Our experience with down syndrome patients us taught us that early to severe periodontal disease is often seen with onset in the mid to late teen years. Some studies report an incidence of periodontal disease to be between 90 and 96% of adults with Down syndrome. This is related to a compromised immune system in Down syndrome. The teeth most affected are the mandibular incisors and maxillary molars. Good oral hygiene and semi-annual cleaning appointments may not be enough to prevent the progression of periodontal disease in these patients. More frequent cleaning is needed and as well as early, aggressive treatment. These patients may need to be seen as often as every three months for deep cleaning and may also benefit from the use of chlorhexedine mouth rinse and possibly systemic antibiotic therapy. Parents and care giving need to realize the importance of proper daily home care because the child with Down syndrome may be resistant to tooth brushing. Our approach to Down Syndrome patients is first to carefully gaining their trust. We will assure them that they will not be hurt, restrained or harmed in any way. In most cases, I.V. sedation is required for patient with Down Syndrome for the comprehensive treatment because gagging reflex due to their often enlarged tongue and it is hard for them to sit in the dental chair for long duration. We will take great care of them during their comprehensive dental treatment. For the most part of the treatment, they will be a sleep and will remember very little of the treatment. We will be vigilant of factoring their compromised immune system and they are prone to periodontal disease into our treatment. We will treat that aggressively and get them to a dental healthy state. At the end, we will show them and the parent the proper brushing technique and ways to getting them brushing daily because we stress home prevention is the most important part of dentistry.