Caries Management By Risk Assessment in a Cleft and Craniofacial Center

Abstract

Patients with craniofacial anomalies have an increased incidence of dental caries. The prevention program "Caries Management By Risk Assessment" (CAMBRA) has been previously validated but has not yet been introduced at a widespread level in a medical setting, particularly for this high-risk population.In this cross-sectional study, we aimed to evaluate the feasibility of implementing CAMBRA during the medical visit at an institutional tertiary care center, which treats children with craniofacial anomalies. The study included 161 participants aged 1 to 18 years. Patients and parents received a personalized educational session, toothbrushing tutorial, and fluoride varnish application. We assessed the prevalence of dental caries, caries risk factors, and knowledge of oral hygiene in this patient population.The overall caries prevalence in this group was higher than average (57% compared with 42%, according to the Centers for Disease Control and Prevention). The most prevalent risk factors were developmental delay, deep pits/fissures, low socioeconomic status, orthodontic appliances, and carbohydrate snacks. The greatest predictors of dental caries were having 1 or more risk factors and having low socioeconomic status. In summary, children with craniofacial anomalies were at high risk for dental caries, with high rates of risk factors and low rates of preventive factors.Our findings revealed that basic oral hygiene standards are not being met in this high-risk population, highlighting the need for implementation of protocols such as CAMBRA. The results of this study can aid healthcare workers in craniofacial centers and children's hospitals to improve the understanding of oral hygiene and dental care of their patients.

Are there any solutions for improving the cleft area hygiene in patients with cleft lip and palate? A systematic review

“…Fourteen studies, including an epidemiological survey, and cross-sectional, case-control, prospective and observational studies, showed the same pattern compared to those that analysed these parameters separately. 16,35 The use of fluoride products was reported in a variety of studies, [4][5][6]8,12,16,21,29,34 and some of them showed that this was higher in CLP patients than in controls. 6,12,23,35,38 This was observed in patients in different phases of oral development, and it was similar in the primary, mixed and permanent dentitions, suggesting that the increased risk of oral problems persists.…”

“…In this review, the selected articles included information on the bacterial plaque indexes, 3,10,17-20 the prevalence of dental caries 1,5,9,14,16,21,22,24,[29][30][31][32] and on both plaque indexes and dental caries. In this review, the selected articles included information on the bacterial plaque indexes, 3,10,17-20 the prevalence of dental caries 1,5,9,14,16,21,22,24,[29][30][31][32] and on both plaque indexes and dental caries.…”

“…[1][2][3]9,10,17,19,20,[25][26][27][28]30 Additionally, this did not improve over time. 5,29 Other pertinent observation is related to the education in oral hygiene and the motivation of the parents to perform regular preventive dental home care for their children. This is an important observation given the role of the oral hygiene in CLP children.…”

“…Fifteen studies were conducted in European populations, 3,4,6,8,11,12,15,17,18,20,[25][26][27]31 thirteen from Asia, 2,7,14,19,[21][22][23][24]32,33 five from South America, 1,16,28,30,35 two from North America, 5,29 one from Africa 39 and three studies do not mention the country. 9,10,40 The age range varied from 0 to 49 years old, and the studies addressed a wide 1,3,5,6,12,15,17,[26][27][28][29]35 or a narrow 4,7,8,11,14,16,…”

“…[1][2][3][4][6][7][8][9][10][11][12]14,17 About the oral health indexes, the plaque index was not reported in a variety of studies. 1,5,7,9,11,14,21,22,24,[29][30][31][32]36 Also, some of them address caries lesions other than those related to bacterial plaque 1,3,5,10,14,16,17,[19][20][21][22]24,[27][28][29] and others investigate both issues. 2,4,6,8,12,15,23,25,26,[33]…”