgical mechanical periodontal therapy with the adjunctive use of chlorhexidine and monthly recalls in adults with DS with chronic periodontitis and mild-to-moderate learning disabilities. Such a treatment regimen seems appropriate and beneficial for adults with DS and chronic periodontitis.

Oral health status of adults with Down syndrome in Hong Kong.

The aim of this survey was to study the oral health status of Hong Kong Chinese adults with Down syndrome (DS). Sixty-five community-dwelling adults with DS (aged 17 to 42 years, 26.8+/-6.4) and age- and gender-matched controls attending a dental hospital were included in a cross-sectional survey. The subjects with DS had fewer filled (2.4+/-4.6 vs. 2.7+/-3.1, p=0.017) and fewer decayed (1.1 2.5 vs. 1.7+/-2.4, p=0.007) teeth than the control subjects. Significantly more peg-shaped maxillary lateral incisors and retained primary teeth (p<0.001) were observed in subjects with DS, compared to the control subjects. Adults who had DS had a significantly higher percentage of surfaces with detectable plaque (81.5+/-19.1 vs. 61.9+/-16.0, p<0.001) and a higher percentage of sites with bleeding on probing (76.3+/-25.8 vs. 55.6+/-21.4, p<0.001). A higher proportion of subjects with DS showed one or more occurrences where probing pocket depth was > or =6mm than control subjects (49% vs. 24.5%, p<0.021). In conclusion, while having fewer caries, Hong Kong Chinese adults with DS had poorer periodontal health than age- and gender-matched control subjects.