Predisposing Factors to Dental Caries in Children with Cleft Lip/Palate

Sahar Doostzadeh, DMD; Donna Kritz-Silvestein, PhD; Setareh Ghafouri, DDS

Section of Pediatric Dentistry, University of California School of Dentistry, Los Angeles, CA

Cleft lip and palate is a common congenital malformation in the pediatric population, ranging from ... Patients with craniofacial anomalies may be at increased risk for dental and periodontal disease.x AAPD guidelines suggest that patients with craniofacial deformities should be integrated with a multidisciplinary team. Few epidemiologic studies assess the oral health of cleft lip and/or palate patients followed by an integrated craniofacial team (CFT); and studies of caries prevalence in cleft patients have been inconsistent. 2 The purpose of this study is to retrospectively assess the oral health status of healthy cleft patients followed by UCLA craniofacial team compared to healthy patients followed at UCLA Childrens Dental Center. HYPOTHESIS: Cleft patients actively followed by the integrated craniofacial team will have oral health similar to that of matched, non-cleft healthy control subjects.
N= Age (months) Miles to clinic All 146 Mean 49.1 45.8 % Race White Hispanic Asian AA/Other Payment type MediCal Insurance Cash 62.2 31.4 6.3 45.6 52.9 1.5 77.7 12.0 10.7 26.9 61.9 13.4 1.5 30.4 43.5 23.2 2.9 20.0 70.7 2.7 6.7 29.56 <.0001 CFT 71 Mean 52.8 83.4 % Control 75 Mean 46.2 11.7 % t 2.61 8.33 X2 19.33 p .01 .0001 p .0002 Caries Risk Low Med High Oral Hygiene Poor/Fair Good Plaque Score Mild Mod-Heavy

Bilateral Cleft Lip and Palate 3%

Bilateral Cleft Lip 6% Cleft Lip 7%

Unilateral Cleft Lip and Palate 45%

Cleft Palate 39%

Figure 1: Distribution of types of Cleft

CFT(n= 71) mean # Brushing/Day # months since last recall 1.9 9.3 % Healthy (n=75) mean 1.9 9.1 % t 0.95 0.13 X2 3.75 66.2 14.1 25.3 62.7 6.7 30.7 6.92 58.2 41.8 53.1 46.9 46.5 53.5 .21 55.9 44.1

p 0.17 0.90 p .15

71 patients with clefts from the UCLA craniofacial team (CFT) aged 2-7 years; 75 randomly sampled aged matched patients from the UCLA Childrens Dental Center. Inclusion criteria: Healthy (CFT) patients categorized by the type of cleft with no underlying syndromes; Control group patients were healthy with full primary dentition; all patients were ASA 1. Data was collected at both the UCLA craniofacial clinic, and at the UCLA Childrens Dental Center. Oral exams were conducted with light, mirror and tongue blades. Data collected from patients charts included: demographic characteristics, distance traveled to clinic, and time since last recall. Caries prevalence measured by the dmft index. Patients were divided into three categories according to number of decayed teeth: (1) low caries rate: less than 2 teeth with caries (2) moderate caries: rate 2-3 teeth with caries; (3) high caries rate: > 4 teeth with caries. Oral Hygiene was categorized as: poor, fair, good; Plaque was categorized as: mild, moderate or heavy Data was analyzed using VasserStats; comparisons of CFT and control groups were performed with t-test and chi-square analyses; p <.05 was considered significant.

.009

CFT patients were significantly older than controls, event though they were in the same age range; possibly contributing to a higher number of fillings observed in the dmft score. Racial distribution was in accord with published literature; Whites and Asians had a higher prevalence of clefts . The majority of control patients were Hispanic possibly representing the predominant population served by the clinic. CFT patients were required to travel significantly longer distances to obtain comprehensive care; thus they represent a wider geographic range including a more varied racial distribution. CFT patients predominantly had private insurance while the control group was predominantly covered by MediCal reflecting the characteristics of population of UCLA CDC. CFT patients have fewer decayed teeth, but more filled teeth than the controls, possibly reflecting CFT patients have established a dental home earlier, received treatment sooner and have less active decay. In contrast to previous studies, there was no significant difference between controls and CFT patients in number of missing teeth; CFT and controls patients had similar dmft scores. Although CFT patients had better oral hygiene than control patients, there was no differences in plaque score, and about half of each group had only fair or poor oral hygiene; implying that children in this age group still need instruction and review of oral hygiene at routine recall appointments. This study is limited in that CFT patients seen at the UCLA Craniofacial Clinic had no radiographic assessment in their clinical exam, and carious lesions may have been missed.

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Table 1: Subjects Characteristics

Table 2: Oral Health Subjects Characteristics

2.5 2 1.5 p= .01 1 0.5 0 D M F DMFT Control CFC p= .05

Patients followed by the UCLA Craniofacial team had less active decay than their healthy controls, Although CFT patients have fewer decayed teeth, they have more filled teeth and comparable numbers of missing teeth and total dmft scores. Continued oral health education and instruction for parents of both groups of children is needed to ensure optimal oral health Prospective studies are needed to follow the CFT children relative to healthy children on their caries risk, especially during their orthodontic treatment.

Figure 2: decayed, missing, and filled teeth in Cleft Lip and/or Palate and Control Groups

1. Lauterstern AM, Mendelsohn M. An analysis of the caries experience of 285 cleft palate children. Cleft Palate J 1964; 1: 314319. 2. Ishida R, Yasufuku Y, Miyamoto A, Ooshima T, Sobue S. Clinical survey of caries incidence in children with cleft lip and palate. Shoni Shikagaku Zasshi 1989; 27: 716724. 3. Mahmoud Al-Dajani.Comparison of Dental Caries Prevalence in Patients With Cleft Lip and/or Palate and Their Sibling Controls Cleft Palate Craniofac J. 2009 Sep;46(5):529-31 4. Dalben Gda S, Costa B, Gomide MR. Oral health status of children with syndromic craniosynostosis. Oral Health Prev Dent. 2006;4(3):173-9. 5.