{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:41:02Z","timestamp":1792428062166,"version":"4.5.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individuals with Down syndrome commonly present with a variety of craniofacial and dental anomalies that increase the prevalence of malocclusion and the need for orthodontic treatment. Despite this, data regarding orthodontic needs in this population in the middle east, particularly in Egypt, remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim of the study<\/jats:title>\n                    <jats:p>This study aimed to assess the patterns of malocclusion and orthodontic treatment needs among individuals with Down syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A total of 117 individuals with Down syndrome aged 12\u201325 years, who met the study\u2019s eligibility criteria, were recruited from specialized institutions in Egypt in a multi-centred cross-sectional study. Clinical examination included extraoral and intraoral assessment, occlusal analysis using Angle\u2019s classification, and assessment of the need for orthodontic treatment using Dental Health Component of Index of Orthodontic Treatment Need (IOTN). Additional data on oral hygiene, oral habits, and craniofacial features were recorded. Descriptive statistics were computed for all study variables. Qualitative (categorical) variables were presented as frequencies (n) and percentages (%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Class I molar relationship was the most common (41.0%), followed by Class II (29.9%) and Class III (29.1%). Anterior open bite (23.1%) and posterior crossbite (21.4%) were also frequently observed. Regarding orthodontic treatment need, 71.7% of participants demonstrated borderline to very great need (IOTN Grades 3\u20135), with 49.6% exhibiting great or very great need (Grades 4\u20135). Fair or poor oral hygiene was identified in 81.2% of participants. Mouth breathing was the most common oral habit (32.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with Down syndrome exhibit a high prevalence of malocclusion and a significant need for orthodontic treatment. Early orthodontic assessment, preventive strategies, and multidisciplinary management are essential to improve oral health outcomes in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-09995-9","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T03:36:04Z","timestamp":1792380964000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Malocclusion and orthodontic treatment needs among individuals with down syndrome in Egypt: a multicentre cross-sectional study"],"prefix":"10.1186","volume":"26","author":[{"given":"Hani","family":"AlSwafeeri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Bedwani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Badran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Shehata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hala","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menna Allah","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"issue":"5","key":"9995_CR1","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1542\/peds.2014-1909","volume":"134","author":"AM Davis","year":"2014","unstructured":"Davis AM, Brown RF, Taylor JL, Epstein RA, McPheeters ML. Transition care for children with special health care needs. Pediatrics. 2014;134(5):900\u20138.","journal-title":"Pediatrics"},{"issue":"Suppl 1","key":"9995_CR2","doi-asserted-by":"publisher","first-page":"S279","DOI":"10.4103\/jpbs.JPBS_84_20","volume":"12","author":"SD Mangat","year":"2020","unstructured":"Mangat SD. Assessment of malocclusion and orthodontic treatment needs among subjects with Dental Aesthetic Index: a clinical study. J Pharm Bioallied Sci. 2020;12(Suppl 1):S279\u201382.","journal-title":"J Pharm Bioallied Sci"},{"issue":"1","key":"9995_CR3","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s00439-009-0696-8","volume":"126","author":"D Patterson","year":"2009","unstructured":"Patterson D. Molecular genetic analysis of Down syndrome. Hum Genet. 2009;126(1):195\u2013214.","journal-title":"Hum Genet"},{"issue":"3","key":"9995_CR4","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/S1079-2104(97)90343-7","volume":"84","author":"SS Desai","year":"1997","unstructured":"Desai SS. Down syndrome: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(3):279\u201385.","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"4","key":"9995_CR5","first-page":"58","volume":"2","author":"ES Pilcher","year":"2001","unstructured":"Pilcher ES. Treating the patient with Down syndrome. J Contemp Dent Pract. 2001;2(4):58.","journal-title":"J Contemp Dent Pract"},{"issue":"4","key":"9995_CR6","first-page":"734","volume":"76","author":"DR Musich","year":"2006","unstructured":"Musich DR. Orthodontic intervention and patients with Down syndrome. Angle Orthod. 2006;76(4):734\u20135.","journal-title":"Angle Orthod"},{"issue":"10","key":"9995_CR7","doi-asserted-by":"publisher","first-page":"2360","DOI":"10.1002\/ajmg.a.34235","volume":"155A","author":"BG Skotko","year":"2011","unstructured":"Skotko BG, Levine SP, Goldstein R. Self-perceptions from people with Down syndrome. Am J Med Genet A. 2011;155A(10):2360\u20139.","journal-title":"Am J Med Genet A"},{"issue":"1","key":"9995_CR8","doi-asserted-by":"publisher","first-page":"19895","DOI":"10.1038\/s41598-020-76984-5","volume":"10","author":"A Vicente","year":"2020","unstructured":"Vicente A, Bravo-Gonz\u00e1lez LA, L\u00f3pez-Romero A, Mu\u00f1oz CS, S\u00e1nchez-Meca J. Craniofacial morphology in down syndrome: a systematic review and meta-analysis. Sci Rep. 2020;10(1):19895.","journal-title":"Sci Rep"},{"issue":"4","key":"9995_CR9","first-page":"412","volume":"43","author":"ZB Al-Bitar","year":"2023","unstructured":"Al-Bitar ZB, Al-Omari IK, Sonbol HN, Al-Haj Ali SN. Craniofacial and dental characteristics of individuals with Down syndrome: A controlled comparative study. Spec Care Dentist. 2023;43(4):412\u201320.","journal-title":"Spec Care Dentist"},{"issue":"1","key":"9995_CR10","first-page":"22","volume":"41","author":"S Al-Najadh","year":"2014","unstructured":"Al-Najadh S, Al-Khamees S, Al-Mulla A. Evaluation of orthodontic treatment urgency in a Kuwaiti population with Down syndrome using the Dental Aesthetic Index. J Orthod. 2014;41(1):22\u20139.","journal-title":"J Orthod"},{"issue":"2","key":"9995_CR11","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4103\/NJM.NJM_169_20","volume":"30","author":"N Aghimien","year":"2021","unstructured":"Aghimien N, Utomi IL, Isiekwe IC. Prevalence of malocclusion and orthodontic treatment needs among a pediatric cohort with Down syndrome. Niger J Med. 2021;30(2):145\u201350.","journal-title":"Niger J Med"},{"issue":"1","key":"9995_CR12","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s12903-023-03031-w","volume":"23","author":"M Alio-Sanz","year":"2023","unstructured":"Alio-Sanz M, Iglesias-Linares A, Celem\u00edn-Vi\u00f1uela A, Solano-Reina E. Orthodontic treatment outcomes and compliance barriers in patients with Down syndrome: A retrospective investigation. BMC Oral Health. 2023;23(1):284.","journal-title":"BMC Oral Health"},{"issue":"10","key":"9995_CR13","first-page":"888","volume":"8","author":"H Alkawari","year":"2021","unstructured":"Alkawari H. Down Syndrome Children, Malocclusion Characteristics and the Need for Orthodontic Treatment Needs (IOTN): A Cross-Sectional Study. Child (Basel). 2021;8(10):888.","journal-title":"Child (Basel)"},{"issue":"1","key":"9995_CR14","doi-asserted-by":"publisher","first-page":"7","DOI":"10.14219\/jada.archive.1964.0034","volume":"68","author":"JC Greene","year":"1964","unstructured":"Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc. 1964;68(1):7\u201313.","journal-title":"J Am Dent Assoc"},{"issue":"2","key":"9995_CR15","first-page":"86","volume":"37","author":"S Shore","year":"2010","unstructured":"Shore S, Lightfoot T, Ansell P. Oral disease in children with Down syndrome: causes, prevention and treatment. Dent Update. 2010;37(2):86\u201393.","journal-title":"Dent Update"},{"issue":"3","key":"9995_CR16","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1111\/j.1754-4505.2010.00134.x","volume":"30","author":"A Khocht","year":"2010","unstructured":"Khocht A, Janal M, Turner B. Periodontal health in Down syndrome: contributions of mental disability, personal, and professional dental care. Spec Care Dentist. 2010;30(3):118\u201323.","journal-title":"Spec Care Dentist"},{"issue":"5","key":"9995_CR17","first-page":"356","volume":"33","author":"A Frydman","year":"2012","unstructured":"Frydman A, Nowzari H. Down syndrome-associated periodontitis: a critical review of the literature. Compend Contin Educ Dent. 2012;33(5):356\u201361.","journal-title":"Compend Contin Educ Dent"},{"issue":"2","key":"9995_CR18","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/scd.12084","volume":"35","author":"M AlSarheed","year":"2015","unstructured":"AlSarheed M. A comparative study of oral health parameters in a Down syndrome population. Spec Care Dentist. 2015;35(2):68\u201372.","journal-title":"Spec Care Dentist"},{"issue":"1","key":"9995_CR19","doi-asserted-by":"publisher","first-page":"72","DOI":"10.3104\/reports.2022","volume":"12","author":"FA Oredugba","year":"2007","unstructured":"Oredugba FA. Oral health condition and treatment needs of a group of Nigerian individuals with Down syndrome. Down Syndr Res Pract. 2007;12(1):72\u20136.","journal-title":"Down Syndr Res Pract"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-026-09995-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-09995-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-09995-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:02:40Z","timestamp":1792425760000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-026-09995-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["9995"],"URL":"https:\/\/doi.org\/10.1186\/s12903-026-09995-9","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"16 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in full compliance with the Declaration of Helsinki and the ethical standards of Pharos University. The research protocol was reviewed and approved by the Research Ethics Committee of Pharos University in Alexandria (PUA-REC). Ethical approval was granted on January 6, 2026, with reference approval code PUA-REC-012 (Council Serial: 0220260163463), as illustrai ated in Appendix 1.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants for the publication of their personal and clinical details, as well as any identifying images, where applicable, in this study.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2060"}}