Impact of different surgical protocols on dental development in oro-facial cleft children

Abstract

Aim: To determine the association between dental anomalies and type of facial cleft, gender, ethnicity and timing of hard palate repair surgery. Methods: This observational study comprised a total of 85 non-syndromic cleft children (mean age 9.7 ± 3.2 years) of different ethnicity (68 Caucasians, 7 Asians, 4 Africans, 5 Hispanics and 1 Indian). Sixty-four patients were affected by lip palate cleft, 11 by lip alveolus cleft and 10 by palate cleft. Sixty-one children underwent delayed palate repair at 4.3 years of age, while 21 underwent early palate periosteoplasty at 7.2 months of age. Patients were examined clinically and radiologically to assess dental anomalies. Dental cavities were registered using dmft/DMFT indexes in primary and permanent dentition, while enamel defects were evaluated only in permanent teeth using Aine index. Results: Tooth rotation and agenesis were the most common tooth anomalies affecting 59% and 42.2% of cleft patients, respectively. While a late closure of the cleft palate was associated with a higher number of rotations (P = 0.03), an early surgical correction was associated to a higher frequency of tooth agenesis (P = 0.02), number of carious lesions in primary dentition (P = 0.002) and more severe enamel defects in permanent teeth (P < 0.01). A late palate repair increased 3.5 times the likelihood of having at least one rotated tooth (P = 0.034), while decreased the odds of having agenesis by 70% (P = 0.029) compared to an early surgical repair. Conclusion: Early surgical approaches seem to have more detrimental effects on dental development in both primary and permanent dentition than late surgical protocols. Dental abnormalities in cleft patients have complex etiology combining genetic and external factors and their prevalence can also depend on timing of hard palate surgery.

Oral-Health-Related Quality of Life among Non-Syndromic School-Age Children with Orofacial Clefts: Results from a Cross-Sectional Study in Northern Italy

“…Difficulties with oral hygiene are consistent with the dental anomalies associated with orofacial clefts. Tooth malposition, crowding, rotation along with collapsed maxillary arch, and skeletal discrepancies are highly prevalent among children with CLP [ 14 , 15 , 16 ]. In a recent study from Italy, CLP subjects scored higher on the Oral Health Impact Profile (OHIP)-14 questionnaire than non-cleft peers after a tailored oral hygiene program [ 28 ].…”

“…The DPP included infant orthopaedics using a Hotz neonatal plate, cheiloplasty at the age of 3–6 months, and soft palate repair at 8–10 months. Closure of the cleft in the hard palate was carried out at 4 years with a mucoperiosteal flap [ 16 ]. The exclusion criteria were subjects with intellectual disabilities and any syndrome or associated craniofacial malformation.…”

“…Aesthetic concern and speech impairment are often the reason why these patients fail to develop the social skills typical for their age [ 13 ]. The most frequent difficulties are related to dental anomalies, constricted maxillary arch form, oronasal fistulas, and velopharyngeal incompetence [ 14 , 15 , 16 ].…”

Influence of Cleft Lip and Palate on Oral Health-Related Quality of Life in Northern Italy: Exploring Both the Children’s and Caregivers’ Perspectives

“…CL ± P represents a relevant public health issue because of the complex surgical and rehabilitative treatment extending from infancy to adulthood, the long-term consequences on oral health and the psychosocial implications for daily life [ 4 ]. The abnormal craniofacial growth and the presence of dental anomalies can result in oro-facial malocclusions, such as open bite, crossbite, crowding and skeletal Class III, which may impact on esthetics and functions, such as speech and swallowing [ 5 , 6 , 7 , 8 ]. Furthermore, in recent years it has become more and more evident that the CL ± P condition may severely impact on oral health-related quality of life (OHRQoL) [ 9 , 10 ]: children and adolescents with CL ± P report worse social, functional and psychological well-being in everyday life than their non-cleft peers do [ 11 , 12 , 13 , 14 ].…”