A 12 year old female patient complains of multiple missing teeth. The karyogram of  the patient is shown below. Intra-oral ﬁndings include missing 12, 17, 33 and 43.
Open bite, macroglossia and generalised periodontitis is also present. Which of the  following is commonly seen in this condition?
Patient is suffering from Down's syndrome (trisomy of chromosome No. 21).
Skeletal ﬁndings are an underdeveloped mid-face, creating a prognathic occlusal relationship. 
Oral ﬁndings include mouth breathing, open bite, appearance of macroglossia, ﬁssured lips and tongue, angular cheilitis, delayed eruption times, missing and malformed teeth, oligodontia, small roots, microdontia, crowding, and a low level of caries. 
Children with Down syndrome experience a high incidence of rapid, destructive periodontal disease, which may be related to local factors such as tooth morphology, bruxism, malocclusion, and poor oral hygiene.
Mouth breathing
Prognathic maxilla
Macrodontia
High level of caries