Traumatic injury to maxillary incisor teeth in a group of South Wales school children

Abstract This study examines, from photographic records, the prevalence of accidental damage to maxillary incisor teeth in a group of 968 11/12-year-old South Wales school-children; 15.3% showed evidence of trauma ranging from enamel fractures or discolouration to actual loss of a tooth. Boys (19.4%) showed a higher prevalence of trauma than girls (11%). Maxillary central incisors were the most at risk from trauma, with coronal fractures being the most commonly sustained injury. Those subjects who showed evidence of trauma had an statistically (p< 0.001) but not clinically significantly greater overjet than did those who had none. The percentage of subjects suffering trauma increased significantly with increasing overjet, but lip incompetence did not affect the prevalence of accidental damage. Though statistically unsupported due to the small numbers involved in this cohort, it appeared that the rougher nature of boys activities and their more active participation in sports were of greater importance than the magnitude of their overjet in determining whether their teeth were at risk from trauma. In contrast, it was the magnitude of the overjet which was the dominant factor in girls. Despite the wide availability of relatively simple means of restoration and, in the majority of cases, regular dental examinations, only 14.8% of traumatised teeth had received treatment at this age.     

Traumatic injury to maxillary incisor teeth in a group of South Wales school children

This study examines, from photographic records, the prevalence of accidental damage to maxillary incisor teeth in a group of 968 11/12-year-old South Wales school-children; 15.3% showed evidence of trauma ranging from enamel fractures or discolouration to actual loss of a tooth. Boys (19.4%) showed a higher prevalence of trauma than girls (11%). Maxillary central incisors were the most at risk from trauma, with coronal fractures being the most commonly sustained injury. Those subjects who showed evidence of trauma had an statistically (p less than 0.001) but not clinically significantly greater overjet than did those who had none. The percentage of subjects suffering trauma increased significantly with increasing overjet, but lip incompetence did not affect the prevalence of accidental damage. Though statistically unsupported due to the small numbers involved in this cohort, it appeared that the rougher nature of boys activities and their more active participation in sports were of greater importance than the magnitude of their overjet in determining whether their teeth were at risk from trauma. In contrast, it was the magnitude of the overjet which was the dominant factor in girls. Despite the wide availability of relatively simple means of restoration and, in the majority of cases, regular dental examinations, only 14.8% of traumatised teeth had received treatment at this age.     

Risk factors for injuries to maxillary permanent incisors and upper lip among schoolchildren in Dar es Salaam, Tanzania

Background.   Dental trauma is common among children, and the maxillary permanent central incisors are the most often affected teeth.
Aim.   This study aimed to investigate the risk factors for injury to maxillary permanent incisors and the upper lip among Tanzanian schoolchildren aged 8–14 years.
Design.   A cross-sectional study involving 1119 children. The risk variables investigated included age, gender, lip competence, and overjet. The corresponding proportions of injuries and the relative risk (with 95% confidence interval) were calculated and tested by Fisher's exact test. Logistic regression was applied to ascertain the strength and direction of the association of the risk variables to injuries, and backward selection was used to test significant risk factors.
Results.   About 24% of the children had trauma to maxillary incisors, 45% had incompetent lip whereas 31% had increased overjet. Age, gender, overjet, and lip competence showed significant association with injuries to upper lip and maxillary incisors. Boys had sustained more injuries than girls, with a higher relative risk for luxation injuries. Enamel fracture was associated with overjet combined with lip competence, whereas enamel dentine fracture without pulp involvement was related to gender. Luxation injuries were associated with gender, tooth avulsion with overjet, and lip competence. Injury to the upper lip was associated with age.
Conclusion.   Male gender, increased overjet, and lip incompetence were the main risk factors of getting trauma to maxillary incisors, whereas age was the risk factor for injury to the upper lip.     

Traumatic anterior dental injuries in 7- to 12-year-old Brazilian children

Abstract –  The aim of this study was to determine the prevalence and risk factors of dental trauma in the permanent anterior teeth of schoolchildren in Campina Grande, Brazil. A sample of 448 schoolchildren, 228 boys and 220 girls, aged 7–12 years, were randomly selected from 17 public schools in an urban area. The sample selection was carried out in two stages: first, schools were selected by simple sampling and then children were chosen using a proportionality coefficient. Data were collected through clinical examinations and interviews, after examiner calibration. Overjet (OJ) was considered a risk factor when it presented values higher than 3 mm, while lip coverage was classified as adequate or inadequate. Yates' chi-squared test verified the association between the variables and odds ratio. Significance level was set at 5%. The prevalence of dental injuries was 21%. Boys experienced more injuries than girls, 21.9% and 20%, respectively ( P  > 0.05). Falls and collisions were the main causes of dental trauma, 63.8% and 24.5%, respectively. There was a statistically significant difference between traumatic dental injuries (TDI) and OJ (95% CI 0.22–0.63) ( P  < 0.001) and between TDI and inadequate lip coverage (95% CI 9.16–34.93) ( P  < 0.001). Data indicated that boys presenting an OJ size >3 mm and inadequate lip coverage were more likely to have TDI in Campina Grande, Brazil.     

An investigation into the association between facial profile and maxillary incisor trauma,a clinical non‐radiographic study

Abstract – Objectives: To explore the association between maxillary incisor trauma (MIT) and facial skeletal forms (sagittal and vertical), overjet (OJ), lip coverage, and gender. Subjects and methods: Five hundred and two subjects (253 females and 249 males, aged 11–14 years) were examined. Sagittal (Class I, II or III) and vertical skeletal pattern (average, increased or decreased Frankfort‐Mandibular Plane Angle (FMPA)) were recorded. Samples were categorized into four groups according to OJ severity: OJ ≤ 3.5 mm, 3.5 mm < OJ ≤ 6.0 mm with competent lips, 3.5 mm < OJ ≤ 6.0 mm with incompetent lips and OJ > 6 mm. Samples were also subdivided into two groups: OJ ≤ 3.5 mm and OJ > 3.5 mm. Chi‐square test was performed to determine any gender differences in trauma experience. Logistic regression was performed to test for any differences in risk of MIT in different groups, and to estimate the predictive value of facial skeletal pattern (sagittal), FMPA, gender, OJ, and lip competence for MIT. Results: Nine percent had incisor trauma (8.4% MIT). Boys had greater odds of receiving MIT than girls (OR = 2.16; 95% CI, 1.11–4.21). Subjects with Class II skeletal patterns had greater odds of MIT than those with Class I skeletal patterns (OR = 3.98; 95% CI, 1.98–8.00). Subjects with decreased FMPA had greater odds of MIT than subjects with average FMPA (OR = 4.55; 95% CI, 2.28–9.06). Lip competence was not associated with MIT (P > 0.05). Subjects with OJ > 3.5 mm had greater odds of MIT than subjects with OJ ≤ 3.5 mm (OR = 2.83; 95% CI, 1.49–5.37). Conclusion: Compared with children with normal OJ (≤3.5 mm), Class I skeletal pattern (Straight profile) and average FMPA, the odds of MIT increased significantly in children with OJ > 3.5 mm (OR = 2.83), Class II skeletal pattern (OR = 3.98) and decreased FMPA (short face profile) (OR = 4.55), respectively.     

Prevalence of traumatized permanent incisors in Jordanian children, according to age, sex and socio-economic class.

The purpose of this retrospective study was to analyse firstly the prevalence of firsty fractured permanent incisors, secondly their distribution according to age, sex and socio-economic class and thirdly the location of the trauma, in a population sample of schoolchildren from Jordan. The sample consisted of 3041 children aged 7-12 years enrolled in 6 public and private schools from the city of Amman and its outskirts. The prevalence of fractured permanent incisors was 10.5% (12.1% in boys and 8.8% in girls). The largest number of injuries was observed in the 11-12 years group (15.0%) and there was an increase of the prevalence of trauma associated with the increase of age. Significantly more boys suffered injuries than girls (P less than 0.01). The teeth most commonly injured were the maxillary central incisors (79.1%) and 85.2% of children sustained one fractured tooth only. The numbers of traumatized children in each of the low and middle socio-economic classes were significantly higher than those in the high socio-economic class.     

Dental injuries among schoolchildren aged from 6 to 15, in Rennes (France)

Abstract A representative sample of 2020 schoolchildren, aged 6 to 15 years, was randomly selected from 85 state and private schools in Rennes and distributed in 10 groups, according to their age. Type and prevalence of dental injuries were determined in each group, using Ellis & Davey's classification, giving rise to a subset of 345 subjects. Simple enamel fracture was the predominant injury (59.4%), occuring most often on maxillary central incisors. Most time (77.1%), the trauma affected only one tooth. Mean prevalence of dental injuries was 13.6% from 2020 subjects. Boys showed a higher prevalence than girls (respectively 17% and 10.2%), but this difference was only significant for age-groups 12 and 13 (p<0.001) and for the whole group of 6–15 (p<0.001).     

Traumatic dental injuries in a sample of Dominican schoolchildren

Abstract The purpose of this retrospective study was to analyze 1) the prevalence of traumatic injuries to permanent incisors and canines, 2) their distribution according to type, 3) etiology, 4) place of occurrence, and 5) location of trauma, in a population sample of schoolchildren from the Dominican Republic, located in the Caribbean Archipelago. The sample consisted of 596 children aged 7–14 years enrolled in 21 public and private schools from the city of San Pedro de Macoris, in the southeastern part of the country. This sample represents 10.8% of the schoolchildren of the city. The prevalence of injuries was 18.1 % (17.4% in boys and 18.8% in girls). The largest number of injuries was found in the 14-year-old children followed by the 12-year-olds. Significantly, girls had a larger number of actual teeth injured than boys (P < 0.05). The most common type of injury in both sexes was the enamel fracture (51.1%) followed by concussions (25.6%). Significantly, more girls suffered concussions than boys (P < 0.05). The most common cause of injury in both sexes was falling against an object (60.0% in boys and 42.6% in girls). The most frequent place of occurrence of trauma, in both sexes, was at home (34.1 %), followed by outside of home (19.3%) and at school (12.5%). The teeth most commonly injured were the maxillary central incisors (63.9%). Girls presented significantly more mandibular lateral incisors injured than boys (P < 0.02).     

Risk factors for traumatic dental injuries in an adolescent male population in India

AIM: The aim of this study was to determine the prevalence of traumatic injuries to the anterior teeth and evaluate the role of anatomic risk factors in the occurrence of such injuries in a group with an assumed behavior predisposing them to trauma. METHODS AND MATERIALS: The study population consisted of 370 male enrollees of the National Cadet Corps (NCC) in India. Risk factors such as the socioeconomic status (SES) of parents, lip coverage, incisor overjet, and the cause and nature of trauma to anterior teeth were recorded. The Chi-square test was used for testing the association between these factors. Increasing overjet was further analyzed using chi-square for linear trends. Variables found significant were subjected to logistic regression. RESULTS: A prevalence of 14.9% of traumatic injuries to anterior teeth was found in the study population with sports activities being the most common cause. Permanent maxillary central incisors were most commonly injured with injuries involving enamel and dentin being the most frequently observed. Increased overjet and inadequate lip coverage were significantly associated with the occurrence of trauma. With an odds ratio of 7.2 inadequate lip coverage was identified, using binary logistic regression, as the single most independent risk factor for the occurrence of traumatic injury to the maxillary anterior teeth.     

Traumatic injuries to the anterior teeth among South Kanara school children--a prevalence study

The present study was carried out to assess the prevalence and distribution of the traumatic injuries to anterior teeth among 4500 school children in the age group of 3 to 16 years from South Kanara District of Karnataka. Information concerning sex, age, cause of trauma, number of injured teeth, type of the teeth, lip competence, terminal plane relationship and the molar relationship were recorded. A total of 238 cases (5.29%) had incisor and canine fractures, which was more prevalent among the boys (72.27%) than the girls (27.73%). The leading cause of injury was undefined falls and the maxillary central incisors were commonly affected in both the primary and the permanent dentition. Enamel fracture was the most common form of injury noted. Class 1 Type 2 and Class 2 division 1 molar relationship cases exhibited significantly very high number of fractured teeth. Only 1.68% of the cases with traumatized teeth had undergone treatment.     

Traumatic injuries to the teeth in young individuals with cerebral palsy

Abstract –  The purpose of the study was to assess the characteristics of dental trauma in individuals with cerebral palsy (CP). The study group consisted of 68 individuals (36 boys and 32 girls) who visit daily a school dedicated for children with CP. Their age ranged between 7 and 21 years with a mean age of 12.6 years. The majority (74%) required a wheel chair for mobility, 13% used a walker and the others were able to walk with crutches or without aid. The parents were asked to complete a questionnaire regarding their child's age, gender, medical history, and history of dental trauma. The teeth were evaluated clinically for evidences of past injuries to the teeth, enamel defects in the permanent incisors, scars on the chin and size of overjet. Thirty-nine individuals (57%) had signs of trauma to the permanent teeth. Sixty-eight teeth, mostly the maxillary central incisors, were injured. Boys were slightly less affected than girls, 56% (20/36) and 59% (19/32), respectively. Fracture of enamel and dentine was the most common type of injury (62%). Scars on the chin were detected in 28% of the individuals but only one had fractures of the molar (primary) teeth. The overjet ranged between −3.0 and +14 mm but no correlation could be found between the size of the overjet and tendency to injure the teeth. Localized enamel defects were detected on the labial surface of 13 teeth in nine individuals, probably due to luxation injuries to the primary incisors. The prevalence of dental injuries in a group of individuals with CP was found to be much higher than that of healthy populations despite the fact that CP individuals do not take part in violent sport activities as healthy children do. This should alert caregivers to carry out a profound investigation of the events that result in dental injuries in disabled individuals and suggest methods to reduce this type of morbidity.     

Epidemiology of traumatic injuries to the permanent incisors of 9-12-year-old schoolchildren in Damascus, Syria.

This cross-sectional survey was carried out to assess epidemiological data concerning dental injuries to the permanent incisors of Syrian children. It included 1087 children aged 9 to 12 years, of both sexes, randomly selected from public and private primary schools in Damascus. The response rate was 100%. The prevalence of traumatic injuries to the permanent incisors rose from 5.2% at the age of 9 years to 11.7% at the age of 12 years (P = 0.007). The difference in prevalence between boys and girls was not statistically significant (P > 0.05). The majority (59.8%) of children who had experienced injuries to the permanent incisors reported that they were not taken to the dentist for evaluation or treatment of the damage. Among those children who had experienced traumatic injuries to the teeth 93.1% presented with untreated damage. Because some injuries were minor, such as small enamel fractures, the proportion of children who needed treatment was 63.2%. There was a tendency for children with an incisal overjet greater than 5 mm to have experienced dental injuries (P = 0.06). Children with inadequate lip coverage were more likely to have experienced dental injuries than those with adequate lip coverage (P = 0.000). The most common reported cause of injuries to the permanent incisors was violence (42.5%), followed by traffic accidents (24.1%), collisions with people or inanimate objects (16.0%) and falls (9.1%). In conclusion, traumatic dental injury may pose a serious dental public health problem.     

Epidemiology of traumatic injuries to the permanent incisors of 9–12-year-old school children in Damascus, Syria

Abstract— This cross-sectional survey was carried out to assess epi-demiological data concerning dental injuries to the permanent incisors of Syrian children. It included 1087 children aged 9 to 12 years, of both sexes, randomly selected from public and private primary schools in Damascus. The response rate was 100%. The prevalence of traumatic injuries to the permanent incisors rose from 5.2% at the age of 9 years to 11.7% at the age of 12 years ( P= 0.007). The difference in prevalence between boys and girls was not statistically significant ( P>0.05 ). The majority (59.8%) of children who had experienced injuries to the permanent incisors reported that they were not taken to the dentist for evaluation or treatment of the damage. Among those children who had experienced traumatic injuries to the teeth 93.1% presented with untreated damage. Because some injuries were minor, such as small enamel fractures, the proportion of children who needed treatment was 63.2%. There was a tendency for children with an incisal overjet greater than 5 mm to have experienced dental injuries ( P=0.06 ). Children with inadequate lip coverage were more likely to have experienced dental injuries than those with adequate lip coverage (P=0.000). The most common reported cause of injuries to the permanent incisors was violence (42.5%), followed by traffic accidents (24.1%), collisions with people or inanimate objects (16.0%) and falls (9.1%). In conclusion, traumatic dental injury may pose a serious dental public health problem.     

Prevalence of traumatic injuries to maxillary permanent teeth in 9‐ to 14‐year‐old school children in Yazd,Iran

Abstract – Aim: Trauma to maxillary anterior teeth is a common reason for emergency room visits among children; therefore, the goal of this study was to evaluate the prevalence and related factors of such trauma among 9‐ to 14‐year‐old children in Yazd. Materials and methods: A sample of 1440 schoolchildren aged 9–14 years old, consisting of 720 boys and 720 girls, were randomly selected from 24 schools in Yazd. Ellis classification was used to record the dental injuries. Results: The prevalence found was 27.56%. The occurrence of trauma was significantly higher in male patients; furthermore, most of the dental trauma occurred in children between 9 and 10 years of age (47.38%). The most common type of injury was the ‘enamel only’ fracture; falls being the main cause of trauma. The most affected tooth was the maxillary central incisor Conclusions: The prevalence and most common causal factor of traumatic injuries to the maxillary anterior teeth in schoolchildren living in Yazd was approximately the same as that found in other countries.     

Profile of an orthodontic patient at risk of dental trauma

Increased overjet and inadequate lip coverage of the maxillary incisors are considered significant risk factors in many clinical studies. The purpose of the present study was to examine this issue of dental injury by actual cephalometric measurements in orthodontic patients. Pretreatment cephalograms (taken with lips in repose) of consecutive patients were used. The patients were allotted to two groups Group T (trauma): 56 patients who had injured their maxillary incisors prior to their orthodontic treatment, mean age at the start of treatment 11.9 years (SD = 1.5); and Group C (control): 98 patients with intact maxillary incisors, mean age at the start of treatment 11.6 years (SD = 1.3). Twelve cephalometric landmarks on the soft and hard tissue profile were identified and digitized and the relevant dental, skeletal and soft tissue measurements recorded. The variables in Groups T and C were compared and their predictive values for possible occurrence of trauma were tested by logistic regression analysis. No statistically significant differences between boys and girls were found. Overjet or maxillary incisor exposure or interlabial gap, each as a single variable, could differentiate between the two groups. Logistic regression analysis indicated that only a small percentage (28.7%) of the dependent variable variation (trauma vs control) can be explained by interlabial gap, gender, upper incisor long axis to facial plane (degree), upper incisor long axis to interlabial gap and overjet.     

Profile of an orthodontic patient at risk of dental trauma

Abstract – Increased overjet and inadequate lip coverage of the maxillary incisors are considered significant risk factors in many clinical studies. The purpose of the present study was to examine this issue of dental injury by actual cephalometric measurements in orthodontic patients. Pretreatment cephalograms (taken with lips in repose) of consecutive patients were used. The patients were allotted to two groups Group T (trauma): 56 patients who had injured their maxillary incisors prior to their orthodontic treatment, mean age at the start of treatment 11.9 years (SD=1.5); and Group C (control): 98 patients with intact maxillary incisors, mean age at the start of treatment 11.6 years (SD=1.3). Twelve cephalometric landmarks on the soft and hard tissue profile were identified and digitized and the relevant dental, skeletal and soft tissue measurements recorded. The variables in Groups T and C were compared and their predictive values for possible occurrence of trauma were tested by logistic regression analysis. No statistically significant differences between boys and girls were found. Overjet or maxillary incisor exposure or interlabial gap, each as a single variable, could differentiate between the two groups. Logistic regression analysis indicated that only a small percentage (28.7%) of the dependent variable variation (trauma vs control) can be explained by interlabial gap, gender, upper incisor long axis to facial plane (degree), upper incisor long axis to interlabial gap and overjet.     

Traumatic dental injuries among primary school children in Sulaimani city, Iraq

Abstract –  A cross-sectional survey was carried out through clinical examination of anterior teeth among 4015, 6- to 13-year-old children enrolled in 20 public primary schools of Sulaimani city, northern Iraq. The prevalence and pattern of traumatized anterior teeth were studied in relation to age, gender, type of injury, dental treatment needs, place and cause of the trauma in addition to occlusal relation and upper lip position. The prevalence of children with traumatic dental injuries was found to be 6.1% (243 children) of the total sample. Age and gender were highly significantly associated with dental trauma ( P  < 0.001). Males were more affected than females and the prevalence increased with age. Simple enamel fracture was the most common type of injury followed by enamel-dentine fracture and concussion. The maxillary central incisors were found to be most affected by trauma followed by mandibular central incisors and the maxillary lateral incisors. The number of injured teeth per child was 1.38 (totally 336 anterior teeth were found with dental trauma) and single tooth trauma was the most common type (69.5%). Results showed that only 7% of the traumatized anterior teeth received treatment and about half (48.7%) of the remaining traumatized teeth did not need dental treatments, while the least treatment type needed was extraction (3.5%). The highest proportions of traumatized children were found with class II division 1 malocclusion and inadequate upper lip coverage. Falls and playing were the most common causes of dental injury, while home was the most common place of trauma occurrence. The present study revealed a relatively low prevalence of dental trauma, but still this figure represents a large number of children. Therefore, educational programs are to be initiated for the community regarding causes, prevention and treatments of traumatic dental injuries.     

Labial-cervical-vertical groove in maxillary permanent incisors--prevalence, severity, and affected soft tissue.

OBJECTIVES: To investigate the prevalence and severity of a labial-cervical-vertical groove (LCVG) in maxillary permanent incisors and its effect on the associated gingival tissue. METHODS: A total of 600 adolescents (293 boys and 307 girls, mean age 13.6+/-1.99 years) were randomly selected and examined for the presence of LCVG. The deformity was classified as mild, moderate, or severe according to predetermined criteria. Gingival coverage at the groove site was defined as normal, partial, and irregular. RESULTS: LCVG was found in 27 adolescents (4.5%). It was unilateral in 24 (89%) and bilateral in 3 (11%). The ratio of central to lateral incisors was 29:1. No sexual dimorphism or side prevalence were found. Mild LCVG was found in 22 incisors, moderate LCVG in 7 incisors, and severe LCVG in one incisor. Moderate LCVG was 5 to 6 times more susceptible to partial or irregular coverage of the gingival margin than mild LCVG. The gingival sulcus in teeth with LCVG demonstrated a significant (P = .001) increase in depth compared to non-LCVG teeth (1.55+/-0.90 mm vs 1.18+/-0.75 mm). CONCLUSIONS: An LCVG is a deformity confined predominantly to a single permanent maxillary central incisor. Its prevalence is not connected with gender. Most LCVGs are mild and often difficult to detect. However, the greater the severity, the more gingival irregularity is associated. This and the increase in sulcus depth in LCVG incisors are adverse predispositions for periodontal sequelae, calling for cautious oral hygiene maintenance.     

Causes and prevalence of traumatic injuries to the permanent incisors of school children aged 10-14 years in Maseru, Lesotho

Traumatic dental injuries are widespread in the population and the prevalence of traumatic dental injuries among school children in different parts of the world varies from about 3% to 45%. Most injuries involve the anterior teeth, which may lead to eating restrictions, changes in physical appearance, speech defects and psychological impacts that affect the child's quality of life. A cross-sectional survey was carried out to investigate the prevalence, aetiology and types of injuries to permanent incisors among schoolchildren aged 10-14 years from Maseru, Lesotho. Upper and lower permanent incisors were examined for dental injuries. The prevalence of traumatic injuries to the permanent incisor teeth was 9.3% (13.3% boys and 6.3% girls). Significantly more boys than girls suffered injury. The most common type of injury was enamel fractures and most common cause was falls. Health promotion policies should aim to create an appropriate and safe environment for children. Soft playground surfaces, school-crossing patrols, marked zebra crossings and bicycle lanes would help create a safe environment. Speed limits for cars and the use of seat belts, air bags, special car seats for children and bicycle helmets should be enforced. Mouth guards should be used when playing sport, in particular contact sports. Education regarding the epidemiology of dental injuries and their prevention through health promotion may play a major role in reducing the prevalence of dental injury and avoiding the financial costs of treatment, especially in developing countries.     

Hypodontia in children with various types of clefts

The prevalence of hypodontia in children with clefts, both inside and outside the cleft region, and the possible association between the side of the cleft and the side of the missing teeth were studied using radiographs of 278 patients with cleft lip, cleft palate, or both (158 boys and 120 girls), age 5 to 18 years (mean age 10.4 years). A hypodontia prevalence of 77% (excluding third molars) was found for the total cleft sample. This was significantly higher, both statistically and clinically, than the incidence of hypodontia reported for noncleft populations, and considerably higher than the prevalence reported in other studies of children with clefts. The maxillary permanent lateral incisors were the teeth most frequently missing on the cleft side (259 teeth) followed by the maxillary (47 teeth) and mandibular (23 teeth) second premolars, in both boys and girls. The teeth that were most often missing on the noncleft side were the maxillary second premolars (12 teeth), followed by the maxillary lateral incisors (10 teeth) and mandibular second premolars (6 teeth). Hypodontia of both the maxillary lateral incisors and second premolars was found more frequently on the left side, which also has a higher frequency of clefting.