The morphology of tongue may vary between individuals with Down syndrome. Fissured, geographic, scrotal tongue with midline, double or multiple fissures as well as with possible presence of various oval depressions was observed [12] and [13]. According to Pilcher and Guimaraes [14] and [15]

buy NLG919 the tongue may seem too large, but is not due to macroglossia, but as a result of midface hypoplasia and small oral cavity. Characteristic features of midface hypoplasia in Down syndrome include smaller maxilla, narrower bridge of the nose and presence of “stair” palate [16] and [17]. Hypotension of muscles with decreased masticatory capability due to lower neuromotoric control is observed in stomatognathic system [18]. The decrease in force of masticatory muscles was not stated by some authors after the electromiography in patients with Down syndrome was done. Only the change in muscles’ work during centric movements was observed. Muscles were not characterized by hypotonia but by lack of equilibrium during centric occlusion [19]. In patients with Down syndrome hypotension of tongue muscles, muscle orbicularis oris, lips and habitual mouthbreathing is observed. ZD1839 Physiological actions like sucking, swallowing are distorted [20]. Dysfunction of sucking is caused not only by

the distorted action of masticatory muscles but also by distortion of fluent tongue movements [21]. Articulation pentoxifylline is also distorted, speech

becomes incoherent. Maxilla is underdeveloped, which manifest itself by presence of malocclusions like mesiocclusions, crossbites and open bites [22]. Hypodontia of permanent tooth buds (mainly upper lateral incisors and II lower premolars), retardation in tooth eruption, inflammations of oral mucosa, especially in the region of lower anterior teeth and parodontopathies are frequently observed [23]. Treatment of patients with Down syndrome is multidisciplinary. The cooperation between pediatrician, genetician, neurologist and psychologist is essential. Conservative and orthodontic stomatological treatment is also necessary, however due to mental retardation those ways of treatment are highly difficult. Treatment of patients with Down syndrome requires from the doctor patience and empathy. When orthodontic treatment in patients with Down syndrome is planned, assessment of patient’s growth potential and cooperation between the doctor and patient’s parents is mandatory. Possibilities of an active orthodontic treatment and its impact on tongue position, oral hygiene, quality of speech and bruxism in patients with Down syndrome, treated orthodontically at the Orthodontic Department Medical University of Lodz. Patients were admissioned for orthodontic treatment during school stage of development at the age of 7 years and 10 years, respectively.