Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.     

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.     

唇腭裂患者龋病易感性的研究进展

唇腭裂患者是否为龋病的高危人群是近年来龋病研究的热点之一,大量调查表明,唇腭裂患者是龋病的易感人群,龋病的发生与口腔卫生状况、口腔微生物、唇腭裂类型及伴发疾患、社会生活方式等因素密切相关。本文对唇腭裂患者龋病流行特征及其影响因素进行综述。     

Caries prevalence in Belgian children: a review

A review of epidemiological surveys on dental caries prevalence, published between 1980 and 1999 in Belgian children, was compiled through a literature search. The number of studies performed in Belgium to date is limited. Methodological differences and confounding factors, especially socio-demographic influences, limit national comparisons of caries prevalence data.
Although exact comparisons are difficult, data suggests a decline in caries prevalence in 5, 7 and 12 year-old Belgian schoolchildren in the last 20 years. In the primary dentition dmft values have decreased from 2·66 (1981) to 1·38 (1994) in 5-year-olds and from 4·1 (1983) to 2·24 (1996) in 7-year-olds. In 12-year-olds DMFT values in the permanent dentition have decreased from 3·9 (1983) to 1·93 (1994). WHO goals for the year 2000 appear to have been already reached in Flanders, with a recent estimate of 1·93 for DMFT in 12-year-olds and 56% of children being recorded as caries free at the age of 5.
Continuing efforts are needed to screen the oral health of different age groups but standardised criteria and sampling procedures should be used if benefits are to be gained from national and international comparison. Data has often been limited to small selected areas and information representing the entire community of Flanders or Wallonia would be of particular value.     

Fat grafting in patients with cleft lip and palate: A systematic review

This systematic review aims to compare different fat-grafting techniques for cleft lip and palate repair. A search was conducted in PubMed, Embase, Cochrane Library, gray literature and reference lists of selected articles. A total of 25 articles were included, 12 on closure of palatal fistula and 13 on cleft lip repair. The rate of complete resolution of palatal fistula ranged from 88.6% to 100% in studies with no control group, whereas in comparative studies patients receiving a fat graft showed better outcomes than those not receiving a graft. Evidence suggests that fat grafting can be indicated for the primary and secondary repair of cleft palate, with good results. The use of dermis-fat grafts in lip repair was associated with gains in surface area (11.5%), vertical height (18.5%–27.11%), and lip projection (20%). Fat infiltration was associated with increased lip volume (6.5%), vermilion show (31.68% ± 24.03%), and lip projection (46.71% ± 31.3%). The available literature suggests that fat grafting is a promising autogenous option for palate and fistula repair and for improvement of lip projection and scar aesthetics in patients with cleft. However, to develop a guideline, further studies are needed to confirm whether one technique is superior to the other.     

Caries, gingivitis, and dental abnormalities in preschool children with cleft lip and/or palate

Oral health was studied in 49 children aged 5 or 6 years old with clefts of the lip and/or palate (CL(P] and 49 healthy controls matched for sex and age. The results showed a statistically significant increase in the prevalence and activity of caries in CL(P) children. The mean number of decayed and filled surfaces in the CL(P) group was 7.0 compared with 3.9 in the control group (p less than 0.05). The most evident difference between the two groups was found in the number of decayed proximal surfaces. The mean number of decayed proximal surfaces in the CL(P) group was 2.5, as compared with 0.9 in the control group (p less than 0.001). There were no significant differences in the caries prevalence and activity in children with clefts that involves the alveolus compared with those of children with isolated clefts of the lip or palate. The CL(P) children also exhibited a significant increase (p greater than 0.01) in the number of gingival units with gingivitis. Other dental abnormalities included an increased frequency of enamel hypomineralization (p less than 0.05), supernumerary teeth (p less than 0.01), unilateral crossbite (p less than 0.001), mesial terminal plane (p less than 0.01), and crowding (p less than 0.001). The results show that the CL(P) children must be considered as a group with an increased caries risk and should therefore be subjected to an additional preventive program.     

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.     

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.     

A review of tooth formation in children with cleft lip/palate

The literature on tooth formation in children with cleft lip and/or palate is reviewed. The main focus of interest is the association of cleft type and dental abnormalities in number, size, shape, timing of formation, and eruption and cause of the abnormalities. The upper lateral incisor is the most susceptible to injury in the area of cleft in both deciduous and permanent dentitions. This tooth is affected in most instances, even in the cases of microforms of the cleft lip. The prevalence of hypodontia increases strongly with the severity of cleft. More teeth are congenitally missing from the upper jaw than from the lower jaw; however, in the permanent dentition both jaws are affected. Very high prevalence of hypodontia are observed in connection with the Van der Woude syndrome associated with cleft and with the Pierre Robin anomaly. Hypodontia is similarly prevalent in subjects with isolated cleft palate with and without a positive family history of clefts. The prevalence of hypodontia varies largely in different populations. Asymmetric formation of the contralateral teeth is a milder form of hypodontia. The prevalence of asymmetrically developing pairs of teeth is far more common in children with clefts than in children with normal palates or lips. In the permanent dentition the timing of tooth formation is delayed in children from all cleft groups compared to noncleft children. The delay lengthens (with increasing severity of cleft) from 0.3 to 0.7 years and is similar in all permanent teeth in both jaws. In children with hypodontia, the delay is still more severe. As the child becomes older, the delay may increase.(ABSTRACT TRUNCATED AT 250 WORDS)     

Orthodontic treatment of children with cleft lip and cleft palate

Orthodontic treatment of children with cleft palates continues through the periods of the three dentitions: temporary, mixed, and adult. Using examples, this paper deals with the different difficulties that can be encountered during treatment of this malformation. Orthodontic interception at the time of the temporary dentition corrects the heart of the problem, the transverse insufficiency, but also addresses moderate maxillary retrusion. Cooperation with a speech therapist at this stage is essential. In the mixed dentition, orthodontists correct incisal malalignment and, depending upon the severity of the deformity, consider surgical intervention. In the adult dentition, a variety of decisions must be made: whether to open or close the spaces left by absent lateral incisors; whether to accept an orthodontic compromise or to elect surgical advancement of the maxilla; and, if surgery is deemed appropriate, whether to embark on an early distraction procedure or to rely on a classical osteotomy.     

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.     

Tooth abnormalities associated with non-syndromic cleft lip and palate: systematic review and meta-analysis

Clinical Oral Investigations - To evaluate the association between orofacial clefts (OFC) and tooth abnormalities (TA). We searched PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and...     

The psychosocial effects of cleft lip and palate: a systematic review

This systematic review examined the published scientific research on the psychosocial impact of cleft lip and palate (CLP) among children and adults. The primary objective of the review was to determine whether having CLP places an individual at greater risk of psychosocial problems. Studies that examined the psychosocial functioning of children and adults with repaired non-syndromal CLP were suitable for inclusion. The following sources were searched: Medline (January 1966-December 2003), CINAHL (January 1982-December 2003), Web of Science (January 1981-December 2003), PsycINFO (January 1887-December 2003), the reference section of relevant articles, and hand searches of relevant journals. There were 652 abstracts initially identified through database and other searches. On closer examination of these, only 117 appeared to meet the inclusion criteria. The full text of these papers was examined, with only 64 articles finally identified as suitable for inclusion in the review. Thirty of the 64 studies included a control group. The studies were longitudinal, cross-sectional, or retrospective in nature.Overall, the majority of children and adults with CLP do not appear to experience major psychosocial problems, although some specific problems may arise. For example, difficulties have been reported in relation to behavioural problems, satisfaction with facial appearance, depression, and anxiety. A few differences between cleft types have been found in relation to self-concept, satisfaction with facial appearance, depression, attachment, learning problems, and interpersonal relationships. With a few exceptions, the age of the individual with CLP does not appear to influence the occurrence or severity of psychosocial problems. However, the studies lack the uniformity and consistency required to adequately summarize the psychosocial problems resulting from CLP.     

Tooth size in children with cleft lip and palate

The mesiodistal and buccolingual dimensions of primary and permanent teeth were measured in 246 children with either isolated cleft palate or complete unilateral cleft lip and palate. The primary teeth of males with clefts were reduced in their buccolingual dimension compared to the control, while in females there were reductions in the mesio-distal dimension. There were no remarkable differences in the size of the permanent teeth in males with clefts. Females with clefts had reduced buccolingual dimensions of the permanent teeth, in both jaws.     

Craniofacial variability in parents of children with cleft lip and cleft palate.

The purpose of this study was to determine whether there are variations in the craniofacial morphology between parents of children with non-syndromic cleft lip and palate and normal controls with no history of cleft in the families in a Saudi sample. Frontal skull radiographs were obtained from a study group consisting of 40 couples, who have a child with cleft deformity and control group of 32 males and 35 females, who have no history of clefts in the family. A total of 18 landmarks were digitized for each individual by a custom made computer program. T-test, logistic regression analysis were applied to the data. Significant findings were obtained for both males and females of the affected children. The males displayed wider nasal cavity and a narrower maxillary width with asymmetry of the face. Females showed smaller facial dimension as a whole, and asymmetry of the face.     

A study of prevalence of caries and oral health behavior in Japanese children with cleft lip and palate

The aims of this study were to investigate the condition of dental caries in 1–4 years old Japanese children with cleft lip and/or palate, and also to examine the relationships between age, location of the cleft, oral health behavior of cleft children and the incidence of dental caries. The study was carried out through a dental examination of a sample of children and a questionnaire to their parents which included questions about infant feeding practices, frequency of consumption of specific drinks and children's frequency of tooth brushing. A sample of 116, 1–4 years old Japanese children (58 boys and 58 girls) with oral clefts referred to the Department of Pediatric Dentistry Clinic, Showa University, after receiving surgical treatment, participated in this study. Results indicated that the prevalence of caries in cleft children was related to patient age, location of clefts and oral health behavior. A higher level of dental caries was recognized in children with cleft lip and alveolus/palate than in those with cleft lip alone. Incidence of caries increased with patient age. Children who had been fed in a determined time were less affected than those who had been fed at will. Incidence of caries was also high in the children who ingested drinks with sugar than in those who did not. The results of this study suggest that it is important to improve the oral health behavior of cleft children to minimize the risk of caries. Moreover, children with clefts and their parents should as early as possible undergo a preventive program to ensure preservation of primary dentition.     

Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review

The vomer flap technique for repair of the hard palate is assumed to improve maxillary growth because it causes less scarring in growth-sensitive areas of the palate. The aim of this systematic review was to investigate the effect of techniques using the vomer flap compared with the palatal flap on facial growth in patients with cleft lip and palate. All papers published before 21 July 2012 were sought in the databases PubMed and MEDLINE. Search terms included “facial growth”, “cleft lip and palate”, “palatal repair technique”, and “vomer flap”. Additional studies were identified by hand searching the reference lists of the papers retrieved from the electronic search. Two independent reviewers assessed the eligibility of studies for inclusion, extracted the data, and assessed the quality of the methods. Six studies met the selection criteria. Outcomes assessed in 4 studies were dentofacial morphology after vomer or palatal flap, maxillary dental arch in 1 study, and dental arch relations in 2 studies. The quality of the methods used in 3 studies was poor. Contradictory results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the vomer flap technique has more or less of an adverse effect on maxillary growth than the palatal flap. Further well-designed, well-controlled, and long-term studies particularly of the vomer flap (2-stage) and palatal flap (von Langenbeck or two-flap, 1-stage) are needed.     

Population and family studies of HLA in Japanese with cleft lip and cleft palate

Population and family studies of HLA were performed in Japanese patients with cleft lip and/or cleft palate (CL/P). Frequency of HLA-Cw 7 was significantly increased in cleft lip (CL) patients (37.5%) and cleft palate (CP) patients (37.8%) but was not increased in cleft lip and palate (CLP) patients (17.5%), compared with control subjects (13.3%). However, the intensities of the associations were not great (relative risk = 4.0). The affected sib pairs method was studied in 13 families with CL- or CLP-affected sib pairs and 10 families with CP-affected sib pairs. However, in both groups of families the distributions of HLA haplotypes in affected sib pairs did not significantly differ from random Mendelian expectation. Thus, HLA-linked major genes (loci) which determine the development of CL/P were not found. These results seem indirectly to support the multifactorial theory of CL/P, but does not exclude other possible genetic mechanisms.