|Year : 2019 | Volume
| Issue : 1 | Page : 38-42
To assess the prevalence of dental caries and to evaluate oral health-related quality of life in cleft lip and palate patient
Amit Manohar Reche, Shrutika Dhanrajji Chordiya, Sakshi Pradeep Joshi, Nikita Suresh Bhumbre, Shivani Kishore Jadhav, Nikita Pramod Dhange
Department of Public Health Dentistry, Public Health Dentistry, Sharad Pawar Dental College, Sawangi, Maharashtra, India
|Date of Web Publication||4-Feb-2019|
Dr. Shrutika Dhanrajji Chordiya
C/o Vimal Medical and General Stores, Opp. Mission Hospital, Durga Mata Road, Jalna - 431 203, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to assess the prevalence of dental caries and evaluate oral health-related quality of life (QoL) in patients with cleft lip and palate (CLP) in Vidarbha region. Settings and Design: A cross-sectional questionnaire study was conducted in the Department of Public Health Dentistry of our institute. The sample was divided into three groups. Subjects and Methods: Group A (110) patients with unilateral CLP (UCLP), Group B (110) patients with bilateral CLP (BCLP), and Group C (150) control group. From self-administered questionnaire, the patients were asked 10 questions based on eating, speaking, toothbrushing, sleeping, smiling, emotional status, carrying out work, and social contact and rated as 0, 1, 2, and 3 (no problem, mild, moderate, and severe). Statistical Analysis Used: ANOVA and Pearson's correlation tests were performed. Results: According to the results, there is no statistical difference for decayed, missing, and filled teeth score seen between UCLP and BCLP patients; however, there is significant difference (<0.001) seen between the cleft patients and control group. According to questionnaire result, the patients with bilateral cleft experienced more difficulty while eating, speaking, smiling, and maintaining social contact as compared to the control group. Conclusion: Patients suffering from CLP showed higher caries prevalence compared to the control group; on the other hand, negative impact has been seen on the QoL of CLP patients.
Keywords: Cleft lip and palate, dental caries, oral health-related quality of life
|How to cite this article:|
Reche AM, Chordiya SD, Joshi SP, Bhumbre NS, Jadhav SK, Dhange NP. To assess the prevalence of dental caries and to evaluate oral health-related quality of life in cleft lip and palate patient. J Cleft Lip Palate Craniofac Anomal 2019;6:38-42
|How to cite this URL:|
Reche AM, Chordiya SD, Joshi SP, Bhumbre NS, Jadhav SK, Dhange NP. To assess the prevalence of dental caries and to evaluate oral health-related quality of life in cleft lip and palate patient. J Cleft Lip Palate Craniofac Anomal [serial online] 2019 [cited 2019 Aug 26];6:38-42. Available from: http://www.jclpca.org/text.asp?2019/6/1/38/251466
| Introduction|| |
Good oral health is an integral part of general health and is essential for well-being of a human. Oral health is a state of the oral cavity and its associated structures, where there is no disease or pain, no restriction of ability to perform different functions such as mastication of food and teeth which are of a socially acceptable appearance. In India, there is an increase in oral health problems, especially dental caries, which has been consistently increasing both in prevalence and in severity over the last five decades.
Dental caries is a multifactorial microbial disease of calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitations. During pregnancy (6–11 weeks), there is failure in fusion of maxillary, palatine, and nasal process leading to cleft lip and palate (CLP), which compromises the function and esthetic. These anomalies cause difficulty for the children to maintain their oral hygiene, speech, swallowing, mastication, and respiration. Other than orofacial defect, cleft patient has oral problems caused by dental and arch segment discrepancy, along with the postoperative scar, leading to dental caries. It was also found that children with clefts exhibited poor oral hygiene as well as poor gingival and periodontal conditions.
Quality of life (QoL) has been defined as an individual's perception about his or her own position in life from a cultural perspective based on the prevailing system of values, considering objectives, expectations, patterns, and concerns. QoL is an intricate concept that reflects a person's insight into physical, psychological, and social function as well as mental well-being. There is a need to monitor the incidence of dental caries and QoL in CLP patient, to plan proper treatment.
The aim of this study was to assess the prevalence of dental caries and oral health-related QoL in patients with cleft lip and palate in Vidarbha region.
| Subjects and Methods|| |
The research project was submitted to the Institutional Ethical Committee and approval was obtained (DMIMS (DU)/IEC/2018-19/7159).
Standardization of examiner
Before this study, the examiner was calibrated with a standard examiner in order to obtain strong interrater agreement (Kappa statistics >0.80).
The cross-sectional study was conducted in the Department of Public Health Dentistry at our college. Screening of the patients with unilateral CLP (UCLP) and bilateral CLP (BCLP) was done for the Outpatient Department of the Institute for 6 months. A total of 370 patients were identified which were according to our inclusion criteria, that is, between 6 and 15 years of age, primary repair of cleft lip, and palate had been done. The purpose of this study was explained to the patients, and an informed consent form was signed by all patients or their parents. Syndromic CLP patients were excluded from the study. The above patients were divided into three groups – Groups A, B, and C. They were examined as per the World Health Organization (WHO) criteria (1997) for dental caries. Group A includes patients with UCLP, Group B includes BCLP, and Group C includes control group.
Quality of life assessment
Dental impact on daily living instrument was used to collect data on the state of OHRQoL of the volunteers who were able to answer the questions offered. Patients were asked to answer the questions based on the events that occurred in the last 6 months. This instrument consists of ten questions which were divided into eight criteria, that is, eating, speaking, toothbrushing, sleeping, smiling, emotional status, carrying out work, and enjoying social contact. For each question, the answer was given in oral impact on daily performance scale (no problem, mild problem, moderate problem, and severe problem with values ranging from 0 to 3).
| Results|| |
The present study was conducted on 370 patients. Based on clinical examination DMFT index was 5.13 ± 1.98 in UCLP cases, 5.37 ± 2.49 in bilateral cases and 2.66 ± 0.79 in control group (as shown in [Table 1]) and along with questionnaire survey, it was found that out of 220 patients, in those with UCLP [Table 2], 90 (81.8%) patients had no problem during eating, 54 (49.1%) had mild problem in speaking, 91 (82.7%) had no problem in toothbrushing, 86 (78.2%) had mild problem during smiling, 106 (96.4%) had no problem during sleeping, 88 (80.0%) had no problem in maintaining social contact, only 35 (31.8%) had mild problem in reading loud in class, 57 (51.8%) were mildly emotionally disturbed while very few of them were emotionally sound, 86 (78.2%) patients had no problem in going to school, 12 (10.9%) patients were mildly affected by hearing difficulties, and 47 (42.7%) patients get mildly irritated easily.
|Table 1: Decayed, missing, and filled teeth index and its components in children with clefts lip and palate|
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|Table 2: Quality of life assessment in unilateral and bilateral cleft lip and palate patient|
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In patients with BCLP [Table 2] 54 (49.1%) patients had moderate problem in eating, 79 (71.8%) had moderate problem in speaking, 51 (46.4%) had no problem in toothbrushing, 40 (36.4%) had moderate problem in smiling, 85 (77.3%) had no problem during sleeping, 72 (65.5%) had mild problem in maintaining social contact, 79 (71.8%) had mild problem in reading out loud in class, 46 (41.8%) were moderately emotionally disturbed, 71 (64.5%) showed slight refusal to attend school, 70 (63.6%) had no hearing difficulties, and 79 (71.8%) individual used to get irritated easily.
In control group [Table 3] 50% of patients had no problem in eating, 60% had no problem in speaking, 70% had no problem in toothbrushing, 60% had no problem in smiling, 80% had no problem during sleeping, 70% had no problem in maintaining social contact, 50% had no problem in reading out loud in class, 70% were emotionally stable, 70% had no problem in attending school, 90% did not have any hearing problem, and most of the individual used to get irritated easily.
| Discussion|| |
This study was conducted to assess the prevalence of dental caries and to evaluate OHRQoL in CLP patient, a total of 220 CLP patients and 150 control group were examined for decayed, missing, and filled teeth-WHO (DMFT-WHO criteria), and their parents answered self-administered questionnaire.
The prevalence of caries in patients with UCLP patients in mean values was 5.14 ± 1.98, and that for BCLP patients was 5.372 ± 0.5 standard deviation (SD). However, the mean value of DMFT in the control group was significantly less than cleft patients, that is, 2.66 ± 0.79 SD. This result is consistent with the study conducted by Hazza'a et al., which was 4.58 ± 5.37 and 2.25 ± 2.04, respectively. Cleft participants when compared with their control groups demonstrated that the number of carious teeth was more than twice as high in cleft participants. These findings confirmed that the results reported by other authors,,, and are in contradictory with that of Kirchberg et al., who reported that there were no significant differences in caries experience between clefts participants and control group.
According to this study, 49.1% BCLP had moderate problem while eating, whereas 81.8% UCLP and 50% control population had no problem during eating.
When asked about experiencing any difficulty in pronouncing words containing letters (for example, T, F, S), 49.1% of UCLP had mild problem, more than half (71.8%) of the BCLP had moderate problem while pronunciation. This result was in accordance with the study on the Brazilian population by Galitesi et al., in which he concluded more prevalence in the dimensions hygiene (46%), speech (34%), and smiling (28%), which demonstrates the clear need to intensify education about criteria for oral hygiene, the care in speech, and orofacial attention to esthetics.
However, majority of BCLP, that is, 41.8% of patients had mild problem while brushing. However, majority of UCLP and control group patients had no significant problem while brushing. The reason for difficulty in achieving optimal toothbrushing can be because of the anatomy of the cleft area in BCLP patients, also incompetent lip closure was found in many cleft patients which, in turn, make it difficult to assess adequate oral hygiene in maxillary quadrant.
Statistically, it was observed that 78.2% of UCLP patients mildly hesitated to smile or laugh in public places, whereas 36.4% of BCLP patients were moderately shy for smiling and laughing in common crowd.
Surprisingly, it was found that majority of UCLP, BCLP, and control cases do not experience any difficulty while sleeping. These results are in contrary with the study of Silvestre et al., resulted that 1 out of 7 cleft palate patients are screened positive for obstructive sleep apnea. The mean age was 8.4 years. The overall incidence of positive screening was 14.7%.
According to the results of our study, 65.5% of BCLP patients experience moderate problem while communicating with peer group and avoid speaking with friends. On the other hand, UCLP patients (80%) and 70% of control group were contented while speaking with friends.
Majority of participants in UCLP and control group were at ease to read out loud in class; however, 71.8% of BCLP patients found moderate problem while reading out loud in class.
It was observed that 51.8% of UCLP patients were not so composed and got mildly disturbed from bullying in the society or in school; similarly, BCLP patients (41.8%) were moderately affected by the discrimination in society.
As the majority of BCLP patients were moderately affected by the maltreatment, 64.5% of them refuse to go to school because of teasing, while 78.2% of UCLP patients and 70% of control group were happy to attend school on a daily basis.
Mildly 42.7% of UCLP patients, 71.8% of BCLP patients, and 80% of control participants get irritated easily when inquire to their parents.
The gravity of such emotional problem is obvious in cleft patients due to their facial deformities, and thus exhibits more episodes of depression, irritability, and low self-esteem.
Due to their facial appearance and difficuty in communicating, teasing has become part of their life and made them socially recluse and they are comfortable only in interacting with their family members.
When asked about any hearing difficulties most of the participants had no hearing problem, that is, 81.8% of UCLP patients, 63.6% of BCLP patients, and 90% of control group mentioned usual hearing. These results are contradictory to the study carried by Sheahan et al. in Ireland which concluded that the peak incidence for ear problems was in the 4–6-year-old age group, with 56% of parents of children in this age group reporting some ear-related problems in the preceding year, and 40% reporting their child to currently have below normal hearing. However, middle ear problems were found to persist at a significant level for many years beyond the 4–6-year-old age group; thus, nearly half of the children in the 7–9 and 10–12-year-old age groups were reported to have suffered from ear problems in the preceding year (44% and 46%, respectively), with a substantial proportion also reported to have below normal hearing (31% and 46%, respectively)., Children with oral cleft are at greater risk for tooth decay which subsequently leads to negative impact on QoL, and therefore, there is a need for comprehensive and readily available dental care for such patients. It was also found that children with clefts exhibited poor oral hygiene as well as poor gingival and periodontal conditions.
| Conclusion|| |
Results of this study lead to the conclusion that presence of CLP anomaly had negative impact on both the prevalence of dental caries as well as the QoL of cleft individuals, when compared to the control group. It was also acknowledged by the parents that the focus on the numerous medical procedures required to correct the birth defect can lead to the neglect of the oral health needs of the child. For this reason, there is a need to educate and encourage the parents and families regarding the need for oral hygeine measures and the preventive protocols available for such patients. Surprisingly, there are very few research studies that are carried out related to this topic of significance. Furthermore, there are no specific instruments available in the literature that can effectively assess the perception of clefts patients, including esthetics, functional deficits in chewing, swallowing, breathing, and speaking and treatment benefits, which would positively and directly enhance patient loyalty and adherence toward treatment. Hence, to asses all these aspects collectively, there is a need to develop new comprehensive QoL questionnaires and measurement instrument.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]