Dental Caries, Oral Hygiene, and Oral Clearance in Children with Craniofacial Disorders

Abstract

The reason that children with cleft palates tend to have a greater prevalence of tooth decay than normal children is unclear. We hypothesized that children with cleft palates would have increased oral clearance times for foods and, consequently, higher levels of caries and caries-associated micro-organisms than control children. Children aged 6-16 yrs, with (n = 81) or without (n = 61) cleft palates, were studied. Children with cleft palates had DMFT and dmft scores greater (p < 0.01) than those of the control group. The number of caries-associated organisms was greater in the saliva of the cleft palate children (all p < 0.001). The oral hygiene, plaque and gingival index scores were greater (p < 0.0001), oral clearance was longer (p < 0.01), and levels of sucrose and starch-derived saccharides higher (p < 0.01) in the cleft palate group. However, salivary concentrations of organic acids were lower in the children with craniofacial disorders, probably reflecting the altered physiology of the more mature dental biofilm. The longer oral clearance times of foods and the consequent generation of fermentable sugars from starches may contribute to the higher caries prevalence observed in children with cleft palates.

Outpatient dental treatment under general anesthesia in children with cleft lip palate: case report

“…Lauterstein and Mendelsohn [22], Lucas et al [24], and Hewson et al [16] did not observed significant difference in the caries prevalence of these two groups. But, other studies [1,4,6,14,18] found greater risk for individuals with CLP.…”

“…The anterior teeth may have greater accumulation of plaque in individuals with cleft lip and palate, as they have lower lip elasticity due to the surgical repair, in addition to brushing fear in the cleft region [14]. Concerning to oral hygiene, may studies [1,25,30,32] reported worst results in individuals with cleft lip and palate.…”

“…According to Ahluwalia et al [1], sugars are fermented from starch intake and cause the appearance of tooth decay. The presence of cleft palate promotes food impaction, causing the food cake escapes to the nose and is regurgitated to the mouth, increasing the risk of caries because food is available for a longer time in the oral cavity for bacteria [11].…”

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

“…A number of factors can contribute to higher susceptibility such as enamel defects (Maciel, Costa et al 2005, Gomes, Neves et al 2009), early colonization of caries-associated microorganisms (Bokhout, van Loveren et al 1996) and impaired oral hygiene (Dahllöf, Ussisoo-Joandi et al 1989, Turner, Zagirova et al 1998, Wong and King 1998, Chopra, Lakhanpal et al 2014. A prolonged oral clearance time in children with CL/P may also contribute to a cariogenic environment (Ahluwalia, Brailsford et al 2004). Additionally, parents tend to overindulge children with CL/P and offer them sucrose-containing food and snacks as compensation for their medical condition (Johnsen 1984, Johnsen andDixon 1984).…”

“…High and frequent consumption of sugar changes the balance between and presence of microorganisms in the oral biofilm (Fejerskov 1997, Moynihan and Petersen 2004, Zero 2004, Moynihan and Kelly 2014 increasing the amount and the proportion of acid producing bacteria such as mutans streptococci and lactobacilli (van Houte 1980, Loesche 1986). The magnitude of acid production is also depending on oral clearance time of fermentable carbohydrates depending on saliva secretion, orofacial sensibility and function (Ahluwalia, Brailsford et al 2004, Gabre, Norrman et al 2005, Dawes 2008). Furthermore, saliva buffering capacity will also affect duration of the acid demineralization of enamel and dentine (Lingström and Moynihan 2003).…”