Caries experience and oral health behavior in Chinese children with cleft lip and/or palate.

PURPOSE: The aims of this study were to investigate whether there were different caries levels in 3- to 6-year-old Chinese children who had a cleft lip compared to those with a cleft lip/palate. The goal also was to evaluate parental attitudes toward the feeding habits and oral health care for their children. METHODS: A cross-sectional study was carried out through a dental examination of a sample of children and a questionnaire to their parents. A sample of 104 3- to 6-year-old children (66 boys and 38 girls) with cleft lip, cleft palate or both were selected from those receiving pre-surgical treatment. Each child was examined and a short questionnaire was given to parents of the children. The form included questions about infant feeding practices, frequency consumption of specific drinks and, children's toothbrushing frequency. RESULTS: One hundred and four children were examined. Seventy-five percent had some caries experience and rampant caries was present in 26%. Children with cleft palate had a higher prevalence of rampant caries (30%) compared to those with cleft lip (12%). A multivariate analysis yielded feeding practices and mother's education as the variables significantly associated with caries and rampant caries. CONCLUSIONS: The results of this study show that: 1. Children with a cleft lip/palate have higher levels of dental caries compared to those with a cleft lip alone; 2. The two most important factors for dental caries were: a. whether the child had been bottle-fed and; b. the educational attainment level of the mother.     

Abstracts from other journals

The aims of this study were to investigate whether there were different caries levels in 3- to 6-year-old Chinese children who had a cleft lip compared to those with a cleft lip/palate. The goal also was to evaluate parental attitudes toward the feeding habits and oral health care for their children. A cross-sectional study was carried out through a dental examination of a sample of children and a questionnaire to their parents. A sample of 104 3- to 6-year-old children (66 boys and 38 girls) with cleft lip, cleft palate or both were selected from those receiving pre-surgical treatment. Each child was examined and a short questionnaire was given to parents of the children. The form included questions about infant feeding practices, frequency of consumption of specific drinks, and children's toothbrushing frequency. One hundred and four children were examined. Seventy-five percent had some caries experience and rampant caries was present in 26%. Children with cleft palate had a higher prevalence of rampant caries (30%) compared to those with cleft lip (12%). A multivariate analysis yielded feeding practices and mother's education as the variables significantly associated with caries and rampant caries. The results of this study show that: 1. Children with a cleft lip/palate have higher levels of dental caries compared to those with a cleft lip alone; 2. The two most important factors for dental caries were: (a) whether the child had been bottle-fed and; (b) the educational attainment level of the mother.     

Dental and oral hygiene status in Jordanian children with cleft lip and palate: a comparison between unilateral and bilateral clefts

To cite this article:
Int J Dent Hygiene 9 , 2011; 30–36
DOI: 10.1111/j.1601‐5037.2009.00426.x
Hazza’a AM, Rawashdeh MA, Al‐Nimri K, Al Habashneh R. Dental and oral hygiene status in Jordanian children with cleft lip and palate: a comparison between unilateral and bilateral clefts. Abstract: Objectives: The purpose of this study was to assess and compare the dental health and oral hygiene status of subjects with unilateral and bilateral cleft lip and palate (BCLP). Methods: Oral and dental examinations were carried out in 98 children with cleft lip and palate and 98 unaffected subjects matching in gender and age, using the standard dental indices dmft and DMFT. Plaque and gingival indices were scored using the plaque and gingival indices of Silness and Löe. Results: The prevalence of dental caries was significantly higher in children with cleft lip and palate than their control in both permanent and deciduous teeth. Patients with BCLP experienced more dental caries than unilateral cleft lip and palate (UCLP) patients in both dentitions. Similarly, plaque accumulation and gingivitis were significantly higher in the cleft lip and palate patients compared with their controls. Only plaque accumulation was significantly higher in the BCLP patients than in the UCLP patients. Conclusion: Bilateral cleft lip and palate patients appear to be at a higher risk of caries experience and poorer in oral hygiene than those with UCLP patients. These findings not only provide a baseline for oral health parameters in patients with cleft lip and palate but also emphasize the need for intensive preventive measures of oral disease to optimize clinical outcome.     

Caries prevalence and bottle-feeding practices in 2-year-old children with cleft lip, cleft palate, or both in Taiwan.

OBJECTIVE: The purposes of this study were to investigate the caries prevalence in cleft lip, cleft palate, or both in children under the age of 2 years and to evaluate parental attitudes toward bottle-feeding, dental care, and their relationship to baby bottle tooth decay (BBTD) in Taiwan. DESIGN: Randomized and prospective study. SETTING: Institutional setting. PATIENTS AND METHODS: One hundred twenty-three 2-year-old children (68 boys and 55 girls) with cleft lip, cleft palate, or both were selected for this study. A questionnaire that asked questions about knowledge of oral health, knowledge and beliefs about BBTD, children's feeding habits, children's dental care, and parenting attitudes toward children with clefts was completed by the parents or caretakers. Children were divided into bottle-feeding and non-bottle-feeding groups according to the questionnaire responses of parents or caretakers. Each child was examined with a dental mirror and explorer under focused flashlight using defs index to determine the presence of BBTD. RESULTS: Thirty-nine percent (48) subjects reported a bottle-feeding habit; the overall prevalence of BBTD was 15.4%. The habit of bottle-feeding was significantly related to BBTD (p = .019). The defs score for children who were bottle-fed was significantly higher than children who were not bottle-fed (p = .045). Parents or caretakers of both bottle-feeding and non-bottle-feeding children showed no significant differences in their attitudes toward bottle-feeding and feeding habits (p > .05). However, parents of non-bottle-fed children had significantly better dental care than parents of bottle-fed children in brushing frequency (p < .001) and brushing before bed (p < .001). CONCLUSIONS: Children with clefts who took a bottle to bed showed an increased risk of developing BBTD. The parents or caretakers of bottle-fed children also showed a lack of motivation to perform regular preventive dental home care for their children. This suggests that oral health promotion programs should begin in infancy for children with clefts and their parents.     

2002 BSPD Clinical Case Presentations, sponsored by South Yorkshire branch of BSPD

Aims. To determine the oral health of children attending a Clinical Standards Advisory Group (CSAG) audit and to assess whether this varied with the type of cleft. To record the fre-quencies of dental anomalies occurring at the site of the cleft.
Methods. Children with clefts attending the 5-, 10-, 15- and 20-year audit at Broomfield Hospital Essex over a 2-year period were examined using standardized criteria for caries experience, dental anomalies and oral hygiene status. Comparisons were made for the different cleft types.
Results. The mean DMFTat 5 years was 1·83. The DMFT for 10- and 15-year children combined was 0·64. Sixty-two percent of the children had dental anomalies in the region of the cleft. Children with cleft lip and palate had significantly more dental anomalies than cleft palate alone. Children withbilateral cleft lip and palate often had anomalies remote from the cleft.
Conclusions. Dental caries in this population of cleft children was similar to national figures. Hypodontia and hypoplasia were more common in cleft lip and palate than in cleft palate alone. Dental anomalies remote from the cleft site in bilateral clefts suggests that a field change may influence dental development.     

The prevalence of caries in children with a cleft lip and/or palate in Southern Vietnam.

OBJECTIVE: The aim of this study was to investigate the prevalence of caries in South Vietnamese children with a known oral cleft. SETTING: The children were screened at local dental hospitals in five different cities in southern Vietnam. PARTICIPANTS: One hundred fifty-four children aged 4 to 6, 11 to 13, and 14 to 16 years old with a cleft lip, cleft palate, or both were included in the study. OUTCOME MEASUREMENTS: For every age group, clefts were divided in four types. The dmft/DMFT was specified according to criteria of the World Health Organization (1997). RESULTS: The mean number of teeth affected by caries was 9.95 for 4- to 6-year-old children, 2.97 for 11- to 13-year-old children, and 4.93 for 14- to 16-year-old children, respectively. Four- to 6-year-old children with a unilateral or bilateral cleft lip and palate had significantly more caries and a higher dmft (decayed, missing, and filled teeth index) than children of the same age with only a cleft lip or a cleft lip and alveolus. CONCLUSIONS: Vietnamese children with an oral cleft have high numbers of teeth affected by dental caries, and special attention will be necessary for their oral health.     

Factors Influencing Early Childhood Caries of Cleft Lip and/or Palate Children Aged 18 to 36 Months in Southern Thailand

Objective: To clarify whether oral health care behavior or oral cleft status influences early childhood caries in southern Thailand cleft children. Design: A comparative cross-sectional study. Patients, Participants: A total of 138 southern Thai children aged 18 to 36 months comprised two groups of 69 participants, one with cleft lip and/or palate and controls with no cleft. Methods: All children were examined for early childhood caries by using the severity (DMFT/tooth) index. A structured interview was conducted among caregivers, and then multiple regression analysis was applied. Results: Children with oral clefts had a larger number of early childhood caries (ECC) and poorer feeding habits than those without. From a structured questionnaire, the caregivers of children with clefts exercised poorer oral health behavior than those of the controls, but the cleft status was not an important factor for caries prevalence when oral health behaviors were controlled. Multivariate analysis showed that sweetened bottled milk consumption, night-time feeding habit, and frequent sugary food consumption were the variables significantly associated with dental caries. Conclusions: Children with oral clefts in southern Thailand had greater caries experience when compared with noncleft subjects. However, cleft status was not significant for ECC, and night-time feeding habit was the most important factor for higher ECC in children with clefts.     

Investigation of caries prevalence in children with cleft lip, alveolus, and palate.

AIM: The purpose of this study was to assess the prevalence of dental caries in children with orofacial clefts. PATIENTS: A total of 623 children aged 6-16 years with cleft lip, alveolus, and palate were included in the study. They were compared with 47,646 schoolchildren from Leipzig (Germany). METHODS: This cross-sectional study used the standard dental indices dmf(t) and DMF(T) for clinical assessment. Children underwent a dental examination under standard conditions of seating and lighting in the out-patient department of paediatric dentistry as part of a regular checkup. RESULTS: The prevalence of caries was significantly higher in children with cleft lip, alveolus, and palate in permanent and deciduous teeth. CONCLUSION: These assessments not only provide a baseline for oral health parameters in young patients with clefts, but also underline the need for a more aggressive approach to the prevention of oral disease to optimize clinical outcome.     

Dental caries of primary incisors in children with cleft lip and palate

Visual dental examinations were performed on 64 children ages 18 months through 4 years presenting at a Craniofacial Defects Team charged with diagnostic and referral services. Of the 41 children with cleft lip and/or cleft palate, 13 (32%) had dental caries of one or more maxillary primary incisors. One of the remaining 23 children examined experienced caries of the maxillary primary incisors. In incisors of children having clefts of the alveolus, caries tended to correspond to sites of enamel deficiency in caries-free children with alveolar clefts. Caries patterns in children with clefts involving only the palate resembled "nursing carries". Children with clefts are at significant risk for caries of the primary incisors; a dental prevention program is to be emphasized in referring these children for care.     

贫困家庭唇腭裂儿童患龋情况及相关因素分析

目的　调查贫困家庭唇腭裂儿童的患龋水平及其相关因素。方法　对贫困家庭唇腭裂患者作龋病现况调查和问卷调查。结果　所调查的 10 4例 3～ 6岁唇腭裂患儿 ,患龋率为 75 %。多因素回归分析表明 ,儿童喂养方式和母亲的受教育水平是引起龋病的两个主要变量。结论　贫困家庭唇腭裂儿童的患龋水平较高 ,口腔卫生行为较差。     

Type of oral cleft and mothers' perceptions of care, health status, and outcomes for preadolescent children.

OBJECTIVE: To evaluate the outcomes of care for children by type of oral cleft. DESIGN: Data were collected through structured telephone interviews during 2003 in Iowa with mothers of 2- to 12-year-old children with oral clefts. Interviews with mothers of children with clubfoot and statewide data on Iowa children were used for comparison. PARTICIPANTS: Participants included mothers of children in Iowa born between 1990 and 2000 with nonsyndromic oral clefts. Children were identified by the statewide Iowa Registry for Congenital and Inherited Disorders. MAIN OUTCOME MEASURES: Rating of cleft care, severity of condition, health status, esthetic outcome, speech, and school performance were evaluated by type of oral cleft. RESULTS: Children with cleft lip and palate were most likely to have their clefts rated as very severe. Children with palatal involvement were reported to have a lower health status and were almost twice as likely to be identified as having a special health care need compared with either children with cleft lip or children statewide. Children with cleft lip had more esthetic concerns; children with palatal involvement had the most speech concerns. CONCLUSIONS: Although mothers generally believed their children had received high-quality care, ratings of the children's current health status and outcomes of care varied significantly by type of cleft (cleft lip, cleft palate, and cleft lip and palate). Differences observed in this population-based study support the proposition that cleft type should be considered when examining outcomes of care for children with oral clefts.     

An investigation of the dentition of parents of children with cleft lip and palate.

OBJECTIVE: The aim of this investigation was to identify whether any dental features in parents of children with cleft lip and palate can be useful as predictors of clefting. METHODS: The dentition of 28 pairs of parents of children with complete unilateral (17) and bilateral (11) cleft lip and palate and 21 pairs of parents of noncleft children were evaluated. Clinical and radiographic examinations were carried out to identify abnormalities of tooth number and morphology. Study cast assessment was undertaken to evaluate incisor relationship, overjet, overbite, intercanine widths, and mesiodistal widths of individual teeth, and these data were subjected to statistical analysis. RESULTS: The prevalence of abnormalities of tooth number in parents of cleft children was similar to those reported elsewhere for general populations. In parents of children with unilateral clefts, there was no tooth-size asymmetry between teeth on the side corresponding to the child's cleft and noncleft sides, respectively. No differences were found in tooth widths and intercanine widths between parents of children with unilateral clefts and parents of children with bilateral clefts. The incisor relationship, overjet, overbite, and intercanine widths were found not to differ statistically between the parents of cleft children and parents of noncleft children. CONCLUSIONS: No predictors of clefting could be identified in the dentition of parents of children with cleft lip and palate.     

非综合征唇裂伴或不伴腭裂对口腔健康相关生活质量的影响

目的 探讨非综合征唇裂伴或不伴腭裂对口腔健康相关生活质量的影响。方法 回顾分析2017年1月—2019年6月山东省菏泽市立医院收治的非综合征唇裂伴或不伴腭裂90例患儿的临床资料,其中唇裂不伴腭裂52例（唇裂不伴腭裂组）,唇裂伴腭裂38例（唇裂伴腭裂组）;选择同期我院口腔科常规口腔检查、口腔健康的40例儿童作为对照组,所有入组者均进行口腔健康检查。应用问卷调查法评估口腔健康对日常生活的影响,采用SPSS 22.0软件包对口腔健康与日常生活质量的相关性进行Spearman相关分析。结果 唇裂不伴腭裂组与唇裂伴腭裂组在龋失补指数（DMFT）、功能牙数目（TH）、咬合牙对、龋齿牙数、LOA≥6 mm牙数间差异具有统计学意义（P<0.05）;唇裂不伴腭裂组与唇裂伴腭裂组的DMFT、TH、咬合牙对、龋齿牙数、LOA≥6 mm牙数均显著高于对照组（P<0.05）;唇裂伴腭裂组OIDP量表各条目得分、OIDP总分显著高于唇裂不伴腭裂组（P<0.05）;唇裂不伴腭裂组OIDP量表各条目得分、OIDP总分显著高于对照组（P<0.05）。采用Spearman法分析临床口腔健康指数与OIDP分数的相关关系,唇裂不伴腭裂组与唇裂伴腭裂组DMFT、MT与根龋牙数、LOA≥6 mm牙数与OIDP分数呈负相关;咬合牙对与OIDP分数呈正相关（P<0.05）。结论 非综合征唇裂伴或不伴腭裂的口腔健康对日常生活质量均有不同程度影响。     

Evaluation of oral health knowledge and oral health status in mothers and their children with cleft lip and palate.

OBJECTIVE: To assess the oral health knowledge of mothers of children with cleft lip and/or palate, analyzing the practical application of this information on the basis of the oral hygiene of the children and caries prevalence of mothers and children. DESIGN: Cross-sectional. SETTING: Pediatric Dentistry sector of the Hospital for Rehabilitation of Craniofacial Anomalies. PATIENTS: Mothers (n = 300) and their children with cleft lip and/or palate, ages 3 years to 5 years 6 months. MATERIALS AND METHODS: An interview with questions related to dietary habits and oral health knowledge and habits was conducted. Children and their mothers also were evaluated by intraoral clinical examination. Results: Of the mothers, 47.3% displayed poor oral health status (Group A) and 52.7% had a satisfactory oral health status (Group B). Children in Group A presented a mean dmft of 6.0, whereas children in Group B had a mean dmft of 5.6. No significant differences were observed between groups. Mothers demonstrated a reasonable knowledge on prevention of dental caries and oral hygiene. CONCLUSION: Even though the mothers interviewed had some knowledge on the causes and prevention of dental caries, other factors should be regarded as relevant in the caries process.     

Increased caries prevalence in 2.5-year-old children with cleft lip and/or palate

The prevalence of dental caries was determined clinically in 2.5-year-old Dutch cleft lip and/or palate children ( n =76) and in children without congenital malformation ( n =75). The parents were given a structured questionnaire regarding the child's dietary habits, oral hygiene, fluoride exposure and social economic background. The prevalence of dental caries was higher in children with oral cleft than in children without oral cleft. Initial caries (white spots) was diagnosed in 17.1% of the subjects with oral cleft compared with 4.0% of the control subjects. Manifest caries (cavities) was found in 26.3% of the children with oral cleft compared with 5.3% of the controls. The dft score (manifest caries) was significantly higher for the oral cleft group (0.59±1.35) than for the control group (0.11±0.54). 52% of the total number of initial and manifest lesions were localized to the maxillary incisors. A multivariate analysis yielded initial caries, oral hygiene and treatment with preoperative infant orthopaedics as the variables significantly associated with manifest caries.     

Family environment of individuals with oral clefts in Argentina.

OBJECTIVE: The purpose of this investigation was to study the social environment of families of children with different types of nonsyndromic oral clefts (OC) and to compare these groups with a control population of families of children without clefts. DESIGN: The study compared three nonsyndromic oral cleft groups and the control group using the Moos Family Environment Scale, which examines cohesion, expressiveness, conflict, independence, achievement-orientation, intellectual-cultural orientation, active-recreational orientation, moral-religious emphasis, organization, and control. SETTING: All parents of children with nonsyndromic oral clefts from a large craniofacial clinic in Buenos Aires, Argentina, were identified and were enrolled in this study between June 2000 and August 2001. Control families were ascertained from the pediatrics service of a hospital located in the vicinity of the craniofacial clinic. PARTICIPANTS: One hundred and sixty-five parents were selected, based on having a child with nonsyndromic unilateral cleft lip with or without cleft palate (UCL/P), bilateral cleft lip with or without cleft palate (BCL/P), or isolated cleft palate (ICP). One hundred and eighty control parents with no family history of congenital anomalies were selected, as well. RESULTS: There was no major difference in the social environment of families of children with different types of nonsyndromic oral clefts. When compared with families in the control group, families of children with nonsyndromic oral clefts scored better in all three subdimensions of family relationship, revealed a high level of independence, and showed better structure and organization than control families did; however, families of children with nonsyndromic oral clefts reported participating in fewer recreational activities. CONCLUSIONS: Overall, families of children with nonsyndromic oral clefts displayed a good social environment. Efforts should be focused to involve them in recreational activities.     

Predisposing factors to dental caries in children with cleft lip and palate: a review and strategies for early prevention.

OBJECTIVE: To review predisposing factors contributing to dental caries in patients with cleft lip, cleft palate, or both (CL/P). DESIGN: Patients with CL/P have a higher susceptibility to caries compared with the population group without clefts. A review of the literature was undertaken to determine factors that could account for the compromised oral hygiene and the high caries prevalence in patients with CL/P. RESULTS: After a literature review, modern strategies for the prevention of early childhood caries were developed and should be considered for integration into the overall management protocol of patients with CL/P. CONCLUSIONS: Preventive dental care is ever more so important in patients with CL/P compared with patients without clefts.     

Association of the GABRB3 gene with nonsyndromic oral clefts.

OBJECTIVE: Nonsyndromic oral clefts are common craniofacial anomalies classified into two subgroups: cleft lip with or without cleft palate and isolated cleft palate. Nonsyndromic oral clefts are multifactorial diseases, with both genetic and environmental factors involved in their pathogenesis. The inhibitory neurotransmitter, gamma-aminobutyric acid plays a role in normal embryonic, and particularly facial, development and gamma-aminobutyric acid receptor type A beta-3 subunit (GABRB3) knockout mice have been shown to have cleft palate. The GABRB3 gene is therefore a strong candidate gene for nonsyndromic oral clefts. We investigated here whether genetic variations of the GABRB3 gene affect the risk for nonsyndromic oral clefts. METHOD: In this case-control study, a total of 178 Japanese patients with cleft lip with or without cleft palate and 374 unrelated controls were recruited and were genotyped for six single nucleotide polymorphisms and a dinucleotide repeat marker of the GABRB3 gene. RESULTS: None of the single nucleotide polymorphisms showed complete linkage disequilibrium with other single nucleotide polymorphisms. In a case-control association study with the six-locus haplotype of the gene, TGTGCT haplotype frequency in patients with cleft lip with or without cleft palate was significantly higher than in the controls (corrected p value = .029). None of the alleles of the dinucleotide repeat marker showed significant association with cleft lip with or without cleft palate. CONCLUSIONS: Our data suggest that the GABRB3 gene is involved in the pathogenesis of cleft lip with or without cleft palate in the Japanese population.     

Left-sided predominance of hypodontia irrespective of cleft sidedness in a French population

Objective : Individuals with oral clefts exhibit considerably more dental anomalies than do individuals without clefts. Our aim was to evaluate the prevalence of tooth agenesis in a sample composed of 124 children (81 boys and 43 girls, mean age 12.5?years) with clefts registered with the Cleft Palate Center in Strasbourg (France). Design : Cleft types and dental agenesis were assessed by clinical and radiographic examination. Cleft types were divided into four groups according to the clinical extent of the cleft (cleft lip only [CL, 12.9%], cleft lip and alveolus [CLA, 4%], cleft lip and palate [CLP, 49.2%], and cleft palate only [CP, 33.9%]). Results : Of the subjects 63% had evidence of hypodontia: maxillary lateral incisors (54%) and upper and lower premolars (32%) were the most common missing teeth. The number of dental ageneses associated with CP (54%) and CLP (79%) was significantly higher than that with CL (33%). All these anomalies were found in proportionately higher frequencies as the severity of the cleft increased, and we found left side predominance for hypodontia (p < .01) irrespective of cleft sidedness. Conclusions : Both right-sided and left-sided clefts were more frequently correlated with left-sided dental agenesis. This left-sided prevalence suggests that common signaling malfunctions might be involved, both in dental development anomalies and cleft genesis.