Abstract
To explore centre-level variation in fluoride treatment and oral health outcomes and to examine the association of individual- and area-level risk factors with dental decay in Cleft Care UK (CCUK). Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP). Data on caries and developmental defects of enamel (DDE) were collected. The child's history of fluoride ingestion and postcode was used to assess exposure to fluoridated water. Centre-level variation in fluoride exposure and caries was examined using hierarchical regression. Poisson regression was used to estimate the association between individual- and area-level fluoride exposures and outcome. Children had high levels of caries, rampant caries and DDE. There was no evidence of variation between centres in the number of children with caries or rampant decay. There was evidence of variation in prescription of fluoride tablets and varnish and the type of toothpaste used. Area level of deprivation was associated with a higher risk of dental caries-risk ratio (RR) in the lowest quartile versus the rest was 1.43 (95% CI 1.13 to 1.81). Use of fluoride tablets and varnish was associated with higher risk of caries-RR 1.73 (95% CI 1.29 to 2.32) and RR 1.33 (95% CI 1.04 to 1.70), respectively, adjusted for age, sex and deprivation. The association with use of fluoride tablets and varnish probably reflects reverse causality but indicates the need for early preventative interventions in children with UCLP.
Highlights
Our previous research examined the impact of centralization on oral health in 5-year-old children with unilateral cleft lip and palate (UCLP) in the Cleft Care UK study.[4]
| 20 teeth of 2.3.4 By comparison, the most recently published UK Child dental Health (CDH) survey reported that the average dmft in 5-year-olds was 0.9.5 No studies have investigated whether oral health treatment and outcome varies between centres in a centralized model of care
There is scant evidence as to why children born with a cleft have a high prevalence of developmental defects of enamel (DDE) but a case control study looking at permanent teeth showed colour changes of enamel three times more likely in these children.[22]
Summary
Many studies have reported that children with cleft lip and palate have poorer oral health outcomes.[1,2,3] Our previous research examined the impact of centralization on oral health in 5-year-old children with unilateral cleft lip and palate (UCLP) in the Cleft Care UK study.[4] We found that there had been no improvement in oral health following centralization of services with a mean number of decayed missing and filled primary. Few studies have examined the association between individual-and area-level factors and oral health in children with cleft lip and palate
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