Tooth abnormalities associated with non-syndromic cleft lip and palate: systematic review and meta-analysis

Characterization of hypomineralization second primary molar and molar incisor hypomineralization in patients with orofacial clefts

AIMS

To identify and characterize hypomineralization in the second primary molar (HSPM) and molar incisor hypomineralization (MIH), as well as other developmental defects of enamel (DDE) in patients with clefts considering dentition type, tooth type, phenotype and cleft laterality.

MATERIALS AND METHODS

In this cross-sectional retrospective study, 6432 deciduous and permanent teeth of 290 patients with clefts aged between 3 and 14 years in a referral hospital were assessed using intraoral photographs. The classification of demarcated hypomineralization was carried out by a calibrated examiner using the MIH index. Statistical analyses were performed using a binomial generalized linear model.

RESULTS

Deciduous and permanent molars were the most affected by HSPM and MIH, whereas incisors and canines were most affected by hypoplasia, with the upper arch being most affected by DDE. Cleft phenotypes involving the palate were associated with HSPM (OR = 31; 95% CI: 1.0-59.3) and MIH (OR = 31.6; 95% CI: 0.6-53.2).

CONCLUSION

Patients with clefts had a high prevalence of HSPM and MIH in the upper arch and were associated with more severe cleft phenotypes.

CLINICAL RELEVANCE

Pediatric dentists who are members of the multidisciplinary teams responsible for caring for patients with clefts need to have a more discerning clinical eye when diagnosing DDE in patients with clefts. Posterior teeth are more susceptible to demarcated hypomineralizations in patients with clefts, while anterior teeth are more susceptible to hypoplasias.

Evaluating Differences in Non-Syndromic Orofacial Clefts by Infant Sex: National Birth Defects Prevention Study, 1997 - 2011

OBJECTIVE

To investigate non-genetic factors that may contribute to observed differences in non-syndromic orofacial clefts by infant sex.

STUDY DESIGN

Using data for 1997-2011 deliveries from the National Birth Defects Prevention Study, a case-control study, we separately examined associations between 23 maternal factors and cleft lip with or without cleft palate (CL/P) and cleft palate alone (CP) using multivariable logistic regression stratified by infant sex.

RESULTS

We compared 2,986 infants with CL/P and 1,557 with CP to 11,271 control infants without birth defects. After adjusting for maternal age at conception and education, lower odds of non-syndromic orofacial clefts were observed among male infants of non-Hispanic Black mothers (CL/P aOR: 0.36; 95% CI: 0.28 - 0.45; CP aOR: 0.56; 95% CI: 0.41 - 0.76) and of Hispanic mothers (CL/P aOR: 0.84; 95% CI: 0.73 - 0.96; CP aOR: 0.57; 95% CI: 0.45 - 0.72) compared with non-Hispanic White mothers. Similar, though attenuated, lower odds of non-syndromic orofacial clefts were observed among female infants of non-Hispanic Black mothers, but no association was observed among female infants of Hispanic mothers. Differences in associations between maternal education and nutrient intake (carbohydrate, energy, total lipids/fat, Vitamin E, and zinc) and CL/P, as well as maternal vitamin C intake and CP, were also observed by infant sex.

CONCLUSIONS

Associations between non-syndromic orofacial clefts and minority racial and ethnic groups were attenuated or non-existent among female infants compared with male infants. Sex-specific differences of CL/P appear more susceptible to environmental factors (eg, maternal education and nutrient intake) than sex-specific differences of CP.

Exploring polymorphisms in genes encoding growth factors associated with non-syndromic cleft lip with or without cleft palate and tooth agenesis

OBJECTIVE

To evaluate the association between non-syndromic cleft lip with or without cleft palate (NSCL±P) and tooth agenesis (TA), as well as the association of both conditions with polymorphisms in genes encoding growth factors.

METHODOLOGY

This cross-sectional study included children with NSCL±P and a control group of children without NSCL±P. Permanent teeth TA (excluding third molars) was evaluated using panoramic radiographs by a trained examiner. Only TA located outside the cleft was considered in the NSCL±P group. Genetic polymorphisms in Transforming Growth Factor Beta 1 (TGFB1)-rs1800470 and rs4803455-Transforming Growth Factor Beta Receptor 2 (TGFBR2)-rs3087465 and rs764522-Epidermal Growth Factor (EGF)-rs4444903 and rs2237051-and Epidermal Growth Factor Receptor (EGFR)-rs2227983- were genotyped by real-time PCR allele discrimination from buccal cell samples. Associations were tested by uni and multivariable Poisson regression models (5% significance level).

RESULTS

A total of 243 children-127 with NSCL±P (mean age = 8.80±2.14 years) and 116 without NSCL±P (mean age = 8.58±2.03 years) were included. TA was more frequent in the NSCL±P group (23.8%) than in the control group (6.2%) (p<0.01). The EGF rs2237051 was significantly associated with NSCL±P, independently of the other variables (PRa=1.41; p=0.042). Regarding TA, only the cleft presence was associated with a higher prevalence of TA regardless of different variables (PRa=3.70; p=0.001). There was no association between TA and the investigated genetic polymorphisms. When TA and NSCL±P were considered together, a borderline association was observed with rs1800470 in TGFB1 (p=0.06).

CONCLUSION

NSCL±P is associated with TA outside the cleft area. The EGF rs2237051 was associated with NSCL±P. Polymorphisms in genes encoding growth factors are not associated with TA.

Polymorphisms and dental age in non-syndromic cleft lip and palate: a cross-sectional study

BACKGROUND

Children with non-syndromic cleft lip with or without palate (CL ± P) may present alterations in dental development. The purpose of this cross-sectional study was to compare the dental age (DA) between children with and without CL ± P, and whether single nucleotide polymorphisms (SNPs) in genes encoding growth factors are associated with DA variations.

METHODS

Children aged between 5 and 14 years with and without CL ± P were recruited to participate in this study. DA was evaluated by calibrated examiners (kappa > 0.80) using the method proposed by Demirjian et al. (1973). Genomic DNA was extracted from buccal cells, and SNPs in Epidermal Growth Factor (EGF) - rs4444903 and rs2237051, Epidermal Growth Factor Receptor (EGFR) - rs2227983 -, Transforming Growth Factor Beta 1 (TGFB1) - rs1800470 and rs4803455 -, and Transforming Growth Factor Beta Receptor 2 (TGFBR2) - rs3087465 - were genotyped by real-time polymerase chain reactions using the TaqMan assay. The Student T-test was used to compare the variations in DA between the phenotypes "with CL ± P" and "without CL ± P", and the ANOVA two-way test was performed to compare the variations in DA among the genotypes (α = 0.05). A post-hoc analysis was performed using Bonferroni correction.

RESULTS

Two hundred and nine (n = 209) children (100 with CL ± P and 109 without CL ± P) with a mean chronological age of 8.66 years - standard deviation (SD) = 1.92 - were included. The group with CL ± P demonstrated a significantly delayed DA (mean=-0.23; SD = 0.71) compared to the group without CL ± P (mean=-0.01; SD = 0.88) (p = 0.049). Genotype distributions were in Hardy-Weinberg equilibrium. The SNP rs4803455 in TGFB1 was significantly associated with DA variations in children without CL ± P (p < 0.01). In the group with CL ± P, no significant differences in DA were observed among the genotypes.

CONCLUSION

Children with CL ± P presented delayed DA compared with children without CL ± P. The SNP rs4803455 in TGFB1 is associated with variations in DA in children without CL ± P.

Patterns of Congenital Tooth Agenesis and Crown Width in Patients with Alveolar Clefts in Guizhou, China: A Retrospective Study

OBJECTIVE

This study aimed to investigate the prevalent pattern of congenital tooth agenesis and the development of crown width in patients with alveolar clefts in Guizhou, China.

METHODS

The imaging data and complete medical record information of 222 patients who met the criteria were studied. The rate of tooth agenesis, tooth agenesis patterns, type of cleft, gender, and crown width in patients with alveolar cleft were counted.

RESULTS

Twenty-two congenital tooth agenesis patterns were statistically identified in patients with alveolar clefts by the tooth agenesis code method. The rate of congenital tooth agenesis in patients with alveolar cleft was 72.5%, and the most common missing teeth were lateral incisors. The rate of tooth agenesis was higher in bilateral alveolar cleft (87.1%) than in unilateral alveolar cleft (67.4%). No correlation was found between gender and tooth agenesis patterns, tooth agenesis rate, or number of missing teeth. Crown width in patients with alveolar clefts is less than normal. No correlation was found between the number of missing teeth and crown width.

CONCLUSIONS

The congenital tooth agenesis patterns and tooth agenesis rates in patients with alveolar clefts in Guizhou, China, were related to the type of cleft, independent of gender. The crown widths in patients with alveolar clefts were smaller than normal, irrespective of the number of tooth agenesis.

Instructional videos for parents/guardians of children with lip and palate clefts: integrative literature review

OBJECTIVE

This study aimed to review literature from the past five years, focusing on the use of educational videos as a guidance tool for parents and guardians of children with lip and palate clefts.

SOURCE OF DATA

Conducted between April and July 2022, this integrative literature review was framed around the question: 'What is the evidence regarding the use of videos in health education for parents/guardians of children with cleft lip and palate? PICO strategy was used to develop the research. A literature search was undertaken across PubMed, Web of Science, Scopus, and the Virtual Health Library databases. Of the eight articles included in this review, four were sourced from the PubMed database, with three published in 2021.

SUMMARY OF THE FINDINGS

The findings indicated that YouTube videos were moderately satisfactory and met the needs of parents or legal guardians to a partial extent. The majority of the videos analyzed in this review were characterized by a moderate level of informational content. One study particularly underscored that the content of these videos only partially satisfies the requirements of the parents or legal guardians of the children.

CONCLUSIONS

Nevertheless, such videos are considered viable alternatives for health education, offering numerous benefits yet facing challenges, primarily due to the scarcity of information on orofacial malformations.

Prevalence of tooth agenesis and supernumerary teeth related to different Thai cleft lip and cleft palate populations

BACKGROUND

Pattern of dental anomalies encountered in cleft patients shows subtle signs of genetic involvement. This study aimed to evaluate the prevalence and pattern of tooth agenesis and supernumerary teeth in Thai cleft population according to the cleft type.

METHODS

Data collected from patients with cleft lip and palate, who had been treated at Tawanchai Cleft Center, Khon Kaen University, Thailand, available during year 2012-2022, were investigated. Records from 194 patients with non-syndromic clefts met the inclusion criteria. Standard dental records, and at least either orthopantomogram (OPG) or cone beam computed tomography (CBCT), were examined. Statistical analysis was performed using chi-square and binominal test (p ≤ 0.05).

RESULTS

Prevalence of tooth agenesis was higher (77.3%) than that of supernumerary teeth (5.7%) and was more common in bilateral cleft lip and palate (BCLP) (88.1%) than in unilateral cleft lip and palate (UCLP) (72.6%) (p = 0.017). The upper lateral incisor was more frequently affected (46.4%), followed by the upper second premolar. The number of missing teeth observed on the left side was significantly higher. Patients with left UCLP (ULCLP) had the highest prevalence of tooth agenesis. A total of 41 tooth agenesis code (TAC) patterns was found. The prevalence of supernumerary teeth was comparable with 6.6% of ULCLP, 5.1% of BCLP, and 4.5% of URCLP. Tooth-number anomalies were observed more often in the BCLP and were most likely to occur on the left side of the maxilla. Both types of anomalies could be featured in a small proportion of cleft patients.

CONCLUSIONS

More than half of the patients with non-syndromic cleft lip and palate in this study, presented with tooth-number anomalies. Tooth agenesis was approximately 10-time more prevalent than supernumerary teeth. Tooth agenesis was likely to appear on the left-side of the maxilla regardless of the laterality of the cleft.

Breastfeeding and Cleft Lip and Palate: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the association between cleft lip and/or cleft palate (CL/P) and breastfeeding (BF).

DESIGN

A systematic review and meta-analysis were performed based on studies published in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, BBO, and Embase databases, and in the gray literature. The search occurred in September 2021 and was updated in March 2022. Observational studies evaluating the association between BF and CL/P were included. Risk of bias was analyzed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted. Certainty of evidence was evaluated using the GRADE approach.

MAIN OUTCOME MEASURE(S)

Frequency of BF in relation to the presence or absence of CL/P, as well as to the type of CL/P. The association between cleft type and BF challenges was also evaluated.

RESULTS

From a total of 6863 studies identified, 29 were included in the qualitative review. Risk of bias was moderate and high in most studies (n = 26). There was a significant association between the presence of CL/P and absence of BF (OR = 18.08; 95% CI 7.09-46.09). Individuals with cleft palate with or without cleft lip (CP ± L) had a significantly lower frequency of BF (OR = 5.93; 95% CI 4.30-8.16) and a significantly higher frequency of BF challenges (OR = 13.55; 95% CI 4.91-37.43) compared to individuals with CL. Certainty of the evidence was low or very low in all analyses.

CONCLUSION

The presence of clefts, especially those with palate involvement, is associated with higher chances of absence of BF.

Root development differences between cleft-adjacent teeth on the cleft side in comparison to their analogs on the noncleft side in patients with nonsyndromic cleft lip and palate who received secondary alveolar bone grafting

OBJECTIVE

To assess differences in root development between the cleft side (CS) and noncleft side (NCS) for permanent maxillary central incisor and canine longitudinally in patients with nonsyndromic complete unilateral cleft lip and palate (cUCLP) who received secondary alveolar bone grafting (SABG) and to evaluate the effects of SABG on the acceleration of root development of these teeth.

MATERIALS AND METHODS

Permanent maxillary central incisors and canines of 44 subjects with nonsyndromic cUCLP who had all their cleft-related surgeries performed by the same surgeon were analyzed retrospectively from chart notes and radiographs. Panoramic and periapical radiographs at time point 1 (T1) (age, 7.55 years), at SABG (time point 2 [T2], 10.13 years), and a minimum of 2 years after SABG were studied. Root development rating scores on the NCS and CS were compared using paired t-tests and analyses of proportions.

RESULTS

Mean root development score differences (NCS - CS) for canines and central incisors were greatest at T2 but diminished at time point 3 (T3). A larger proportion of teeth on the CS trailed the teeth on the NCS by at least 1 point at T2 than at T1 or T3, with the smallest proportion being observed at T3. The change in root development scores from T1 to T2 and from T2 to T3 showed relative CS acceleration from T2 to T3, indicating a catch-up of root development of cleft-adjacent teeth after SABG.

CONCLUSIONS

Root development of cleft-adjacent central incisors and canines is slow in comparison with their noncleft analogs. Root development of these teeth accelerates following SABG.

Characterization of enamel developmental defects in patients with orofacial clefts and their relationship to surgical procedures

AIMS

This study aimed to characterize the prevalence of development defects of enamel (DDE) in patients with cleft based on the cleft phenotype and explore the relationship between surgical procedures and different types of DDE.

MATERIAL AND METHODS

In this cross-sectional study, 290 standardized orthodontic documentation and medical records from a reference hospital were evaluated, which treated patients with: cleft lip (CL), cleft lip with alveolar bone involvement (CLa), cleft lip and palate (CLP), cleft palate (CP), cleft median (CM), and considering laterality as unilateral or bilateral. DDE was assessed using the Ghanim Index (2015). Information on surgical intervention periods was obtained from medical records. Statistical analyses were performed using prevalence ratio (PR) for DDE comparisons between cleft phenotypes and surgical procedures.

RESULTS

The prevalence of DDE was 77.2%. Demarcated hypomineralization was associated with CP and CLP, while hypoplasia was associated with CLa, especially when bilateral. Hypoplasia was also associated with the labial adhesion surgery.

CONCLUSION

Demarcated hypomineralization was the most common DDE in this population, and the cleft phenotype influenced the type of DDE manifested. The lip adhesion surgery increased the chances of hypoplasia manifestation.

CLINICAL RELEVANCE

The type of DDE in patients with cleft depends on the cleft phenotype. Understanding this susceptibility enables the multidisciplinary team to monitor dental development, thus allowing early diagnosis and timely referral to the pediatric dentist and better prognoses.

Dental caries and periodontitis risk factors in cleft lip and palate patients

Cleft lip and palate (CLP) is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. Risk factors contributing to CLP may conclude as genetic factors and environmental factors. The anatomical and morphological abnormalities related to CLP are favorable for dental plaque accumulation on the tooth surface. Therefore, patients with CLP undergo poorer oral hygiene and higher susceptibility to dental caries and periodontitis. In this review, we aim to conclude and update probable causes underlying the association between CLP and poor oral health and provide novel ideas of targeted early prevention for such oral diseases.