Abstract
The aim was to study the subgingival microbiota in subjects with Down syndrome (DS) with different periodontal health status, using cultural and molecular microbiological methods. In this cross-sectional study, DS subjects were selected among those attending educational or occupational therapy centers in Galicia (Spain). Medical histories, intraoral and periodontal examinations and microbiological sampling were performed. Samples were processed by means of culture and quantitative polymerase chain reaction (qPCR). Microbiological data were compared, by one-way ANOVA or Kruskal-Wallis and chi-square or Fisher tests, according to their periodontal status. 124 subjects were included, 62 with a healthy periodontium, 34 with gingivitis and 28 with periodontitis. Patients with periodontitis were older (p < 0.01) and showed lower prevalence of hypothyroidism and levothyroxine intake (p = 0.01), presented significantly deeper pockets and more attachment loss (p ≤ 0.01). Both gingivitis and periodontitis subjects showed higher levels of bleeding and dental plaque. PCR counts of T. forsythia and culture counts of E. corrodens and total anaerobic counts were significantly higher in periodontitis patients. Relevant differences were observed in the subgingival microbiota of DS patients with periodontitis, showing higher levels of anaerobic bacteria, T. forsythia and E. corrodens, when compared with periodontally healthy and gingivitis subjects. Moreover, periodontitis subjects were older, had lower frequency of hypothyroidism and higher levels of dental plaque.
Highlights
Onset forms of periodontitis and late onset of caries lesions represent the most frequent oral conditions associated with Down syndrome (DS) subjects [9], which may become further aggravated by their motor disability and manual dexterity compromise, that limits their performance in oral hygiene practices [11]
From the 168 subjects screened, 44 were not included due to the established exclusion criteria, so the study group was composed of 124 DS subjects (Table 1 and Table S2)
Higher counts and frequencies of detection of relevant periodontal pathogens, such as P. gingivalis, A. actinomycetemcomitans, P. intermedia, T. forsythia and E. corrodens, were identified in periodontitis, when compared with gingivitis and periodontally healthy DS subjects, as it has been previously reported in periodontitis patients without DS [39]
Summary
Subjects with DS present a characteristic phenotype and intellectual disability [4], together with several systemic diseases [5], such as congenital heart disease and thyroid dysfunction, as well as a number of oral diseases [6,7]. Onset forms of periodontitis and late onset of caries lesions represent the most frequent oral conditions associated with DS subjects [9], which may become further aggravated by their motor disability and manual dexterity compromise, that limits their performance in oral hygiene practices [11]. Several observational studies have reported high prevalence of gingivitis and periodontitis (ranging from 58–96%) at young ages (less than 35) in DS subjects [12]. In The Netherlands, in a study group conformed by 182 DS subjects, 36.6%
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