Periodontal Status and Oral Hygiene in Two Populations of Cleft Patients

Oral flora and functional dysbiosis of cleft lip and palate patients: A scoping review

AIMS

This scoping review aimed to conduct an assessment of the current literature on specific ecological changes in the oral microbiota of individuals living with cleft lip and/or palate.

METHODS

All studies that assess oral microbiota and ecological changes distinct of individuals living with cleft lip and/or palate were included. Ovid MEDLINE and EMBASE databases were used, using planned search keywords. Included articles were grouped into cohort, cross-sectional, case-control, and retrospective reviews.

RESULTS

A total of 164 eligible title articles were recognized. Of these, 32 full-text studies were included in the present review. All the included articles were published between 1992 and 2022. These studies were two retrospective studies, two review studies, and the remaining (n = 28) were observational studies.

CONCLUSION

The oral flora of cleft lip and/or palate patients has been shown in scientific studies to have an increased frequency of potentially pathogenic fungal and bacterial colonization, particularly Candida species, Staphylococcus aureus, Lactobacili and Streptococci mutans. This may influence oral diseases and post-operative repair complications, potentially necessitating further surgical intervention.

The Periodontal Status of Orofacial Cleft Patients: A Systematic Review and Meta-Analysis

Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated supporting structures. The authors performed a systematic review and meta-analysis to assess whether the presence of clefts altered the periodontal status of patients.

The study was registered in PROSPERO (CRD42020210178). A systematic search of literature was performed utilizing unique search strings for PubMed, Scopus, and GoogleScholar as databases including gray literature from April 28, 2020 to October 3, 2020.

Cross-sectional and longitudinal human studies published in the English language, providing information about periodontal disease and its association with cleft lip, alveolus, and palate.

Periodontal outcome measures such as gingival index (GI), clinical attachment level (CAL), plaque index (PI), periodontal probing depth (PPD), and bleeding on probing (BOP) were utilized as the main outcome measures.

Patients with clefts were predisposed to poorer periodontal outcomes. Subgroup analysis revealed compromised periodontal measures for clefts as compared to control sites without cleft which were statistically significant in terms of GI [Z = 2.44, P = .01], CAL [Z = 2.52, P = .01], PI [Z = 2.76, P = .006] and not statistically significant for PPD [Z = 0.27, P = .79] and BOP [Z = 1.47, P = .14].

Within the limitations of the review, the authors conclude that the presence of orofacial clefts may predispose to periodontal compromise when compared to normal controls. The GRADE rating was moderate.

Condition of oral tissues in children with congenital cleft lip and palate

OBJECTIVE

Aim: To study the condition of oral tissues in children with congenital complete cleft lip, alveolar process, hard and soft palate.

PATIENTS AND METHODS

Materials and Methods: From the examined 470 children National Specialized Children's Hospital "OKHMATDYT" (Kyiv, Ukraine) with congenital cleft lip and palate was analyzed: 302 patients aged 8-18 years were subject to in-depth analysis for clinical and radiological - 192 with unilateral and 110 with bilateral complete cleft lip, alveolar process, hard and soft palate.

RESULTS

Results: The average value of primary adention in patients with unilateral and bilateral complete combined cleft is 69.53%, but in females this indicator is higher and in unilateral cleft 92.18% for female against 53.17% for male. In females with unilateral cleft retention - 40.62% and overcomplete - 10,93%. The same high indicators in bilateral cleft: retention - 36.58% and overcomplete - 12.19%. Retention and overcomplete have higher values for men - 44.93% and 23.19%, respectively. Chewing efficiency in females with bilateral cleft as a result of primary dentition is below 80%. Affected by caries - 90.73% in both groups. Inflammatory processes in the periodontal tissues are revealed (80,75%): chronic catarrhal gingivitis, chronic hypertrophic gingivitis, chronic generalized periodontitis. Manifestations of atopic and angular cheilitis in 39.09% and 23.63% with bilateral cleft lip and palate, glossitis in 29.09%.

CONCLUSION

Conclusions: Patients with congenital complete cleft lip, alveolar process, hard and soft palate have high rates of adentia, retention, overcomplete dentition and a wide range of diseases of the oral cavity, which negatively affects surgical and orthodontic rehabilitation.

A Cone-Beam Computed Tomographic Study of Alveolar Bone Morphology in Patients With Unilateral Cleft Lip and Palate

OBJECTIVE

To evaluate the bony support around the teeth adjacent to the unilateral cleft lip and palate (ULCLP) using cone-beam computed tomography.

METHODS AND MATERIALS

Cone-beam computed tomographies of 48 cleft-adjacent teeth (28 anterior and 20 posterior to the cleft) and 48 noncleft control teeth were evaluated. The alveolar bone thickness at 3 and 6 mm apical to the cement-enamel junction (CEJ), the distance between the alveolar crest and CEJ (Alv-CEJ), and the presence of fenestration were assessed in buccal, palatal, and proximal surfaces.

RESULTS

The alveolar bone on the buccal and palatal sides of the teeth anterior to the cleft was significantly thinner than the noncleft teeth (all P < .05). The Alv-CEJ was significantly greater on the buccal and distal surfaces of the teeth anterior to the cleft (P < .001 and P = .010, respectively) and on the palatal and mesial surfaces of the teeth posterior to the cleft (P = .024 and P = .003, respectively) when compared to the noncleft teeth. The frequency of reduced alveolar bone height (>2 mm) was higher than noncleft side for buccal and distal sides of the teeth anterior to the cleft (P = .016 and .006, respectively) and the buccal and mesial sides of the teeth posterior to the cleft (P = .008 and <.001, respectively). The teeth anterior to the cleft had a higher prevalence of fenestration (P = .004).

CONCLUSION

Reduced alveolar bone height is more common in the cleft side compared to the control side. The teeth anterior to the ULCLP have thinner alveolar bone support and higher frequency of fenestration.

Oral Health-Related Quality of Life and Dental Caries Status in Children With Orofacial Cleft: An Indian Outlook

Aim:

To assess the dental caries status and oral health–related quality of life (OHRQOL) among children with orofacial cleft reporting to a hospital in India.

Materials and Methods:

Subjects were divided into two groups. Group 1 cleft children (n = 80) and group 2 noncleft children (n = 80). Decayed, missing, and filled teeth (DMFT) Index, deft Index, and Children Oral Health Impact Profile questionnaire were recorded.

Results:

The mean DMFT was high in noncleft (3.51 ± 2.45) children than in cleft children (2.75 ± 2.68). The mean deft was high in noncleft (1.11 ± 0.96) children than in cleft children (0.86 ± 3.07).

Conclusion:

Cleft children have negative impact on OHRQOL than noncleft children.

Aesthetic Assessment of Infants With Different Cleft Types Before, During, and After Orthopedic Treatment

OBJECTIVE

The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons.

METHODS

Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive. The nasolabial region at stage T3 were masked and also added to the evaluation form (T4). Fifty-one evaluators (17 orthodontists, 17 dentists, and 17 laypersons; mean age = 30.1 ± 3.63) assessed 21 frontal photographs using Asher-McDade et al's 5-point scale.

RESULTS

The scores of the orthodontists for T1 photographs were statistically lower than the dentists and laypersons (P < 0.05). The scores of T3 and T4 were similar in all groups (P > 0.05). The assessment scores progressively decreased from T1 to T3 (P > 0.05). The scores of both treatment methods were similar in the orthodontist group (P > 0.05), whereas the scores were lower for forehead anchored nasal stent in the other groups (P < 0.05).

CONCLUSION

Orthodontists are familiar with cleft patients. Therefore, the aesthetic of infants at any therapy stage with different treatment methods was not categorized as poor. The enhanced scores at post-OT stage and the similar scores of masked and nonmasked post-OT photographs may underline the recognition of the rehabilitation period by not only specialists but also laypersons.

Compensations in Bone Morphology and the Dentition in Patients With Untreated Unilateral Cleft Lip and Palate: A Cone-Beam Computed Tomographic Analysis

OBJECTIVE

The purpose of this study was to quantitatively assess dentoalveolar and skeletal compensations in patients with untreated unilateral cleft lip and palate (UCLP). We hypothesized that there are significant skeletal and dental adaptations in UCLP cases compared to a comparison maxillary crossbite group.

DESIGN

A convenience retrospective sample of 30 patients with UCLP and a comparison group of 30 patients with unilateral posterior crossbite without CLP. Cone-beam computed tomography scans (CBCTs) were used to evaluate dental and skeletal compensations. In addition, alveolar bone thickness was measured at 2-mm increments in mesiodistal and faciolingual cross-sectional views along the long axis of the central incisors. Alveolar bone height was measured, and the percentage of root length supported by bone was calculated.

RESULTS

Compensations for unilateral cleft lip and palate were restricted to the cleft site and adjacent structures. Dental compensations include alteration in the position of cleft-adjacent maxillary incisors and maxillary canines. No gross skeletal compensations were found. Alveolar support of cleft adjacent incisors was similar to controls except for measurements in the most coronal and apical regions. The cleft group contralateral incisors exhibited buttressing effects and had significantly higher alveolar thickness in the coronal half of the tooth. There was less (5%) alveolar coverage of the cleft-facing aspect of the central incisor root than all other incisors.

CONCLUSION

The bone adaptation to the presence of a cleft was localized in the vicinity of the cleft, and adaptations in the mandible were not apparent.

Evaluation of alveolar bone support around incisors in patients with unilateral cleft lip, alveolus, and palate in late mixed dentition using cone beam computed tomography

OBJECTIVES

To evaluate alveolar bone support around cleft-adjacent maxillary central incisors (U1) in patients with unilateral cleft lip, alveolus and palate (UCLAP) in the late mixed dentition and to investigate the correlation between the alveolar bone thickness (ABT) and tooth inclination.

MATERIALS AND METHODS

Cone beam computed tomography scans of 45 subjects with UCLAP (29 boys, 16 girls; mean age = 10.74 ± 1.08 years) were assessed. The distance between the cementoenamel junction (CEJ) and alveolar bone crest (AC), and the ABTs at 3 mm, 6 mm, and the apex were measured on the labial, lingual and distal surfaces of U1. The cleft and normal sides were compared using a paired t-test and Pearson's χ² test. Pearson's correlation was used to explore the association between the ABT and tooth inclination of cleft-adjacent U1 in the labiolingual and mesiodistal dimensions.

RESULTS

The CEJ-AC distances were significantly greater in cleft-adjacent U1 ( P < .01), with more bone height reduction observed labially and distally ( P < .001). The labial, lingual, and apico-distal ABTs were decreased on the cleft side ( P < .01). A positive correlation was found between the apico-labial ABT and the labiolingual inclination ( r = 0.568, P < .01).

CONCLUSIONS

Patients with UCLAP have reduced alveolar bone support around the cleft-adjacent U1, and the apico-labial ABT tends to decrease with increasing lingual tooth inclination; however, the correlation was weak.

Evaluation of Facial Appearance in Patients with Cleft Lip and Palate by Laypeople and Professionals: A Systematic Literature Review

Objective

To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images.

Design

Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol.

Result

Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP.

Conclusions

It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.

Secondary Alveolar Bone Grafting in Patients Born With Unilateral Cleft Lip and Palate

Objective:

To identify factors of oral health important for the final outcome, after secondary alveolar bone grafting in patients born with unilateral cleft lip and palate and compare occlusal radiographs with cone beam computed tomography (CBCT) in assessment of alveolar bone height.

Design:

Observational follow-up study.

Setting:

Cleft Lip and Palate Team, Craniofacial Center, Uppsala University Hospital, Sweden.

Patients:

40 nonsyndromic, Caucasian patients with unilateral complete cleft lip and palate.

Interventions:

Clinical examination, CBCT, and occlusal radiographs.

Main Outcome Measurements:

Alveolar bone height was evaluated according to Bergland index at a 20-year follow-up.

Results:

The alveolar bone height in the cleft area was significantly reduced compared to a previously reported 10-year follow-up in the same cohort by total ( P = .045) and by subgroup with dental restoration ( P = .0078). This was positively correlated with the gingival bleeding index (GBI) ( r = 0.51, P = .0008) and presence of dental restorations in the cleft area ( r = 0.45, P = .0170). There was no difference in the Bergland index generated from scoring the alveolar bone height on occlusal radiographs as with the equivalent index on CBCT.

Conclusion:

Patients rehabilitated with complex dental restoration seems to be at higher risk for progression of bone loss in the cleft area. Supportive periodontal therapy should be implemented after complex dental restorations in cleft patients. Conventional occlusal radiographs provide an adequate image for evaluating postoperative bone height in clinical follow-up.

Gingival esthetics and oral health-related quality of life in patients with cleft lip and palate

While the oral health-related quality of life (OHRQoL) is known to be reduced in patients with cleft lip and palate (CLP), its inter-dependency with the soft tissue characteristics of the CLP area remains unclear. This study aimed to evaluate the soft tissue characteristics in the treated cleft area in order to investigate whether gingival esthetics correlate with OHRQoL. Thirty-six patients with unilateral or bilateral CLP (46 cleft areas) were investigated after secondary/tertiary alveolar bone grafting and orthodontic/prosthetic implant treatment using an adapted score to rate gingival esthetics (clinical esthetic score, CES). The patient's OHRQoL was determined using the German short version of the Oral Health Impact Profile questionnaire (OHIP-G14). The results showed a significantly better rating in patients with their own teeth in situ (12.05±1.10) than in patients with implants (6.95±4.78) or prosthetics (4.00±3.58). The best OHRQoL values were achieved by patients with their own teeth integrated into the cleft area (1.32±2.31), followed by patients with implants (2.33±2.33) and prosthetics (3.75±5.87). A significant (P=0.017) correlation was found between OHIP-G14 and CES scores, suggesting an increased OHRQoL in cases with higher oral esthetics in the cleft area. The therapeutic strategy contributes to both gingival esthetics and OHRQoL. The patient's subjective perception of OHRQoL can be attributed to objective gingival esthetic ratings.

Evaluation of dehiscence and fenestration in adolescent patients affected by unilateral cleft lip and palate: A retrospective cone beam computed tomography study

OBJECTIVE

To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the same patients using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

CBCT scans of 44 patients (26 males, 18 females; mean age, 14.04 ± 3.81 years) with unilateral cleft lip and palate (UCLP) were assessed to define dehiscences and fenestrations of the anterior teeth in both cleft and noncleft sides of the UCLP patients and a control group of noncleft patients (51 patients; 21 males, 30 females; mean age, 14.52 ± 1.16 years). Data were analyzed using Pearson's χ(2) and Student's t-test.

RESULTS

The prevalence of dehiscences at the maxillary central incisors, lateral incisors, and canines teeth were 43.2%, 70.6%, and 34.1% on the cleft side and 22.7%, 53.1%, and 27.3% on the noncleft side of UCLP patients, and 13.7%, 7.8%, and 13.7% in controls, respectively (statistically no difference between the sides of cleft patients). The cleft patients had a statistically significantly higher prevalence of dehiscences than did the controls on both the cleft and noncleft sides (P < .05), except for the maxillary central incisors. Fenestrations for these teeth were significantly more common on the cleft side in UCLP patients compared with controls (P < .05), whereas the difference for maxillary lateral incisors was not statistically significant.

CONCLUSIONS

Patients with UCLP showed a higher prevalence of dehiscence and fenestration defects around the maxillary anterior teeth.

Periodontal Status Among Patients With Cleft Lip (CL), Cleft Palate (CP) and Cleft Lip, Alveolus and Palate (CLAP) In Chennai, India. A Comparative Study

BACKGROUND

Long term health of the stomatognathic system as well as esthetic aspects is the therapeutic goals in patients with oro facial clefts.

AIM

The aim of this study was to assess and compare the periodontal status of patients with cleft lip (CL), cleft palate (CP) and cleft lip, alveolus and palate (CLAP) reporting to a hospital in Chennai, India.

MATERIALS AND METHODS

The study group consisted of 80 cleft patients. Subjects were divided into three groups. Group 1: patients with cleft lip (CL), Group 2: subjects with cleft palate (CP) and Group 3: subjects with cleft lip alveolus and palate (CLAP). Community Periodontal Index for Treatment needs CPITN Index was recorded.

RESULTS

Among the 80 study subjects, 51 (63.8%) were males and 29 (36.2%) were females. Among the 26 study subjects with cleft lip, 10 (38.5%) had healthy periodontium, 4 (15.4%) had bleeding on probing and 12 (46.1%) had calculus. Mean number of sextants coded for healthy and bleeding was maximum among the subjects with cleft palate. Mean number of sextants coded for calculus was maximum among the subjects with cleft lip alveolus and palate. Prevalence of periodontal disease is high among patients with cleft lip, alveolus and palate (35%) than in Cleft lip (32.5%) and Cleft Palate (32.5%).

CONCLUSION

Gingivitis and Calculus is predominantly high in patients with Cleft Palate and Cleft Lip respectively.

Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: a cone-beam computed tomography study

OBJECTIVE

To assess the bone support of the teeth adjacent to a cleft using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The CBCT scans of 31 patients with unilateral cleft lip and palate (UCLP) were assessed. The data for teeth neighboring the cleft were compared with those of contralateral noncleft teeth. For each tooth analyzed, the distance between the cementoenamel junction (CEJ) and the bone crest (AC) at the buccal side was measured as was the thickness of the buccal bone level at 0, 1, 2, and 4 mm.

RESULTS

The bone thicknesses of the central teeth at the cleft region at the crest and 2 mm apically were statistically significantly thinner than that of the central incisor at a noncleft region. The CEJ-AC distance for central teeth at the cleft region was higher than that for central teeth in a noncleft region.

CONCLUSIONS

Subjects with UCLP showed reduced bone support at teeth neighboring the cleft compared with controls. This may cause some problems during orthodontic treatment.

A escola na promoção da saúde de crianças com fissura labiopalatal

O objetivo foi conhecer a influência da escola na vida e nos cuidados com a saúde de crianças e adolescentes com fissura labiopalatal atendidas em um centro de referência do Sul do Brasil. A pesquisa foi do tipo exploratório-descritiva, com abordagem qualitativa. Foram realizadas entrevistas semiestruturadas com 15 mães de crianças e adolescentes com fissura labiopalatal participantes de um programa de acompanhamento da saúde bucal. A análise dos dados foi fundamentada na técnica de análise temática, pertencente à análise de conteúdo, originando duas categorias temáticas centrais: enfrentando e superando o preconceito relacionado à má formação; e a escola influenciando a saúde bucal da criança e adolescente e o seu desenvolvimento. A escola traz à criança e adolescente com fissura labiopalatal possibilidades de cuidados e inclusão social, mas também pode trazer conflitos pelo preconceito gerado pela sua aparência física. O apoio da comunidade escolar é essencial para que possam ter um desenvolvimento adequado com qualidade de vida.

Influence of propolis on hygiene, gingival condition, and oral microflora in patients with cleft lip and palate treated with fixed orthodontic appliances

The aim of this study was to evaluate the influence of 3% ethanol extract of propolis (EEP) on hygiene, gingival and microbiological status of oral cavity in patients with cleft lip and palate treated with fixed orthodontic appliances. The study included forty-one nonsyndromic complete unilateral of bilateral cleft lip and palate subjects with fixed appliance on at least 10 teeth. Twenty-one subjects were instructed to brush their teeth three times a day using toothpaste with propolis. Control group included twenty subjects who were asked to brush their teeth three times a day using a toothpaste without propolis. API, OPI, GI, and supragingival bacterial plaque were taken from each subject twice: baseline and after using the toothpaste for 35 days. The final examinations showed statistically significant decrease in OPI, GI, and the percentage of the Actinomyces spp. and Capnocytophaga spp. compared with baseline in propolis group subjects. The improvement in oral health in these patients confirms antibacterial, anti-inflammatory, and regenerative properties of propolis.

Desenvolvimento bucal e aleitamento materno em crianças com fissura labiopalatal

OBJETIVO: Aspectos funcionais do estado de saúde bucal de crianças portadoras de fissuras de lábio e/ou palato interferem na capacidade natural de serem adequadamente alimentadas, como também em seu crescimento e desenvolvimento. Essa revisão visou verificar a influência do aleitamento materno sobre o desenvolvimento buco-maxilo-facial em crianças com fissuras labiais. FONTES DE DADOS: Revisão das bases de dados Medline e SciELO entre 2000 e 2010, utilizando os termos: "fenda labial", "fissura palatina", "aleitamento materno", "alimentação artificial" e "higiene bucal". As informações foram agrupadas, de modo a estabelecer a relação entre a amamentação natural e artificial no desenvolvimento bucofacial e estado de saúde bucal. SÍNTESE DOS DADOS: A pesquisa inicial selecionou um total de 27.046 artigos, dos quais 26.793 abordaram o aleitamento materno e a alimentação artificial, 119 relacionavam a influência do aleitamento materno sobre o desenvolvimento bucofacial, enquanto 134 analisaram a relação entre a amamentação e o estado de saúde bucal. Foram selecionados para a análise 34 artigos, sendo 20 com crianças portadoras de fendas labiais e/ou fissuras palatinas. CONCLUSÕES: O aleitamento natural em crianças portadoras de fissuras de lábio e/ou palato é fator decisivo para a correta maturação e crescimento craniofacial em nível ósseo, muscular e funcional e na prevenção de problemas bucais. Além disso, essas crianças apresentam maior prevalência de cárie dental, problemas relacionados à doença periodontal, podendo ainda apresentar problemas de má oclusão.

Periodontal and microbiological parameters in children and adolescents with cleft lip and /or palate

Objective. To evaluate the oral hygiene and the periodontal condition of children and adolescents with cleft lip and/or palate (CLP). Methods. Forty-one children and adolescents, 4-18 years, with CLP and 41 normal controls participated. Clinical parameters examined were the plaque and gingival index and Community Periodontal Index of Treatment Needs. For teeth in the cleft area, probing pocket depth, bleeding on probing, and tooth mobility were also evaluated. Samples of subgingival plaque were collected from 21 randomly selected patients of each group. Results. The CLP group had generally poorer oral hygiene (plaque index significantly higher) compared with the control. Children in both groups presented mild degree of gingivitis. Teeth in the cleft area had significantly higher pocket probing depth and tooth mobility, compared with corresponding teeth in the control group. The microbial analysis did not reveal significant differences in the composition of the subgingival microbiota between groups. Teeth in the cleft presented higher isolation frequencies and mean percentages of periodontopathic bacteria. Conclusion. Youngsters with CLP showed poor oral hygiene and worse periodontal condition, compared with controls. The above results advocate their participation in an intensive preventive dental programme that should start at an early age, possibly decreasing the risk of future periodontal disease.

Are Teeth Close to the Cleft More Susceptible to Periodontal Disease?

Objective:

To evaluate whether teeth close to the cleft area present higher prevalence and severity of periodontal disease than teeth in other regions.

Design:

Cross-sectional.

Setting:

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo.

Patients:

There were 400 individuals with complete unilateral or bilateral cleft lip and palate, aged 15 to 49 years, without any previous periodontal treatment.

Main Outcome Measures:

All clinical parameters were evaluated in six sites for each tooth. The arithmetic means were calculated for each sextant.

Results:

Of the sextants, 86.75% presented means of probing depth smaller than or equal to 3 mm. No sextant exhibited means of probing depth greater than or equal to 6 mm. There was a statistically significant difference (p < .001) in probing depth according to age, types of cleft, and sextant; 95.87% of sextants presented mean attachment levels smaller than or equal to 3 mm. The sextant with cleft did not present higher means of probing depth, clinical attachment level, plaque index, and gingival index. There was gingival bleeding in 99.08% of the sample and plaque in 97.40%. The type of cleft was not an important factor influencing the prevalence of periodontal disease. Age seems to be an important factor influencing the prevalence and severity of periodontal disease for all aspects investigated.

Conclusions:

Periodontal disease in individuals with clefts occurred in a similar manner as observed in other populations. The presence of the cleft does not seem to increase the prevalence of the disease.

Comparison of caries prevalence in two populations of cleft patients

OBJECTIVE

To assess and compare the oral and dental status and the level of oral health care among Polish and German patients with cleft lip and palate treated in Łódź and Erlangen, followed by an assessment of the level of realization of oral care procedures.

DESIGN

Oral and dental status were assessed by the presence of dental plaque and caries lesions. Parents of each patient completed a questionnaire related to frequency of tooth brushing, frequency of dental visits, and the use of means with increased fluoride content.

SETTING

Department of Dentistry for Developmental Ages, Medical University of Łódź, Łódź, Poland, and Department of Orthodontics, University of Erlangen-Nuremburg, Erlangen, Germany.

PATIENTS AND INTERVENTION

Thirty-seven Polish patients were examined between February and April 2004. Sixty-three German patients were examined between October 2004 and August 2005.

RESULTS

In Erlangen, decayed teeth = 1.625, missing teeth = 0.014, and filled teeth = 2.39. In Łódź, decayed teeth = 2.5, missing teeth = 0.09, and filled teeth = 0.75. Among the subjects with Approximal Plaque Index scores <40%, the Decayed-Missing-Filled-Teeth Index was significantly higher in Polish than in German patients. In the total population of patients, a positive correlation between the value of the API Index and caries intensity was recorded. Declared parents' answers did not copy the actual oral cavity status.

CONCLUSIONS

Caries prevalence in each group was much higher than in the general population and significantly higher among Polish than German cleft patients. Programs for cleft children promoting oral health, especially aimed at plaque control, are recommended in the early stages of the children's lives.