|Year : 2019 | Volume
| Issue : 2 | Page : 104-109
Oral health status of patients seeking therapeutic and rehabilitative care for cleft lip and cleft palate at specialty hospitals in vadodara
Ricky Pal Singh1, CG Ajithkrishnan2, Thanveer Kalantharkath3, Amrita Pawar4, Harshal Bafna5, Pulkit Kalyan2, Avnish Singh6
1 Department of Land and Food System, UBC-BC Children Hospital, Vancouver, Canada
2 Department of Public Health Dentistry, KM Shah Dental College and Hospital, Vadodara, Gujarat, India
3 Department of Public Health Dentistry, TMU, Moradabad, Uttar Pradesh, India
4 Department of Prosthodontics Crown and Bridge, ITS-CDSR, Muradnagar, Uttar Pradesh, India
5 Department of Public Health Dentistry, GDC, Aurangabad, Maharashtra, India
6 Department of Public Health Dentistry, Seema Dental College, Rishikesh, Uttrakhand, India, Uttrakhand
|Date of Web Publication||7-Aug-2019|
Dr. Ricky Pal Singh
House No. 1, D-Block, Vikas Puri, New Delhi - 110 018
Source of Support: None, Conflict of Interest: None
Aim: To assess the oral health status of the patients seeking therapeutic and rehabilitative care for cleft lip and cleft palate at specialty hospitals of Vadodara district, Gujarat. Objectives: Record the Oral Health Status of the patients undergoing therapeutic and rehabilitative care for cleft lip and cleft palate or both by using WHO 2004 methodology. Material and Methods: A descriptive cross sectional survey was conducted at the three specialty centers of Vadodara district for a period of six months. All the subjects with cleft lip and cleft palate reporting to the OPD of these Centre were examined. Total 52 subjects reporting to these Centre were included and the data was recorded according to the Multi-centric Oral health survey-2004. The data related to oral health status was recorded, compiled, tabulated and was subjected to statistical analysis using SPSS package. Results: Among the 52 subjects examined, 32 were males and 20 were females. All the subjects had dental caries, gingival bleeding was seen in 71.1% of subjects and pockets were seen in 67.30%. Loss of attachment was seen in 96.65% of the subjects. Mean caries experience was more in males 5.78±1.18 as compared to females, whereas gingival bleeding was more in females. 19.23% of the subjects had ulcerations, 50% had abnormality of the upper lips and 15.38% had very mild fluorosis. Conclusion: In general, cleft lip and/or palate subjects exhibited poor oral health status with a higher level of caries experience and poor periodontal condition.
Keywords: Cleft lip, cleft palate, oral health status, WHO Pro forma 2004
|How to cite this article:|
Singh RP, Ajithkrishnan C G, Kalantharkath T, Pawar A, Bafna H, Kalyan P, Singh A. Oral health status of patients seeking therapeutic and rehabilitative care for cleft lip and cleft palate at specialty hospitals in vadodara. J Cleft Lip Palate Craniofac Anomal 2019;6:104-9
|How to cite this URL:|
Singh RP, Ajithkrishnan C G, Kalantharkath T, Pawar A, Bafna H, Kalyan P, Singh A. Oral health status of patients seeking therapeutic and rehabilitative care for cleft lip and cleft palate at specialty hospitals in vadodara. J Cleft Lip Palate Craniofac Anomal [serial online] 2019 [cited 2019 Dec 13];6:104-9. Available from: http://www.jclpca.org/text.asp?2019/6/2/104/264097
| Introduction|| |
Orofacial defects with cleft lip and palate are frequently reported anomalies seen at the time of birth, while as the severity of defects vary from patient to patient, they can occur individually or in combination with other deformities. Oldest reports of the anomaly date back to Egyptian times, while Pierse Franco made the earliest record of cleft lip in 1691., Reports indicate that nearly 700 children around the globe are born with cleft lip/palate every day amassing to nearly 240,000 children annually with this abnormality. Due to the lack of knowledge about deformity among the population, it is considered as wrath of God, and as a result, only 3% of the children receive treatment while the remaining go unattended.
Congenital failure of the maxillary and median nasal processes to fuse, results in the formation of a fissure which is termed as cleft lip while failure in fusion of palatal grooves result in the formation of cleft palate. Orofacial clefts (OFCs) represent a heterogeneous group of defects with a considerable range of dysmorphological severity. Challenges in understanding the health impact of OFC include the lack of data, failure to monitor the cases step by step over the long duration of the treatment, attrition of cases with regard to treatment follow-up, discrepancies in the number of reported cases, and lack of records.,,,
Recent studies have indicated a constant rise in the incidence of cleft lip and palate patients due to multiple risk factors, mainly genetic and environmental modification. The condition is most prevalent among the mongoloids and least among the Negroids. Isolated cleft palate is more commonly reported among the females while the incidence of cleft lip is high among males. Among all the reported cases, isolated clefts are the most common (80%), and among these, isolated cleft of the left side has higher prevalence.
In Indian culture, where female feticide is still in practice and a girl born with a cleft is considered a curse to the family she may suffer total health care neglect resulting in failure to receive any treatment, ultimately leading to psychological trauma and a lifetime of suffering. Due to the underlying risks, these patients need to approach specialty hospitals seeking a complete corrective and rehabilitative management. The developing nature of our nation makes it imperative to record and maintain data of these patients in terms of health education, psychological counseling, speech therapy, measures to maintain oral and general health for creating awareness of management and better quality of life and roadblocks for receiving treatment. The present study was conducted to assess the oral health status of individuals with cleft lip and cleft palate deformities at the specialty hospitals in Vadodara district, Gujarat.
| Materials and Method|| |
A cross-sectional descriptive study was conducted to assess the oral health status of the patient seeking therapeutic and rehabilitative care for cleft lip and cleft palate at super specialty hospitals of Vadodara district, Gujarat.
Method of collection of data
Patients willing to participate in the study from all the three super specialty hospitals of Vadodara were included in the sample.
- Participants not present on the day of examination.
Information collected and methods used
Before the survey, ethical clearance was obtained from the ethics committee, and written informed consent and oral assent from participants were also obtained. Convenience sampling was done, and a total of 52 patients were enrolled in the study comprising of 32 males and 20 females [Figure 1] over the period of 6 months. The age range of the participants was as follows:
- 5–15 years
- 16–24 years
- Above 25 years.
Multicentric Oral Health Assessment Form (2004) by Prakash et al. was used to collect information about the oral health status, treatment needs, demographic details, and oral hygiene habits.
The clinical examination and data recording of all the patients were done by trained calibrated principal investigator using armamentarium as per WHO oral health survey guidelines consisting of plain mouth mirror, WHO-CPITN–E probe (Community Periodontal Index [CPI]), tweezers, kidney trays, enamel trays, cotton holders, and disposables. All the instruments were sterilized by dry heat sterilization. The calibration was done by assigning individuals to the investigator, on whom the investigator applied the WHO oral health assessment form 2004 and recorded the findings. A total of 25 individuals were selected with diverse oral conditions for the calibration. The intraexaminer reliability was found to be almost perfect [k = 0.81, [Table 1]. All the participants were asked to sit on a chair at the center; they were examined with available natural light with good illumination. Clinical examination was done to assess oral mucosal conditions, fluorosis, periodontal conditions, and dental caries status.
The data recorded were entered in Microsoft excel (2007) for the purpose of analysis. The descriptive statistical test to determine average (mean), standard deviation, and percentages was employed using IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp).
| Results|| |
Of the 52 study individuals, 32 (62%) were males and 20 (38%) [Figure 1] were females, which indicates inclination toward males with cleft lip and palate there were 42.3% of patients from the age group of 5 -15 years, 34.61% from 16-24 years and remainder were above 25 years [Figure 2]. In the current study, 26.92% of individuals had cleft lip, cleft palate was seen in 34.61%, and individuals having both cleft lip and cleft palate were 38.46% [Figure 3] nearly 54% of patients reported from SSG Hospital, 27% from the Dhiraj Hospital & 19% from KM Shah Dental College & Hospital [Figure 4]. Individuals with normal extraoral appearance were 36.53%, individuals with abnormalities of upper and lower lip were 50%, Out of the 52 patients, 44 (85%) were seeking therapeutic care and 8 (15%) for rehabilitative care [Figure 5]. 5.76% of individuals had enlarged lymph nodes – head and neck, and remaining 5.76% had swellings of face and jaws [Figure 6]. In the present study, 5.76% of the individuals had leukoplakia in the age group of ≥25 years, and 19.23% of all the age groups had ulceration (aphthous, herpetic and traumatic).
|Figure 3: Distribution of different types of cleft (s) among study participants|
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|Figure 4: Distribution of the study participants according to the Centre|
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|Figure 5: Distribution of the study participants according to type of care sought|
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A total of 15.38% of the individuals were affected with very mild form of dental fluorosis, followed by questionable 9.61% and mild 1.92%. This can be due to variations in fluoride concentration of different water sources used for drinking purposes.
In the current study, all the individuals had dental caries. Mean decayed filled teeth for individuals aged 5–15 years was 2.04 ± 0.87 [Table 2], and the caries experience for all the study individuals was a5.71 ± 0.74; mean decayed missing filed teeth was highest in 16–24 years' age group, i.e., 8.56 ± 0.86 [Table 3].
|Table 2: Distribution of study participants with mean number of deciduous teeth|
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|Table 3: Distribution of study participants with mean number of Decayed (D, d), Missing (m) & Filled (F, f)|
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In this study, since we followed basic oral health methodology 2004, we have applied CPI modified and loss of attachment (LOA) index. Among the study group, it was found that 71.1% of the individuals had gingival bleeding and pocket was detected in 67.30% [Table 4] and [Table 5].
|Table 4: Distribution of mean gingival bleeding scores among different age groups|
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| Discussion|| |
The birth of a child having anomaly such as cleft lip/palate can lead to psychological trauma to the family who are not aware of the condition and consider it as a wrath of God in Indian custom; thus, it is the duty of health workers, doctors, and literate individuals to motivate them for its early management and treatment. On the clinical side, successful treatment involves a multidisciplinary approach, including nursing, speech therapy, pediatrics, orthodontic, and plastic surgery.
There are numerous factors that lead to the development of this disorder which are comprised of genetic and environmental factors. Mainly, the factors include maternal exposure to corticosteroids, retinoic acid, phenytoin, hormonal imbalance, and diabetes mellitus. Other aetiology associated with cleft lip and palate formation are smoking tobacco and alcohol consumption during pregnancy. Other factors that are related to diet are deficiency of folic acid that lead to the formation of clefts in the individuals as discussed by the Webby G.
Findings of this study were in accordance with the study carried out by Nagase et al. (2010) which reported prevalence of cleft lip and palate more among the males than females.
Vanderas reported that the incidence of cleft lip with palate (CL + CP) was greater than those with only cleft lip or cleft palate among people of American or European descent (Canada, England and Europe). International Perinatal Database of Typical OFCs collected data from 2002 to 2005 in USA, Canada, Europe, British Isles, and Australia regarding the prevalence of CL/P or CLP. It was also reported that the incidence of cleft lip and palate was more common as compared to cleft lip/palate only; these study results were in similarity with our survey, where 38.46% of the patients were having cleft lip and palate [Figure 3].,,,,
The incidence of mean caries reported in primary dentition and permanent dentition in the survey among the selected individuals was high [Table 2] and [Table 3]; similar results were also reported in studies conducted by Wong and King, Paul and Brandt, Dahllöf et al., and Chapple and Nunn.
There was a significant association and predominance of dental caries prevalence between cleft and noncleft schoolgoing children which was mainly due to inability to perform oral hygiene methods promptly and effectively. The other reason was that family members are more inclined toward physical appearance and speech; in contrast, they neglect the oral health of their child.
Overall, oral health status of cleft lip and/or palate individuals was generally poor. Extraoral appearance of the cleft cases was distorted due to abnormal lips. A considerable fraction almost 26% cases had dental fluorosis. The presence of leukoplakia can be attributed to the habits of tobacco chewing, spicy food, or UV rays, and the ulceration can be due to stress, hyperacidity, nutritional deficiency, drug intolerance, other factor that can be attributed to occurrence of these lesions, and ulceration due to immune disorders.
In this study, the periodontal status of the individuals was poor with the presence of periodontal pockets and LOA [Table 6]. Poor periodontal health among the individuals may be attributed to the presence of deep clefts and inability of the individual with cleft (s) to maintain a proper oral hygiene.,, LOA was higher in males as compared to the females. Periodontal status in females was poor as compared to the males. The results are in association with the studies of Wong and King, Paul and Brandt, and Dahllöf et al. These studies have also reported poorer oral hygiene status and higher number of sites with gingivitis and periodontitis. Gaggl et al. reported a critical periodontal condition observed in patients with both cleft lip and palate when compared to general population [Table 7].,,,
|Table 6: Distribution of mean sextant loss of attachment scores among different age groups*|
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| Conclusion|| |
The current results throw enough light on the relatively poor oral health status of these children. Individuals born with cleft lip or palate are more susceptible to the development of dental caries and periodontal disease. As parents or caregivers are more inclined toward the therapeutic and rehabilitative care due to its multistage treatment, and in lieu of that, oral health care is ignored. Therefore, there is a urgent need of running public health programs which cater the oral needs with the culmination of medical treatment and rehabilitation.,,
- Individuals with Cleft Lip and Cleft Palate (CLCP) should receive comprehensive oral examination at all the different healthcare system inclusive of primary to tertiary dental care
- Centralized registration center for these patients where the statistics can be monitored and evaluated for betterment of patients with orofacial clefts
- Genetic screening of the fetus to identify high-risk groups could be done.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Turvey TA, Katherine WL, Fonseca RJ. Facial Clefts and Craniosynostosis: Principles and Management. 1st
ed.. Philadelphia: W.B. Saunders Company, Inc.; 1996. p. 537-64.
Lam F, Bendeus M, Ricky W. A multidisciplinary team approach on cleft lip and palate management. Hong Kong Den J 2007;4:38-45
Singh G. Text Book of Orthodontics. 2nd
ed. New Delhi: Jaypee Brothers, Medical Publishers; 2009. p. 685-98.
Nitin SM. Chaudari CG. Growth and development of cleft lip and cleft palate children before and after reconstruction surgery. Int J Recent Trends Sci Technol 2012;4:94-7.
Prakash H, Duggal R, Mathur VP, Petersen PE. Manual for Multi-Centric Oral Health Survey. India: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, World Health Organization; 2004-05.
Gaggl A, Feichtinger M, Schultes G, Santler G, Pichlmaier M, Mossböck R, et al.
Cephalometric and occlusal outcome in adults with unilateral cleft lip, palate, and alveolus after two different surgical techniques. Cleft Palate Craniofac J 2003;40:249-55.
Tettamanti L, Avantaggiato A, Nardone M, Palmieri A, Tagliabue A. New insights in orofacial cleft: Epidemiological and genetic studies on Italian samples. Oral Implantol (Rome) 2017;10:11-9.
Wehby GL, Goco N, Moretti-Ferreira D, Felix T, Richieri-Costa A, Padovani C, et al.
Oral cleft prevention program (OCPP). BMC Pediatr 2012;12:184.
Nagase Y, Natsume N, Kato T, Hayakawa T. Epidemiological analysis of cleft lip and/or palate by cleft pattern. J Maxillofac Oral Surg 2010;9:389-95.
Vanderas AP. Incidence of cleft lip, cleft palate, and cleft lip and palate among races: A review. Cleft Palate J 1987;24:216-25.
Viera AJ, Garrett JM. Understanding interobserver agreement: The kappa statistic. Fam Med 2005;37:360-3.
Sekhon PS, Ethunandan M, Markus AF, Krishnan G, Rao CB. Congenital anomalies associated with cleft lip and palate-an analysis of 1623 consecutive patients. Cleft Palate Craniofac J 2011;48:371-8.
Derijcke A, Eerens A, Carels C. The incidence of oral clefts: A review. Br J Oral Maxillofac Surg 1996;34:488-94.
IPDTOC Working Group. Prevalence at birth of cleft lip with or without cleft palate: Data from the international perinatal database of typical oral clefts (IPDTOC). Cleft Palate Craniofac J 2011;48:66-81.
Wong FW, King NM. The oral health of children with clefts – A review. Cleft Palate Craniofac J 1998;35:248-54.
Paul T, Brandt RS. Oral and dental health status of children with cleft lip and/or palate. Cleft Palate Craniofac J 1998;35:329-32.
Dahllöf G, Ussisoo-Joandi R, Ideberg M, Modeer T. Caries, gingivitis, and dental abnormalities in preschool children with cleft lip and/or palate. Cleft Palate J 1989;26:233-7.
Chapple JR, Nunn JH. The oral health of children with clefts of the lip, palate, or both. Cleft Palate Craniofac J 2001;38:525-8.
Cheng LL, Moor SL, Ho CT. Predisposing factors to dental caries in children with cleft lip and palate: A review and strategies for early prevention. Cleft Palate Craniofac J 2007;44:67-72.
Chhina S, Singh A, Menon I, Singh R, Sharma A, Aggarwal V. A randomized clinical study for comparative evaluation of Aloe vera
and 0.2% chlorhexidine gluconate mouthwash efficacy on de-novo
plaque formation. J Int Soc Prev Community Dent 2016;6:251-5.
Bafna HP, Ajithkrishnan CG, Kalantharakath T, Singh RP, Kalyan P, Vathar JB, et al.
Effect of short-term consumption of amul probiotic yogurt containing Lactobacillus acidophilus
la5 and Bifidobacterium
lactis bb12 on salivary Streptococcus mutans
count in high caries risk individuals. Int J Appl Basic Med Res 2018;8:111-5.
Pawar A, Mittal S, Singh RP, Bakshi R, Sehgal V. A step towards precision: A review on surgical guide templates for dental implants. Int J Sci Stud 2016;3:262-6.
Singh RP, Ajithkrishnan CG, Kalantharkath T, Bafna H, Patel H. An in-vivo
evaluation of the effect of chewing coriander seeds on salivary pH. JADCH 2014;5:31-4.
Ajithkrishnan CG, Thanveer K, Singh RP. An in-vivo
evaluation of the effect of fennel seeds chewing on salivary pH. J Oral Health Community Dent 2014;8:79.
Chawla I, Menon I, Singh RP, Sharma A. Knowledge about research publication: A comparative study among dental postgraduate students. J Dent Spec 2018;6:156-9.
Goyal J, Menon I, Singh RP, Sharma A, Passi D, Bhagia P. Association between maternal dental anxiety and its effect on the oral health status of their child: An institutional cross sectional study. J Family Med Prim Care 2019;8:535-8.
] [Full text]
Bhagia P, Menon I, Singh RP, Sharma A, Goyal J, Tomar D. Effect of educational status on oral health education program amongst Anganwadi workers in improving oral health of preschool children of Muradnagar block, Ghaziabad-a cross-sectional study. J Dent Spec 2018;6:136-9.
Thanveer K, Ajithkrishnan CG, Harshal B, Singh RP, Kalyan P. Student perspectives and opinion on their dental outreach posting experience at Vadodara, India. Indian J Dent Educ 2013;6:173-7.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]