title: Dental surgery and anesthetic precautions of a patient with Down syndrome and juvenile rheumatoid arthritis: a case report.
abstract: Down syndrome and juvenile rheumatoid arthritis have been associated with ligament laxity, specifically the atlantoaxial ligament, which maintains the proper positioning of the cervical first and second vertebrae. The joint consists of different pathological processes, and it is paramount  that individuals with either condition be screened appropriately before surgery is contemplated. The purpose of this paper was to present a case of an individual with both conditions and describe precautionary measures that were undertaken to safely complete dental treatment under general  anesthesia and avoid morbidity.
authors.affiliation: Bon Secours Pediatric Dental Associates, Richmond, VA, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Unkel
authors.forename: Justin S
authors.initials: JS
authors.lastname: Edwards
authors.forename: William P
authors.initials: WP
authors.lastname: Piscitelli
authors.forename: Gary W
authors.initials: GW
authors.lastname: Tye
mesh_terms: D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D001171:Arthritis, Juvenile / Q000150:complications*; D001268:Atlanto-Axial Joint / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000517:prevention & control*; D002648:Child; D003730:Dental Care for Persons with Disabilities / Q000379:methods*; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D006801:Humans; D007570:Jaw Cysts / Q000601:surgery; D008439:Maxillary Diseases / Q000601:surgery; D009809:Odontoid Process / Q000002:abnormalities / Q000000981:diagnostic imaging; D019647:Oral Surgical Procedures / Q000379:methods*; D056888:Patient Positioning; D010482:Periapical Abscess / Q000601:surgery; D011859:Radiography; D014081:Tooth Extraction