Many parents of a child with Down syndrome first notice something different about the teeth when the first tooth is late to arrive. Delayed eruption, missing teeth and an unusual bite are all common, but the issue most worth planning for is the gums. People with Down syndrome are more likely to develop gum disease, and earlier in life, so daily cleaning and regular reviews deserve extra attention from the start.
Gum disease is the main thing to guard against
A systematic review in the Journal of the American Dental Association (Scalioni and colleagues, 2018) looked at 23 studies comparing people with and without Down syndrome. Most of them found gum disease measures were more common in the Down syndrome group, although the reviewers noted many of the studies had methodological weaknesses.
The reasons are thought to include differences in how the immune system responds to the bacteria in plaque, along with local factors such as mouth breathing and the shape and spacing of the teeth. Because part of the risk is biological, good brushing alone may not prevent every problem, but thorough daily plaque removal and regular professional cleans make a real difference. Gum inflammation in children is covered in more detail in our article on gingivitis in children.
Teeth often arrive late and in a different order
Baby teeth commonly come through later than usual, and sometimes in a different sequence. Adult teeth can be delayed too. This is a common feature of Down syndrome rather than a problem in itself, though a dentist will keep track of the pattern. For a general guide to timing, see when adult teeth come in.
Missing and smaller teeth are common
Some teeth may never form. A 2016 meta-analysis in the European Journal of Oral Sciences (Palaska and colleagues) estimated that about half of people with Down syndrome are missing at least one permanent tooth, not counting wisdom teeth, although results varied widely between studies. The teeth most often missing were the upper lateral incisors and the second premolars.
Teeth may also be smaller or differently shaped. Gaps and bite differences can follow, and some children benefit from orthodontic treatment when the time is right. A dentist can advise when an assessment is worthwhile, and complex cases may be referred to a registered orthodontist.
The tongue, palate and breathing
A tongue that rests further forward, a narrow and high palate and a smaller upper jaw are all frequently seen. Together they can encourage mouth breathing and affect how the teeth meet. Breathing through the mouth dries the mouth, and a dry mouth leaves teeth and gums more exposed to decay and inflammation. Tooth grinding is also often reported. Your dentist and doctor can work together on these.
A routine that works for many families
- Brush twice a day with fluoride toothpaste, helping or supervising for as long as it is needed.
- Clean between the teeth once a day. Floss picks or small interdental brushes are often easier to manage than string floss.
- Keep regular check-ups, often every three to six months, with a close eye on the gums.
- Ask about professionally applied fluoride and, where suitable, fissure sealants on the back teeth.
- Raise mouth breathing, snoring or a dry mouth with your dentist and GP.
- Start dental visits early, around the first birthday or when the first teeth appear, and keep them short and familiar.
Some children find dental visits stressful. Our articles on children's dental anxiety and sensory-friendly dental visits include ideas that suit many children with additional needs.
Costs and the Child Dental Benefits Schedule
As a guide, a check-up and clean in Sydney typically costs about $200 to $400 in the general market; this is not a Lumi fee. Eligible children aged 0 to 17 may be covered under the Child Dental Benefits Schedule, which in 2026 provides up to $1,158 in benefits over two calendar years for basic care such as check-ups, cleans, fluoride, sealants and fillings. It does not cover orthodontics or cosmetic work. At Lumi, eligible children are bulk billed under the scheme.
Our oral health therapists, Sabrina Tran and Jennifer Nguyen, see children and families and focus on prevention and gum health, and we are happy to pace visits to suit your child. You can arrange an appointment with a general dentist or oral health therapist, and current offers are on our deals page.
Questions parents ask
Is it a concern if my child's teeth are very late?
Late teeth are common in Down syndrome and are not usually a problem on their own. A dentist will check that teeth are forming and can take an X-ray when it would help.
Will my child need braces?
Some children do, because of missing teeth, spacing or the way the teeth meet. Whether and when treatment helps depends on the individual, and an assessment at the right age can guide the decision.
This article is general information and is not a substitute for advice tailored to the individual.
