Caries Prevalence in Non-Syndromic Patients with Cleft Lip and/or Palate: A Meta-Analysis

Abstract

Aim: To evaluate caries prevalence in non-syndromic patients with cleft lip and/or palate (CLP) in comparison with a matched non-CLP population. Methods: A literature search was conducted in order to identify articles reporting on the prevalence of caries in CLP versus non-CLP individuals. The related citations function in PubMed and reference lists of retrieved articles were used to expand the search. Only studies with a suitable matched control group were included. From each included study, study and sample characteristics were extracted, as were results. The main outcome was the score given for caries prevalence in each study, using a well-defined index. The data were entered into meta-analysis software and a meta-analysis performed using the random-effects model. Results: From the 592 articles initially identified, 7 were chosen according to preset inclusion and exclusion criteria. All of the studies were cross-sectional in nature, and used the decayed, missing, and filled (DMF/dmf) indices as the final outcomes. The included studies involved a total of 474 CLP patients aged 1.5-29 years. When looking at permanent teeth, data from 5 studies suggest that CLP patients have a higher number of DMF teeth than the controls (mean difference 1.38; p = 0.003). For deciduous teeth, data from 4 studies suggest that CLP patients have a higher number of dmf teeth than the controls (mean difference 1.51; p = 0.03). Conclusion: Non-syndromic patients with CLP tend to have higher caries prevalence, both in the permanent and the deciduous dentition, in comparison with matched non-CLP controls.

Children with orofacial clefts : dental caries and health-related quality of life

“…However, when the two age groups were analyzed together the caries prevalence was 41% in children with CL/P compared to 29% in the non-cleft controls group. The results were in agreement with several previous studies (Antonarakis, Palaska et al 2013, King, Wong et al 2013, Kirchberg, Makuch et al 2014) but in contrast to others (Lucas, Gupta et al 2000, Hasslöf and Twetman 2007, Jindal et al 2011. Earlier data suggest that children with cleft lip and palate (CLP) have more caries than children with isolated cleft lip (CL) (Bian, Du et al 2001, Chapple and Nunn 2001, Besseling and Dubois 2004) but this could not be verified in the present study.…”

“…However, conflicting results have been reported including comprehensive reviews (Paul and Brandt 1998, Lucas, Gupta et al 2000, Lages, Marcos et al 2004, Hasslöf and Twetman 2007, Jindal, McMeans et al 2011, Antonarakis, Palaska et al 2013). The present knowledge of caries prevalence in Swedish children with CL/P is sparse, and the most recent investigation dates back to the mid-80s (Dahllöf, Ussisoo-Joandi et al 1989).…”

Effect of presurgical orthopedics on oral-health related quality of life in Chilean children with cleft lip and palate. A pilot study.

“…3 However, some authors emphasize negative aspects of PSO, such as the complexity of its manufacture, high economic costs, higher rates of postoperative complications, and accumulation of plaque. [3][4][5] Consequently, there is no agreement regarding the use and effectiveness of PSO in children with CLP. 6 The quality of life of children with CLP is an important and integral health indicator, observable in functional and psychosocial outcomes.…”

Microscópio operatório no diagnóstico de cárie dentária em crianças com fissura labiopalatina

“…Neste contexto, crianças com fissura labiopalatina parecem ter maior risco de desenvolvimento de lesões de cárie dentária, com os dentes adjacentes à fissura apresentando maior prevalência da doença por causa da maior indulgência dos pais em relação aos hábitos dietéticos e negligência da higiene oral por medo de manipular a área da cirurgia; mau posicionamento dos dentes próximos à área da fissura dificultando a higiene e um maior tempo de clearance salivar pela dificuldade do uso do músculo orbicular devido ao dano da cicatriz do lábio; tônus muscular e mobilidade da língua diminuídos; e impacção alimentar pela presença de fístulas oronasais (AL-DAJANI, 2009;PARAPANISIOU et al, 2009;ZHU et al, 2010;HAZZA'A et al, 2011;ANTONARAKIS;PALASKA;HERZOG, 2013;KING;WONG;WONG, 2013;WELLS, 2013). Considerando todos esses fatos, é importante salientar o maior risco à cárie dos dentes permanentes anteriores próximos à área da fissura labiopalatina, justificando a escolha para o presente estudo.…”

“…Além disso, fibrose do lábio e presença de bridas na região anterior, consequência das cirurgias primárias, são bastante comuns (FREITAS et al, 2012b;ANTONARAKIS;PALASKA;HERZOG, 2013). Todos estes fatores podem ser coadjuvantes no risco à doença cárie, por favorecerem um maior acúmulo de biofilme (PARAPANISIOU et al, 2009;ZHU et al, 2010;KING;WONG;WONG, 2013 Especificamente na população brasileira, um estudo recente encontrou maior prevalência de cárie dentária em uma amostra de indivíduos adolescentes e adultos jovens com fissura labiopalatina comparada com indivíduos sem fissura (FREITAS et al, 2013), enquanto outro estudo não encontrou diferença estatisticamente significativa entre os índices CPOD no grupo com fissura (1,20) e sem fissura (0,90) em uma amostra de crianças e adolescentes com fissura labiopalatina (TANNURE et al, 2012 O uso da sonda exploradora deve ser abandonado devido ao grande risco de promover dano estrutural ao esmalte desmineralizado durante o procedimento de sondagem e ao fato de que seu uso não traz benefícios para a acurácia do diagnóstico das lesões de cárie, sendo recomendado o uso de uma sonda OMS (com extremo arredondado) especialmente durante a verificação da integridade e rugosidade da superfície (MANTON, 2013).…”