Are Cleft Palate Fistulae a Cause of Dental Decay?

Richards, Helen; Bommel, Annelotte van; Clark, Victoria; Richard, Bruce

doi:10.1597/13-282

Cited by 11 publications

(4 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The possibility that cleft areas are associated with areas of stagnation, and the promotion of dysbiotic plaque biofilms, is supported by several observations: the presence of a fistula (Richards et al, 2015); the severity of the cleft (Lehtonen et al, 2015; Mian et al, 2005); and untreated clefts (Kamble et al, 2017) have been positively associated with increased caries. As such, oral health promotion measures in these patients must be prioritised by clinical teams to mitigate against the increased caries risk, and caries incidence, experienced by those patients with CL/P; early access to dental care may help to preclude dental caries, and associated treatments, in childhood and into adulthood.…”

Section: Discussionmentioning

confidence: 96%

Caries in children with and without orofacial clefting: A systematic review and meta‐analysis

et al. 2022

View full text Add to dashboard Cite

This systematic review compared children's primary dentition caries experience for those with cleft lip and/or palate (CL/P) and without. Four databases were searched without date restriction for; cross‐sectional studies comparing caries experience for children with CL/P to those without. Screening, data extraction and risk assessment were carried out independently (in duplicate). Meta‐analyses used a random‐effects model. Twenty studies (21 reports) fitting the inclusion criteria comprised 4647 children in primary dentition from 12 countries. For dmft (n = 3016 children; 15 groups), CL/P mean = 3.2; standard deviation = 2.22 and no CL/P mean dmft = 2.5; sd 1.53. For dmfs (n = 1095 children; 6 groups), CL/P mean = 4; sd = 3.5 and no CL/P mean = 3; sd = 2.8. For % caries experience (n = 1094 children; 7 groups), CL/P mean = 65%; sd = 20.8 and no CL/P mean = 52%; sd = 28.1. Meta‐analysis showed higher caries experience in children with CL/P, standardised mean difference = 0.46; 95% CI = 0.15, 0.77. Studies' risk of bias was high (n = 7), medium (n−10) and low (n = 3). Children with CL/P had higher caries experience compared to those without CLP.

show abstract

Section: Discussionmentioning

confidence: 96%

Caries in children with and without orofacial clefting: A systematic review and meta‐analysis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The development of symptomatic fistulae has consequences for the development of speech, regurgitation of food, decreased oral health, and further scarring that can result in maxillary growth restriction. [1][2][3][4][5] Symptomatic fistulae require the child to undergo further procedures to close the defect. Multiple procedures during childhood may in turn affect the child's psychosocial development due to poor speech attainment, 6 missed schooling, 7 and increased exposure to anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair

Davies,

Main

et al. 2024

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae. Methods: The sample comprised participants from the Cleft Collective who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centers between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula. Results: Fistula data were available for 167 participants when exploring antibiotic regimen and for 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2 = 4.57; P = 0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav and those who had an alternative antibiotic (χ2 = 0.16; P = 0.69). Postoperative fistulae increased with the extent of the cleft (χ2 = 20.39; P < 0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics: OR 1.36; 95% confidence interval, 0.53–3.51; antibiotics up to 7 days postoperatively: OR 0.68; 95% confidence interval, 0.26–1.80). Conclusions: The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trials.

show abstract

“…[1][2][3] Fistulas can have a substantial impact on patient quality of life as they may negatively affect speech (eg, nasal air loss on high-pressure consonants, perpetuation of the use of compensatory articulation, cause discomfort when liquids pass through the fistula from the oral to the nasal cavity, and lead to dental and oral hygiene problems, including halitosis. [4][5][6][7] Another problem is the high recurrence risk after secondary surgery. 1 Palatal fistulas can occur in multiple locations of the palate and in different degrees of severity.…”

Section: Introductionmentioning

confidence: 99%

Unraveling a Major Burden of Orofacial Clefts Analyses: Classification of Cleft Palate Fistulas by Cleft Surgeons

Houkes

Smit

Lachkar

et al. 2023

The Cleft Palate Craniofacial Journal

View full text Add to dashboard Cite

Objective The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations. Design Cross-sectional survey study. Participants Participants in an international webinar that focused on palatal fistula treatment were included. Intervention Participants were presented with a survey pre- and post-webinar. Main outcomes Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system. Results A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and ‘other’). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system. Conclusions This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas.

show abstract

Are Cleft Palate Fistulae a Cause of Dental Decay?

Cited by 11 publications

References 26 publications

Caries in children with and without orofacial clefting: A systematic review and meta‐analysis

Caries in children with and without orofacial clefting: A systematic review and meta‐analysis

Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair

Unraveling a Major Burden of Orofacial Clefts Analyses: Classification of Cleft Palate Fistulas by Cleft Surgeons

Contact Info

Product

Resources

About