A patient with Down's syndrome (Trisomy 21) may have difficulty with mastication and swallowing. The clinical examination should focus on findings that may help to identify and localize problems that may be contributing to the masticatory dysfunction.


General appearance:

(1) open mouth while at rest

(2) mouth breathing

(3) mandibular protrusion

(4) maxillary endognathism

(5) mid-facial deformity

(6) angular cheilitis


Examination of the tongue:

(1) protruding tongue

(2) low anterior tongue position

(3) decreased tongue sensitivity

(4) tongue used to stablize the mandible

(5) decreased tongue mobility and/or tonicity


Examination of the teeth:

(1) delay or abnormalities in tooth eruption

(2) dental caries or fractures

(3) dental wear associated with bruxism

(4) absence of a stable occlusal rest position


Miscellaneous findings:

(1) restricted mobility of the temporomandibular joint

(2) orofacial dyskinesia

(3) food debris retained in the mouth

(4) enlarged tonsils


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