Ethics & Law · patient case with 3 questions
Girl with Down syndrome attending for treatment
Patient: Girl with Down syndrome (trisomy 21), a minor
Chief complaint: Attends with her mother for examination and treatment.
Background: Trisomy 21. Mother is the primary caregiver.
Current findings: Panoramic radiograph and intraoral examination performed.
Question 1
Who provides consent for her treatment?
Show answer and explanation
Correct answer: C. Her mother
- A. A minor cannot provide legally valid consent for treatment.
- B. A court appointment is required only where no parent or guardian exists, or where authority is contested. It is not routinely needed.
- C. CORRECT. She is a MINOR, so consent is provided by her parent or legal guardian — here, her mother. Note the separate obligation of ASSENT: you should still explain the treatment in terms she can understand and seek her cooperation.
- D. A dentist cannot self-authorise treatment outside a genuine emergency.
Note: Consent comes from the parent or guardian; ASSENT should still be sought from the patient. On reaching adulthood, an intellectually disabled patient requires formally established guardianship — parental authority does not automatically continue.
Question 2
Which oral manifestation is characteristic of Down syndrome?
Show answer and explanation
Correct answer: C. Anterior open bite
- A. The tongue is relatively LARGE for the small oral cavity — relative macroglossia, not microglossia. The recall's own annotation confirms this.
- B. HYPOdontia (congenitally missing teeth) is characteristic, not supernumerary teeth.
- C. ANTERIOR OPEN BITE is characteristic, arising from the combination of relative macroglossia, a hypoplastic maxilla, mouth breathing and generalised hypotonia.
- D. Down syndrome is associated with MICROdontia, not macrodontia.
Note: The Down syndrome pattern: microdontia, hypodontia, relative macroglossia, anterior open bite, maxillary hypoplasia, Class III tendency, delayed eruption, fissured tongue and notably aggressive early-onset periodontal disease.
Question 3
Which systemic consideration is most important before invasive dental treatment?
Show answer and explanation
Correct answer: B. Screening for congenital heart disease
- A. Adrenal insufficiency is not characteristic, though thyroid disease — particularly hypothyroidism — is common.
- B. CORRECT. Roughly 40–50% of individuals with Down syndrome have CONGENITAL HEART DISEASE, most commonly atrioventricular septal defects. Cardiac status must be established, and whether antibiotic prophylaxis is indicated determined against current American Heart Association criteria. Atlantoaxial instability is a second important concern, affecting neck positioning in the chair.
- C. Malignant hyperthermia has no association with trisomy 21.
- D. Coagulopathy is not a characteristic feature.