|Year : 2016 | Volume
| Issue : 2 | Page : 73-76
Comparison of oral and dental health status in patients with or without cleft lip and palate deformities undergoing orthodontic treatment
Lakshmi Chandran Nair1, Arun Kumar Singh1, Veerendra Prasad1, Kishore Kumar2
1 Department of Plastic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Medical Oncology, Command Hospital, Lucknow, Uttar Pradesh, India
|Date of Web Publication||2-Aug-2016|
Lakshmi Chandran Nair
Department of Plastic Surgery, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Objective: To compare the oral and dental health in patients with or without cleft lip and palate (CLP) deformities, undergoing orthodontic treatment. Materials and Methods: The study group comprised fifty patients with CLP. These patients were compared with fifty matched patients (control group) who had no CLP and had undergone orthodontic treatment for other indications at the same institute. Oral hygiene was evaluated clinically according to the simplified oral hygiene index (OHI). Dental caries examination was done according to decayed, missing, and filled teeth (DMFT) index. The scores were compared between the two groups. Results: The mean OHI score in cleft patients was 4.5 and in noncleft patients was 3.9 (P < 0.001).The mean DMFT score was 0.980 in cleft patients and 0.380 in noncleft patients (P < 0.001). Conclusion: This study clearly found that oral and dental health is compromised in CLP patients undergoing orthodontic treatment compared to patients undergoing routine orthodontic treatment. This article also proves that CLP is more predominant in males than in females.
Keywords: Dental caries, oral hygiene, orthodontic treatment
|How to cite this article:|
Nair LC, Singh AK, Prasad V, Kumar K. Comparison of oral and dental health status in patients with or without cleft lip and palate deformities undergoing orthodontic treatment. J Cleft Lip Palate Craniofac Anomal 2016;3:73-6
|How to cite this URL:|
Nair LC, Singh AK, Prasad V, Kumar K. Comparison of oral and dental health status in patients with or without cleft lip and palate deformities undergoing orthodontic treatment. J Cleft Lip Palate Craniofac Anomal [serial online] 2016 [cited 2021 Oct 15];3:73-6. Available from: https://www.jclpca.org/text.asp?2016/3/2/73/187509
| Introduction|| |
Facial clefts are ranked as the most common congenital malformations. Cleft lip and palate (CLP) are common congenital deformities that often affect speech, hearing, and facial esthetics and may at times lead to airway compromise.  CLP have an impact on multiple developmental and functional processes. Clefts often coexist with malocclusion. Malocclusion is associated with poor oral health, functions, and esthetics. Therefore, it is necessary to treat the malocclusion orthodontically. The management of CLP patients requires prolonged orthodontic treatment. Orthodontic treatment may lead to poor oral hygiene and severe dental caries in these patients.  The orthodontic treatment of patients with clefts include different treatment stages such as at infancy, at primary dentition stage, at mixed dentition stage, and at permanent dentition stage. Since these patients undergo orthodontic treatment at various stages, they find it hard to maintain their oral hygiene which leads to dental caries and periodontally compromised dentition.
There is very little information about the status of oral and dental health in CLP patients actively undergoing orthodontic treatment. Hence, this study was conducted to compare the oral and dental health between cleft patients (undergoing orthodontic treatment for CLP) and noncleft patients (undergoing routine orthodontic treatment) at a tertiary care specialized craniofacial unit in the Department of Plastic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
| Materials and methods|| |
The present study was conducted in 100 patients with age ranging from 15 to 25 years, mean age being 19.26 years, of which fifty CLP patients (27 were unilateral CLP and 23 were bilateral CLP) were undergoing orthodontic treatment at a tertiary care specialized craniofacial unit in the Department of Plastic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India, and fifty noncleft patients were undergoing orthodontic treatment at the Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh.
They were divided into two groups: Group I consisted of fifty patients with CLP and Group II (control group) consisted of fifty patients without cleft of lip and palate, all undergoing orthodontic treatment. Informed consent was taken from the participants.
Oral hygiene was evaluated according to "the simplified oral hygiene index."  The examination was carried out using a mouth mirror and an explorer under flashlight on the dental chair. Subjects having congenital CLP without any syndrome were included in this study. Subjects with a history of any systemic disease were excluded from the study. Patients who had undergone oral prophylaxis 6 months prior to the study were also excluded from the study.
Dental caries examination was done according to decayed, missing, and filled teeth (DMFT) index.  Changes in tooth color, sticking of the dental explorer in occlusal or proximal areas of each tooth, or the presence of a gray and black pits in a proximal surface was considered to be caries. Restored teeth that had recurrent caries were recorded as caries. Dental examination was done by a single examiner (orthodontist with specialized training in management of clefts).
The data collected were analyzed and tested for significance using statistical software package, SPSS 20.0 (SPSS Inc., Chicago, IL, USA). Frequency tables were computed. Independent t-test was used to compare the mean scores of simplified oral hygiene index (OHI) and DMFT.
| Results|| |
Among the 100 study subjects, out of fifty cleft patients, 28 were male and 22 were female and out of fifty noncleft patients, 16 were male and 34 were female [Table 1]. The cleft patients undergoing orthodontic treatment had a mean OHI score of 4.54 compared to noncleft patients who had a mean score of 3.19 and a mean DMFT index of 0.980 in cleft patients and 0.380 in noncleft patients undergoing orthodontic treatment (P < 0.001) [Table 2].
The mean Debris index score for fifty cleft patients was 2.59 and for fifty noncleft patients undergoing orthodontic treatment was 1.83 (P < 0.001).The mean calculus index score in this study was found to be 2.02 in cleft patients and 1.44 in noncleft patients (P < 0.001) [Graph 1]. These values prove that the oral and dental health in cleft patients is compromised compared to patients without clefts. This study also shows that patients with clefts undergoing orthodontic treatment have higher risk of acquiring dental caries compared to patients without clefts. [Figure 1] shows the oral hygiene and dental status in noncleft patients undergoing orthodontic treatment. [Figure 2] shows chronic lack of oral hygiene showing accumulation of plaque gingivally and around the brackets, and [Figure 3] shows dental caries in CLP patients undergoing orthodontic treatment.
|Figure 1: Oral hygiene and dental status in patients undergoing routine orthodontic treatment (noncleft)|
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|Figure 2: Plaque and gingival inflammation seen in cleft lip and cleft palate patients undergoing orthodontic treatment|
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|Table 2: Comparison of oral hygiene and decayed, missing, and filled teeth index in patients with or without cleft lip and palate|
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| Discussion|| |
The present study was planned to compare the oral and dental health of patients with or without CLP, undergoing orthodontic treatment.
A total of 100 patients were examined for their oral and dental health using the simplified OHI  and DMFT index (1997). 
Among most of the previous studies done in various parts of the world, only oral hygiene and dental caries were evaluated in CLP patients; however, this study compared the oral and dental health between the cleft and noncleft patients undergoing orthodontic treatment. Since orthodontic treatment forms a major part of the multidisciplinary treatment that the CLP patients undergo, this study was necessary to find out the extent of oral and dental health status in these patients.
This study supports Nagappan and John, who conducted a study among patients with cleft lip, cleft palate and cleft lip, alveolus, and palate in Chennai, India. Results showed that the CLP and alveolus patients had poor oral hygiene and dental health.  Turner et al. evaluated the oral and dental health of Russian children with unilateral CLP. They found that the high percentage of poor oral hygiene and dental caries found in this group of patients was likely due to the general unavailability of dental hygiene products and the high cost of these products when available.  Ahluwalia et al. found that the level of caries associated organisms and sucrose levels were high in children with cleft palate.  Al-Dajani evaluated the prevalence of dental caries in Syrian patients with CLP and their sibling controls. He found that the DMFT scores were higher among the CLP patients compared with the control group.  Shashni et al. compared the risk indicators of dental caries in children with or without CLP deformities and found that the risk factors of dental caries among children with CLP were more as compared to noncleft high caries risk and noncleft caries-free children. 
Al-Wahadni et al. found that subjects with CLP are at an increased risk for dental caries and periodontal disease when compared with a noncleft Jordanian population which supports this study.  Studies performed by Mutthineni et al. stated that a healthy periodontium is an important prerequisite for unhindered dentition and long-term oral health. In cleft patients, the oral hygiene maintenance is a difficult task because of the patient's oronasal communication. The crowding of teeth in cleft patients is a common finding, especially in CLP patients. This statement is supported by our study, wherein it was found that cleft patients had severe crowding which leads to difficulty in oral hygiene maintenance. 
Our study has also supported Sundell et al., who found that children with CLP (the entire study group) had significantly higher counts of salivary lactobacilli (P < 0.05) and displayed less good oral hygiene (P < 0.05). 
The only discordant study we found is the one done by Lages et al., who found that the dental and periodontal condition of individuals with CLP was similar to the general population in the region in which this study was conducted. 
The CLP patients were advised daily fluoride rinses, oral prophylaxis once in every 3 months for plaque control, dietary control of sugar intake, interproximal brushes, and proper brushing technique. Reinforcement of oral hygiene and dietary education were performed at each visit for both the groups.
| Conclusion|| |
This study shows that cleft patients undergoing orthodontic treatment have highly compromised oral and dental health compared to noncleft patients undergoing orthodontic treatment. Since patients with clefts may have special problems related to missing, malformed, or malpositioned teeth, they are likely to require intensive oral hygiene measures. This article also proves that CLP is more predominant in males than in females.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]