Tooth Anomalies, Caries, and Gingival Health in Cleft Lip and Palate Patients: A Retrospective Study.

Introduction and aim. This study aims to assess caries experience in children with cleft lip and palate (CLP). Material and methods. A total of 127 children (aged 3-12 years) with CLP and 141 non-cleft controls were assessed for dental caries using the decayed-extracted/missing-filled teeth (deft/DMFT) index. Logistic regression analysis was employed to identify factors associated with dental caries. Statistical tests, including t-test, ANOVA, Chi-square, and Fisher’s exact test, were used to analyze differences between cleft and non-cleft populations. Results. In primary teeth, caries prevalence was significantly higher in children with CLP (63.8%) compared to non-cleft controls (40.4%, p<0.001). The deft scores were 3.30 for CLP and 1.63 for non-CLP group (p<0.01). No significant difference was observed in mean DMFT scores (p=0.02). Significant variations in caries prevalence (p=0.01) and mean DMFT values (p=0.001) were noted in permanent dentition among different cleft groups. Conclusion. Children with CLP show higher caries prevalence and experience, emphasizing the need for targeted dental care interventions in this population. Logistic regression analysis highlights an age-related increase in caries experience among individuals with CLP.

Evaluation of 3-dimensional tooth crown size in cleft lip and palate patients

Purpose: This study aimed to compare maxillary alveolar bone width in 1st molar region and molar angulation between growing individuals with Cleft Lip and Palate (CLP) and Non-Cleft Class III instances that received Rapid Maxillary Expansion (RME) as a treatment of maxillary hypoplasia. Subjects and Methods: This retrospective study included two groups, Cleft Group; 8 CLP patients and Non-Cleft Group; 12 Non-Cleft cases with maxillary hypoplasia. The children's ages spanned from 8 to 12 years old. The two groups received treatment consisting of maxillary expansion utilizing with RME protocol followed by 6 months of consolidation. Cone Beam Computed Tomography (CBCT) was taken prior therapy (T1) and following six months of expansion (T2). Results: In Cleft and Non-Cleft groups, the buccal alveolar bone width displayed statistically significant decline, however the palatal alveolar bone width displayed statistically significant increase. The molar angulation was increased significantly in the two groups. There were statistically non-significant variations in alveolar bone width and 1st molar angulation changes among Cleft and Non-Cleft groups. Conclusion: Patients with CLP have the same maxillary first molar angulation changes as well buccal and palatal alveolar bone width at molar area as non-cleft patients those have Class III malocclusion.

Speech after repair of isolated cleft palate and cleft lip and palate

To determine the effect of surgery on types and colony count of Streptococcus and Staphylococcus species in cleft lip and palate (CLP) patients. Saliva samples were collected after the morning meal by placing a sterile cotton swab in the vestibule of the oral cavity from cleft lip and palate patients immediately preoperative and 12 weeks postoperative. Normal children were examined as a control group. Samples were cultured; Staphylococcus and Streptococcus isolates were identified and quantified. Fifteen cleft lip and palate patients and 22 normal children, aged 3 to 39 months were examined. Streptococcus mitis biovar 1, Streptococcus salivarius and Streptococcus oralis of the viridans group of streptococci were the most commonly found in normal children, as well as in cleft lip and palate children. In the cleft lip and palate group, mean streptococcal count was 32.41 (29.80) and 46.46 (42.80) in the pre- and postoperative periods, respectively; in the normal group, the count was 20.93 (27.93) and 49.92 (34.72) at 0 week and 12 weeks, respectively. Staphylococcus aureus was the most common Staphylococcus species found in CLP patients, representing 47.4% postoperatively. In the cleft lip and palate children, mean staphylococcal count was 5.34 (8.13) and 0.56 (0.92) in the pre- and postoperative periods, respectively; in normal children, the count was 0.82 (1.98) and 0.60 (2.55) at 0 and 12 weeks, respectively. The differences were statistically significant only for the staphylococcal count between pre- and postoperative periods in children with cleft lip and palate as tested by analysis of variance (p < .05). Cleft lip and palate patients had more colonization by S. aureus compared with normal children, and the colony count decreased significantly following surgical repair of the cleft lip and palate.

To determine whether there are differences in the anatomical cleft measurements between patients with isolated cleft palate (CP) with or without Pierre Robin sequence (PR) and those with cleft lip and palate (CLP). Prospective case series. Tertiary care university-based medical center. From 1993 to 2012, CP and CLP patients were prospectively enrolled in a database. Several anatomical cleft parameters were recorded with precise measurements at the time of palatoplasty under general anesthesia. One hundred twenty-five patients were included in our study: 50 patients in the CP without PR group, 87 patients in the CP with or without PR (CPPR) group, and 38 patients in the CLP group. Patients in the CLP group had increased values for the following parameters compared to patients with CP and patients with CPPR: nasopharyngeal depth (P = .02 and P = .01, respectively); cleft width at posterior hard palate border (P < .001 and P < .001); width of the dental arch (P < .001 and P < .001); and total cleft length (P < 01 and P < .001). For cleft width at the soft palate level, there was a significant difference between the CP and CLP groups (P = .005). We found no statistically significant differences between the groups (CLP versus CP and CPPR, respectively) for the length of the soft palate (P = .74, P = .21) or for the length of the hard palate (P = .19, P = .08). There are significant differences in cleft and palate measurements between CLP and CP patients that may be useful to predict the occurrence of velopharyngeal insufficiency or other complications.

The purpose of this study was to determine whether the candidate genes previously studied in subjects with cleft lip, cleft palate, or both are associated with hypodontia outside the region of the cleft. One hundred twenty subjects from the Iowa Craniofacial Anomalies Research Center were selected based on the availability of both dental records and genotype information. The type of orofacial clefting and type and location of dental anomalies (missing teeth, supernumerary teeth, or peg laterals) were assessed by dental chart review and radiographic examination. Genotype analysis of candidate genes was performed using polymerase chain reaction/single-strand conformation polymorphism analysis. The prevalence of hypodontia in this sample was 47.5%, with 30.0% of subjects having missing teeth outside the cleft. There was a positive association between subjects with cleft lip or cleft lip and palate who had hypodontia outside the cleft region (compared with noncleft controls) and both muscle segment homeo box homolog 1 (MSX1) (p =.029) and transforming growth factor beta 3 (TGFB3) (p =.024). It was not possible in this analysis to determine whether this association was specifically associated with orofacial clefting combined with hypodontia or whether it was due primarily to the clefting phenotype. In this sample, there was a significantly greater incidence of hypodontia outside the cleft region in subjects with cleft lip and palate, compared with cleft lip only or cleft palate only. Cleft lip and/or palate with hypodontia outside the cleft region was positively associated with both TGFB3 and MSX1, compared with noncleft controls.

This retrospective, cross-sectional analytical study investigated the incidence of tooth agenesis in cleft lip and palate (CLP) patients. Cone Beam Computed Tomography (CBCT) radiographs of the CLP children were examined for congenitally missing teeth. This study was conducted at three radiology centers in Lahore, namely, the Pakistan Jinnah MRI and Body Scan Centre, the University of Lahore Radiology Centres, and Fatima Memorial Hospital, from September 2021 to August 2022. The CLP patients were divided into four groups based on the location of the cleft: Cleft Lip and Palate Right (CLPR), Cleft Lip and Palate Left (CLPL), Bilateral Cleft (CLPB), and Midline Cleft (CLPM), inside and outside the cleft region. Two-way ANOVA was employed to compare the means of agenesis. Tukey's test was utilized to ascertain where the difference lies. The significance level was set at p ≤ 0.05. Moreover, a significant number of missing teeth were found inside the cleft. This study observed the CLPL (42.3%) and CLPR (13.6%) types more in number. Maxillary first premolars were found more missing outside the cleft region in CLPL and CLPB types. Although CLPB and CLPM types revealed a pattern of missing teeth, only a few cases were found in this study. Moreover, mean tooth agenesis was highest (4.5 SD.71) in the CLPM group, followed up by CLPB (2.75 SD 2.49), CLPR (1.23 SD 1.27), and CLPL Group (1.15 SD 1.12). Unilateral cleft lip and palate patients reported significant agenesis patttern compared to bilateral and median cleft cases.

Objective : This study evaluated the caries experience in the primary teeth of children with and without cleft lip and palate (CLP). Design : Observational study. Setting : Dental hospital clinic. Patients : The sample consisted of 132 pairs of Chinese children with and without CLP matched by gender, age, ethnicity, and socioeconomic status. Their ages were between 2 and 7 years. Methods : The children were dichotomized into 2- to 4-year-old (n = 71) and 5- to 7-year-old groups (n = 61). The oral examination was performed by one trained and calibrated dentist, and the caries experience was determined using the dmft (decay missing filled teeth) index. Results : For the 2- to 4-year-old group, the dmft values were 1.5 for the cleft group and 1.6 for the non-CLP group, but the difference was not statistically significant. For the 5- to 7-year-old group, the dmft indices were 5.2 for the cleft group compared with 2.9 for the control group; this difference was statistically significant (p = .0006). The caries rate for the various tooth types in the 5- to 7-year-old group was higher in the CLP group than in the non-CLP group; the most marked difference was for the lateral incisors, mandibular molars, and maxillary left first molars (p = .0001). Conclusions : The 5- to 7-year-old children with CLP had a higher caries experience in the primary dentition than the children without CLP.

Three-dimensional evaluation of the airway spaces in patients with and without cleft lip and palate: A digital volume tomographic study.

To assess the psychological well-being of patients with cleft lip and palate (CLP). Ninety-four Chinese CLP subjects between 10 and 40 years of age were recruited from the Discipline of Oral and Maxillofacial Surgery, The University of Hong Kong, between June and December 2003. They were divided into two groups for comparison: adolescents (10-16 years old) and adults (17- 40 years old). A control group of 116 healthy non-CLP patients was also recruited during the same period. All CLP and non-CLP patients were asked to complete a set of four questionnaires to assess their psychological status. The questionnaires included the Social Avoidance and Distress Scale, the Satisfaction with Life Scale, the Culture-Free Self-Esteem Inventory, and the Chinese Miller Behavioral Style Scale. Chinese CLP patients exhibited levels of subjective well-being and social anxiety that were similar to the published levels of a group of British CLP patients. They also had significantly lower general and social self-esteem but higher parental self-esteem than the non-CLP control group. CLP patients were generally satisfied with life and did not exhibit more social anxiety than the non-CLP control group. They also had a good relationship with their parents. Gender and educational level had no influence on their psychological profile. However, these CLP patients had lower self-esteem than non-CLP patients.

This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges. The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care-emergency, outpatient, inpatient-within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges. The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p < 0.001) and developmental delay (cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p < 0.001) being most common. Within 30 days of surgery, those with cleft palate were most likely to return to the hospital (p < 0.001). Hospital-based care per 100 children within 4 years was lowest among the cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p < 0.001). Cumulative 4-year charges, however, were highest among the cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p < 0.001). Comorbidity, diagnosis (cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges. Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.

We present an epidemiologic study of cleft lip and palate in the Republic of Korea from January 1, 1993 through December 31, 1993. In 1993, the number of total live births was 715,817. And from 1993 through 1995, a total of 1,293 new patients with cleft lip and palate who were born in 1993 were identified. The incidence of cleft lip and palate was 1.81 per 1000, that is, 1 per 554 live births. The cleft lip: cleft lip and palate: cleft palate alone ratio was 1.13:1:1.19. The male: female ratio was 2.1:1 in the cleft lip group, and 2.5:1 in the cleft lip and palate group. We could detect a male predominance in both groups. In contrast, the ratio was 0.95:1 in the cleft palate group. The left: right: bilateral ratio was 1.9:1:0.23 in cleft lip group, and the ratio was 2.2:1:1.1 in the cleft lip and palate group. This is the first nation-wide study to provide detailed data on the incidence of cleft lip and palate in the live births in the Republic of Korea.

Cleft lip and palate (CLP) is a frequently encountered congenital anomaly occurring due to a failure fusion of maxillofacial processes in the embryonic period. Clefts can be classified as syndromic (combined with other malformations) and non-syndromic (isolated) cleft lip and palate. There are many etiological factors of non-syndromic cleft lip and palate. Many genetic and environmental factors such as malnutrition, exposure to radiation during pregnancy, stress, teratogenic agents, infectious agents such as viruses and genetic transmission are one of these factors. In all cleft lip and palate patients; similar complex occlusal, aesthetic, functional and speech problems increasing with the severity of cleft are observed. Facial profile abnormalities are observed due to incompatibility between the upper and lower jaw in CLP patients. These disorders are often observed as Angle Class 3 anomalies with the formation of maxillary narrowing as a result of a scar resulting from the surgical closure of cleft region; and sometimes with the addition of increased mandibular development. Some malformations are common in these patients in terms of tooth alignment. Sometimes impacted teeth resulting from the lack of sufficient space in the arc due to skeletal narrowness of the upper jaw and sometimes teeth which do not occur congenitally in the region of cleft are seen frequently. Although the absence of lateral incisors are observed mostly, the absence of central incisors and canines may be seen. This can be unilateral or bilateral.[ Even if these teeth are seen particularly in the cleft region, they can be malformed and malpositioned. The bone supports of adjacent teeth are diminished. The management of patients with cleft lip and cleft palate requires prolonged orthodontic and surgical treatment and an interdisciplinary approach in providing them with optimal esthetics, function, and stability. This presentation describes an update on the current concepts and principles in the treatment of patients with cleft lip and palate.Sequencing and timing of orthodontic/orthopedic and surgical treatment in infancy, early mixed dentition, early permanent dentition, and after the completion of facial growth will be discussed.

Feeding interactions of infants with unrepaired cleft lip and/or palate