What caries risk is generally associated with patients with Down syndrome?

Correct answer: A. Lower than the general population

• A. CORRECT. Despite the challenges of oral hygiene, individuals with Down syndrome consistently show a LOWER caries rate. The proposed reasons include delayed eruption (shorter time exposed to the oral environment), a higher salivary pH and buffering capacity, altered salivary composition, microdontia with spacing rather than crowding, shallow occlusal fissures, and a high frequency of missing teeth. PERIODONTAL disease is the opposite story — it is markedly more prevalent, more severe, and earlier in onset because of immune dysfunction and impaired neutrophil chemotaxis.
• B. The reduced caries rate applies across both dentitions.
• C. The difference from the general population is a consistent, well-documented finding rather than an equivalence.
• D. Caries risk is not elevated; it is the periodontal risk that is dramatically elevated in this population.

Note: Clinical priority in Down syndrome is therefore PERIODONTAL: rigorous hygiene support, frequent recall, and early screening. Also screen for atlantoaxial instability before head positioning and for congenital heart disease.