19 Year Old Son with Down Syndrome and Moderate to Severe Underbite, Wore Braces but Not Retainer, What Other Options Are There?

not wear retainer well. Underbite has gotten more prounounced. Effect speechs..and upper teeth are are starting to wear in spots. Dentist and orthodontist said surgery would be hard and considered last option. I'm concerned this will only get worse as he gets older. Need other opinions from doctors/dentists and recommendations of who would be best in the St. Louis area. Any improvements in how surgery is done? Are jaws still wired shut? Experienced with special needs would be high on my list.

Doctor Answers 4

Underbite 19 year old with Downs syndrome

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It sounds like your son has had braces so you are acquinted with the process and his response to it.  From your description you are concerned mostly with tooth wear due to the underbite.  Sometimes only surgery can do much to affect a severe underbite, but there may be non-surgical options in less severe cases.  Although a non-surgical approach may not give as ideal a result as if surgery were done, you may be satisfied with simply correcting the most emergent problem.  Find an orthodontist who has experience with special needs and ask about the options available.  

Seattle Orthodontist

Best thing to do is ask you dentist who they recommend

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I would be more than happy to have a consult with you for your son. I have many Downs and other special needs patients. We review all your options and let you decided what you feel is best for your son. No one knows him better than you.

There are any many things that can be done to avoid surgery, but it is really difficult to diagnose him without seeing him.

Call Holly at 314 576 4955

Jacqueline Demko, DDS, MSD
Chesterfield Orthodontist

Downs pt. with underbite

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If the patient is 19 years old he probably won't grow any more and so the problem as it is shouldn't get much worse.  there could be issues with tooth wear which could be controlled by wearing a night guard.   If you can't get a retainer worn however that may not work.

Surgery could certainly be considered and they don't have to keep them wired shut nearly as much as we used to but surgery does always entail some risk and usually more for a compromised patient.  Always balance how much risk with how great is the benefit.    Does the patient want something changed or is more you as a parent that wants it different?  If the benefit is fairly minor or mainly cosmetic I would tend to be pretty conservative about the surgery.  I have never lost any patients but came close a couple of times.   

Clark L. Jones, DDS, MSD
Phoenix Orthodontist

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Down's syndrome

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Unfortunately, the more the bones are out of position the harder it is to get a good bite and at some point, only surgery can correct the bite.  That said, nobody has ever died of a bad bite and many patients do fine with an uncorrected bite.  Tooth alignment is more difficult to hold and lifelong nightime retention is always needed. 

Surgery is often done now with rigid internal fixation which eliminates the need for wireing the mouth shut, making the whole experience much easier.

Robert Waxler, DMD, MS
Saint Louis Orthodontist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.