September 2025 - Volume 17 - Issue Suppl 3
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INTRODUCTION
MATERIALS AND METHODS
Study design and participants
Data collection
Periodontal assessment
OHRQoL assessment
Statistical analysis
RESULTS
Demographic and clinical characteristics
Periodontal status
Association between periodontal status and OHRQoL
DISCUSSION
CONCLUSION
Financial support and sponsorship
Conflict of interest
REFERENCES
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Original Article
Periodontal Status and Oral Health-Related
Quality of Life in Children with Down Syndrome
Parihar, Anuj Singh1; Baheti, Akanksha2; Sugandhi, Chetan3; Kumar, Ashok4; Krishna,
Sreejith5; Laddha, Rashmi6
Author Information
1Department of Periodontology, People’s Dental Academy, Bhopal, Madhya Pradesh,
India
2Department of Esthetics and Restorative Dentistry, Perfect Smiles Clinic, Chicago, IL,
USA
3Department of Periodontology, Tatyasaheb Kore Dental College and Research Centre,
Nave Pargaon, Maharashtra, India
4Department of Pedodontics and Preventive Dentistry, Vananchal Dental College and
Hospital, Garhwa, Jharkhand, India
5Department of Periodontology, Maharishi Markandeshwar College of Dental Sciences
and Research MM (DU), Ambala, Haryana, India
6Department of Periodontology, Dr. R. R. Kambe Dental College and Hospital, Akola,
Maharashtra, India
Address for correspondence: Dr. Anuj Singh Parihar, Department of
Periodontology, People’s Dental Academy, Bhopal, Madhya Pradesh, India. E-mail:
dr.anujparihar@gmail.com
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License
(http://creativecommons.org/licenses/by-nc-sa/4.0/), which allows others to remix,
tweak, and build upon the work non-commercially, as long as appropriate credit is given
and the new creations are licensed under the identical terms.
Journal of Pharmacy and Bioallied Sciences 17(Suppl 3):p S2196-S2198, September
2025. | DOI: 10.4103/jpbs.jpbs_365_25
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Open
Abstract
Background:
Children with down syndrome (DS) often experience a higher prevalence and severity of
periodontal disease compared to typically developing children. This can negatively
impact their oral health-related quality of life (OHRQoL).
Objective:
This study aimed to assess the periodontal status and OHRQoL in children with DS and
investigate the association between these factors.
Materials and Methods:
A cross-sectional study was conducted involving 50 children with DS and 50 age-
matched typically developing children. Periodontal parameters, including plaque index
(PI), gingival index (GI), probing pocket depths (PPD), and clinical attachment loss
(CAL), were recorded. OHRQoL was evaluated using the Child-OIDP questionnaire.
Results:
Children with DS exhibited significantly higher PI scores (mean difference = 0.85, P <
0.001), GI scores (mean difference = 0.62, P < 0.001), PPD (mean difference = 1.2 mm,
P < 0.001), and CAL (mean difference = 0.9 mm, P < 0.001) compared to the control
group. OHRQoL scores were significantly lower in the DS group (mean difference = –7.5,
P < 0.001). Regression analysis showed a significant negative correlation between PPD
and OHRQoL scores (β = –0.62, P < 0.001), indicating that greater periodontal disease
severity was associated with poorer OHRQoL.
Conclusion:
This study confirms that children with DS experience compromised periodontal health
and reduced OHRQoL. These findings emphasize the need for early and comprehensive
oral healthcare interventions to improve both periodontal health and overall well-being
in this population.
INTRODUCTION
Down syndrome (DS) is a genetic condition that occurs as a result of an additional copy
1
of chromosome 21 and has a worldwide birth prevalence of roughly 1 in 700 live births.[ ]
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People with DS frequently have several health complications, one of them being
2
increased prevalence of periodontal disease.[ ] This heightened risk is attributed to a
multitude of factors, including immune dysfunction, altered oral anatomy, poor oral
hygiene practices, and delayed eruption patterns.
Periodontal disease, characterized by inflammation and destruction of the supporting
tissues of the teeth, can significantly impact oral health-related quality of life (OHRQoL).
[3-5] It can cause pain, discomfort, difficulty eating, and impaired social interactions.
Children with DS may be particularly vulnerable to the negative effects of periodontal
disease on OHRQoL due to their potential cognitive and communication challenges,
6-9]
which can hinder their ability to express discomfort or seek appropriate care.[
Although previous studies have looked into the impact of OHRQoL on children with DS,
there hasn’t been enough understanding of how it interrelates with periodontal disease.
In trying to fill this void, the study will evaluate the periodontal status and OHRQoL in
children with DS and aim to find whether these two factors are associated. These
findings will shed light on targeted oral healthcare interventions that can potentially
improve both the periodontal condition and other health aspects of the children with DS.
MATERIALS AND METHODS
Study design and participants
The study was done on a total of 50 children with DS and 50 children of the same age
without any challenges. Participants with DS were recruited from special needs schools
and DS support organizations in Bhopal. Typically developing children were recruited
from mainstream schools in the Bhopal area. Children with DS aged 6-12 years were
included in the study. Exclusion criteria included the presence of any systemic
conditions other than DS, history of orthodontic treatment, or use of antibiotics within
the past three months. The control group consisted of typically developing children
matched for age and gender. Ethical approval for the study was obtained from the
Institutional Ethical Committee (IEC) of People’s Dental Academy, Bhopal. Informed
consent was obtained from the parents of all participants.
Data collection
Periodontal assessment
Periodontal examinations were conducted by a single calibrated examiner (Dr. Anuj
Singh Parihar), who is a Reader in the Department of Periodontics at People’s Dental
Academy, Bhopal. The following periodontal parameters were assessed:
Plaque Index (PI): This index measures the thickness of plaque accumulation at
the gingival margin. It was measured on six surfaces (mesio-buccal, buccal, disto-
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buccal, mesio-lingual, lingual, disto-lingual) of all teeth present using the Silness
and Löe index. Scores range from 0 (no plaque) to 3 (abundant plaque).
Gingival Index (GI): This index assesses the severity of gingival inflammation. It
was assessed on four sites per tooth (mesial, buccal, distal, lingual) using the Löe
and Silness index. Scores range from 0 (normal gingiva) to 3 (severe inflammation
with spontaneous bleeding).
Probing Pocket Depths (PPD): This measures the depth of the gingival sulcus
or periodontal pocket. It was measured at six sites per tooth (mesio-buccal, buccal,
disto-buccal, mesio-lingual, lingual, disto-lingual) using a standardized periodontal
probe (PCP-UNC 15, Hu-Friedy, Chicago, IL, USA).
Clinical Attachment Loss (CAL): This parameter assesses the amount of
periodontal support that has been lost due to disease. It was determined as the
distance from the cementoenamel junction to the base of the periodontal pocket.
OHRQoL assessment
OHRQoL was evaluated using the Child-OIDP questionnaire. This validated instrument
assesses the impact of oral health on a child’s daily life, including functional, social, and
emotional well-being. The 13-item questionnaire covers domains such as eating
restrictions, oral pain, speech difficulties, and social interaction limitations. Each item is
scored on a 5-point Likert scale, with higher scores indicating a greater negative impact
on OHRQoL. The questionnaire was completed by the parents or caregivers of both the
children with DS and the control group children.
Statistical analysis
The evaluation was made with the use of SPSS software (version 28). The participants’
demographic and clinical data were summarized using descriptive statistics (mean,
standard deviation, frequencies, and percentages). Independent t tests were performed
for intergroup comparison between the continuous variables of the DS group and the
control group. Mann–Whitney U test was applied for the between-group comparisons in
the variables which were not normally distributed. Linear regression analysis was done
to explore the relationship between the Child-OIDP and periodontal score of DS
children. Statistical significance was set at P < 0.05.
RESULTS
Demographic and clinical characteristics
Table 1 presents the demographic and clinical characteristics of the study participants.
There were no significant differences between the DS and control groups in terms of age
and gender distribution.
T1
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Table 1:
Demographic and clinical characteristics of the study participants
Periodontal status
Table 2 shows the comparison of periodontal parameters between the DS and control
groups. Children with DS exhibited significantly higher PI scores, GI scores, PPD, and
CAL compared to the control group.
T2
Table 2:
Comparison of periodontal parameters between children with DS and
typically developing children
Association between periodontal status and OHRQoL
Table 3 bestows the results of the linear regression analysis examining the association
between periodontal parameters and Child-OIDP scores in children with DS. PPD was
significantly negatively associated with OHRQoL, indicating that greater periodontal
disease severity was associated with poorer OHRQoL.
T3
Table 3:
Association between periodontal parameters and OHRQoL scores in children
with DS
DISCUSSION
This study confirms that children with down syndrome (DS) have poorer periodontal
health and reduced oral health-related quality of life (OHRQoL) compared to typically
developing children. They exhibit higher plaque accumulation, gingival inflammation,
and periodontal disease severity.
Such type of periodontal condition may arise because of immune dysfunction, oral DS,
poor oral hygiene, or abnormal eruption patterns. The study also found that there is a
strong inverse relationship between the severity of periodontal disease and OHRQoL,
which in turn indicates the need for focusing on periodontal disease for children with
DS. Even though the material adds understanding to the subject DS, it has some issues,
such as the lack of longitudinal data to assess causation and a small sample size. Further
research should be directed toward the assessing the impact of specific interventions on
dhin OHRQoL and bestel health among children with DS.
CONCLUSION
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This research has established an association between poor periodontal status and low
OHRQoL for children with DS. These results highlight the importance of fostering early
and proactive oral healthcare strategies to enhance the periodontal health and general
health status of children with DS. Healthcare providers ought to be more proactive in the
prevention and treatment of periodontal disease within these high-risk groups. Also, oral
health education and the provision of services for children with DS should be addressed
by public health advocates. By addressing the oral health challenges faced by children
with DS, we can contribute to enhancing their overall quality of life and ensuring their
full participation in society.
Financial support and sponsorship
Nil.
Conflict of interest
There are no conflicts of interest.
REFERENCES
1. AlJameel AH, AlKawari H. Oral health-related quality of life (OHRQoL) of children
with down syndrome and their families:A cross-sectional study. Children (Basel)
2021;8:954.
Cited Here
2. Hamonari NH. Salivary markers of oxidative stress and their relation to periodontal
and dental status among children with down syndrome. Cureus 2024;16:e73852.
Cited Here
3. Choi J, Doh RM. Dental treatment under general anesthesia for patients with severe
disabilities. J Dent Anesth Pain Med 2021;21:87–98.
Cited Here
4. Fiske J, Shafik HH. Down's syndrome and oral care. Dent Update 2001;28:148–56.
Cited Here
5. Ghaith B, Al Halabi M, Khamis AH, Kowash M. Oral health status among children
with down syndrome in Dubai, United Arab Emirates. J Int Soc Prev Community Dent
2019;9:232–9.
Cited Here
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6. Hennequin M, Morin C, Feine JS. Pain expression and stimulus localisation in
individuals with Down's syndrome. Lancet 2000;356:1882–7.
Cited Here
7. Stensson M, Norderyd J, Van Riper M, Marks L, Björk M. Parents'perceptions of oral
health, general health and dental health care for children with down syndrome in
Sweden. Acta Odontol Scand 2021;79:248–55.
Cited Here
8. AlJameel AH, Watt RG, Tsakos G, Daly B. Down syndrome and oral
health:Mothers'perception on their children's oral health and its impact. J Patient Rep
Outcomes 2020;4:45.
Cited Here
9. Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global,
regional, and national prevalence, incidence, and disability-adjusted life years for oral
conditions for 195 countries, 1990-2015:A systematic analysis for the global burden of
diseases, injuries, and risk factors. J Dent Res 2017;96:380–7.
Cited Here
View full references list
Keywords:
Children; child-OIDP; down syndrome; oral health; oral health-related quality of life;
periodontal disease
© 2025 Journal of Pharmacy and Bioallied Sciences
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