Malocclusion in Down syndrome children and adolescents


Down syndrome (trisomy21) first described in 1866 is one of the commonest genetic abnormalities. It is associated with growth delay mild to moderate intellectual disability and characteristic facial features including dental anomalies. While reviews of dental caries and periodontal disease in Down syndrome individuals have been conducted no reviews of malocclusion have been conducted.

The aim of this review was to assess the occurrence of malocclusion among children/adolescents with Down syndrome compared to their peers without Down syndrome.


Searches were conducted in the Biblioteca Brasileira de Odontologia, Cochrane Library, Lilacs, PubMed, SciELO, Scopus, and Web of Science databases. Epidemiological studies (case‐control, cross‐sectional, and cohort studies) assessing the occurrence of malocclusion among children/adolescents with DS compared to individuals without Down syndrome.  Two reviewers selected studies and extracted data with study quality being assessed using the Newcastle-Ottawa Scale for cross-sectional studies. Meta-analysis was conducted.


  • 11 studies were included.
  • Studies came from Argentina, Brazil, Canada, Denmark, Jordan, Nigeria, Norway, Mexico, Saudi Arabia and the USA.
  • Malocclusion was assessed using a wide range of indices
  • 6 meta‐analyses were carried out according to the indices used to evaluate malocclusion.
  No. of studies Risk Difference [RD] or Risk Ratio [RR] (95%CI) Certainty (GRADE)
Angle Class II malocclusion 3 RD = 0.00 (−0.10 to 0.11) low
Anterior open bite 4 RD = 0.21 (0.06 to 0.36) low
Crowding 3 RD = 0.08 ( −0.13 to 0.29) low
Angle Class III malocclusion 4 RD = 0.40 (0.33 to 0.46) moderate
Posterior crossbite 2 RR = 3.09 (2.02 to 4.73) moderate
Anterior crossbite 2 RR = 2.18 (1.41 to 3.39) moderate
  • No differences between Down syndrome (DS) children and non-DS children were seen for Angle Class II and crowding but higher a prevalence was seen in DS children and adolescents for all other indices.
  • No significant difference between DS and control individuals was observed for extreme maxillary overjet, distal molar occlusion, deep bite, and edge to edge bite.


The authors concluded: –

The occurrence of malocclusion was higher in children/adolescents with DS compared to individuals without the syndrome. The strength of the evidence of the studies analysed, however, was considered moderate and low.


We have previously looked at reviews addressing the prevalence of caries (Dental Elf – 31st Jul 2019) and periodontal disease in Down syndrome patients (Dental Elf – 4th Jul 2016). The current review looks in detail at malocclusion in this group finding higher levels of malocclusion.

A number of databases have been searched and 11 studies included, 7 of which scored 7 or more points in the NOS assessment. The authors’ do raise some concerns related to the selection of controls as only 2 studies recruited them from the same population with similar characteristics. While the findings are indicative of an association between Down syndrome and malocclusion only a small number of studies are available overall and contribute to the meta-analyses of the specific types of malocclusion, so some caution is needed in interpreting the findings.


Primary Paper

Doriguêtto PVT, Carrada CF, Scalioni FAR, Abreu LG, Devito KL, Paiva SM,Ribeiro RA. Malocclusion in children and adolescents with Down syndrome: A systematic review and meta-analysis. Int J Paediatr Dent. 2019 Jul;29(4):524-541.doi: 10.1111/ipd.12491. Epub 2019 Apr 14. Review. PubMed PMID: 30834602.

Review protocol on PROSPERSO

Other references

Dental Elf – 31st Jul 2019

Caries experience and dental care in children with and without learning disabilities

Dental Elf – 4th  Jul 2016

Periodontal treatment and prevention in Down syndrome patients

Picture Credits

“Ben is a Downs Syndrome Boy-1=” by Sheba_Also 43,000 photos is licensed under CC BY-SA 2.0


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