Systematic Review of Clinical Practice Guidelines for Oral Health in Children With Cleft Lip and Palate

Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives

ObjectiveInformation regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment.DesignPSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).ResultsTwo themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.ConclusionMultifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.

An Evaluation of Dental Caries Status in Children with Oral Clefts: A Cross-Sectional Study

Oral health is a prerequisite for the rehabilitation of children with oral cleft (OC). Thus, caries negatively affects individuals with OC. This study aimed to investigate dental caries in children with OC, determining the first period of the most significant susceptibility to caries. This cross-sectional study evaluated caries' prevalence and mean dmft in the primary dentition of 300 children with OC, distributed among ten groups at six-month intervals. The exams were carried out using the WHO diagnostic criteria. Fisher's exact test and Student's t-test were used for statistical comparisons with a significant level of 5%. The caries prevalence in the total group was 59.4%, and the dmft was 3.4. The first period of susceptibility occurred between 13 and 18 months and 19 and 24 months, with a prevalence ranging from 6.6% to 40% (p < 0.05) and a dmft ranging from 0.1 to 1.0 (p < 0.05). The prevalence and dmft increase with age. Our findings suggest that in children with OC, the first period of susceptibility to caries occurs from 13 to 18 months. These findings demonstrate the need for pediatric dentistry to establish an early preventive protocol for children with clefts during the first year.

Quality assessment of clinical practice guidelines and position statements on vital pulp therapy: a systematic review

OBJECTIVE

To evaluate different Clinical Practice Guidelines (CPGs) and Position Statements (PS) on Vital Pulp Therapy (VPT) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Appraisal of Guidelines for Research and Evaluation-Recommendation EXcellence (AGREE-REX) tools.

METHODS

Two authors performed the initial search using a set of keywords in six databases. Only CPGs and PS on VPT published during the past five years were included. The included CPGs were appraised independently by six appraisers. AGREE II tool was used to evaluate the methodological quality, and AGREE REX was used to evaluate the quality of recommendations. Intraclass correlation coefficient was used as a reliability indicator among assessors.

RESULTS

Four published CPGs were shortlisted. Guidelines established by the European Society of Endodontology (ESE, 2019), German Society of Endodontology and Dental Traumatology (GSEDT, 2019), American Association of Endodontists (AAE, 2021), and Australian Dental Association (ADA, 2021) were analyzed. The ESE PS obtained the highest average score overall.

DISCUSSION

Endodontists must adhere to clinical practice guidelines established by specialty associations or societies. Improving the domains "Rigour of Development" and "Applicability" is necessary to enhance the overall strength of the guidelines. It is imperative to prevent discouragement and confusion among practitioners regarding VPT procedures by ensuring cohesiveness among various endodontic associations.

CONCLUSION

This assessment aids in determining the standard of CPGs among different specialized societies and associations. It also highlights the essential future actions and initiatives needed to establish robust evidence-based standards on VPT.

REGISTRATION

The protocol of this systematic review was registered in PROSPERO (ID: CRD42023429673).

Tooth Anomalies in Patients With Nonsyndromic Orofacial Cleft: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the frequency of tooth anomalies (TA) in the deciduous and permanent dentition of patients with nonsyndromic orofacial clefts (NSOC), both inside and outside the cleft area.

METHODS

The following databases were searched for the relevant literature: Cochrane, OVID, SciELO, Embase, Livivo, PubMed, Scopus, and Web of Science. The risk of bias was analyzed using the Joanna Briggs Institute. Fixed and random-effects meta-analysis was performed comparing the presence and absence of NSOC subtypes. The certainty of evidence was evaluated using the GRADE approach.

RESULTS

Out of 1939 articles identified, after applying the inclusion and exclusion criteria, a total of 75 articles were included (46 cohort and 29 case-control), including 27,703 patients (16,450 with NSOC and 11,253 healthy controls) from 34 countries. The meta-analyses revealed higher odds for tooth agenesis (ORNSOC: 3.72; p = 0.001) and macrodontia (ORNSOC: 8.04; p = 0.04) across the different cleft subtypes outside the cleft area compared with the control group in the permanent dentition, whereas the frequency of root dilaceration was significantly lower in nonsyndromic cleft lip only (NSCLO) (ORNSCLO: 0.38; p < 0.0001) and in nonsyndromic cleft lip and palate (NSCLP) (ORNSCLP: 0.44; 95% p < 0.0001). The results also demonstrated a higher risk of tooth agenesis (ORNSOC: 16.49; p < 0.0001), microdontia (ORNSOC: 17.14; p < 0.0001), macrodontia (ORNSOC: 10.41; p = 0.02), supernumerary tooth (ORNSOC: 10.03; p < 0.0001), and enamel hypoplasia (ORNSOC: 5.62; p < 0.0001) in the permanent dentition inside the cleft area of patients with NSOC. However, for the deciduous dentition, outside the cleft area, microdontia was the only TA significantly more frequent in patients with NSOC (ORNSOC: 6.24; p = 0.006) and nonsyndromic cleft palate only (NSCPO) (ORNSCPO: 8.45; p = 0.02) compared with the control group. TA associations varied across populations. In Europe, no significant associations were found for NSOC, while in Asia, strong associations were observed for NSCLP and NSCL ± P (ORNSCLP and NSCL±P: 139.19; p < 0.0001). In South America, significant associations were identified for NSCLP (ORNSCLP: 2.16; p < 0.0001), NSCL ± P (ORNSCL±P: 2.48; p < 0.0001), and NSOC (ORNSOC: 2.72; p < 0.0001). In North America, tooth agenesis was more frequent in NSCL ± P (ORNSCL±P: 4.75; p < 0.0001), though no significant associations were found for NSCLP or NSOC. In the cleft area, significant associations were observed in European populations for NSOC, including increased frequencies of tooth agenesis (ORNSOC: 19.57; p = 0.003) and supernumerary teeth (ORNSOC: 9.77; p < 0.0001). Asian populations showed similar patterns (ORNSOC: 19.23; p = 0.002), while no significant associations were noted in South America due to limited data. Root dilaceration remained less frequent in NSCLO (ORNSCLO: 0.38; p < 0.0001) and NSCLP (ORNSCLP: 0.44; p < 0.0001), with no associations identified for microdontia, taurodontism, supernumerary tooth, impacted tooth, or transposition.

CONCLUSION

The results confirm a higher frequency of TA in the permanent dentition of patients with NSOC compared to controls, regardless of cleft subtype. However, significant differences were observed depending on whether the TA occurred inside or outside the cleft area. Although only a limited number of studies were included, microdontia was the only TA significantly more prevalent in the cleft area of patients with NSOC in the deciduous dentition. Variations in the frequency of TA across populations highlight the complex interplay of genetic, environmental, and methodological factors influencing these associations. Despite these findings, the quality of the existing evidence is moderate, with limitations stemming from small sample sizes, methodological variations, and study heterogeneity. These results emphasize the importance of tailored dental management and early intervention strategies for individuals with different cleft subtypes to effectively address and mitigate the impact of these tooth anomalies on oral health and development.

Oral and Maxillofacial Manifestations of Kallmann Syndrome: A Systematic Analysis of the Literature

AIMS

Kallmann syndrome (KS) is a rare genetic disorder characterized by congenital hypogonadotropic hypogonadism and varied clinical features. Despite its recognition, the oral and maxillofacial manifestations remain poorly understood. This study synthesized clinical aspects and management of KS-related oral and maxillofacial alterations.

METHODS

Searches were conducted in the PubMed, Web of Science, Scopus, Embase, and LILACS databases, supplemented by manual scrutiny and gray literature. Case series and/or case reports were included. The Joanna Briggs Institute tool was employed for critical appraisal of the studies.

RESULTS

A total of 46 studies comprising 108 cases were included. The mean age of individuals was 19.8 (±12.6) years, and there was a marked predominance of males (79.3%). Cleft lip/palate (32.7%) was the predominant oral condition, followed by high-arched palate (21.7%), and dental agenesis (19.8%). Oral treatment consisted of corrective surgery of the cleft lip and/or palate (n = 9), myoplasty (n = 1), and tooth extraction/orthodontic treatment (n = 1). Hyposmia/anosmia (71.3%) was the most frequently reported manifestation.

CONCLUSION

Early diagnosis and interdisciplinary collaboration are essential for addressing the complex nature of KS-related oral and maxillofacial alterations and improving patient outcomes. The scarcity of data on oral treatment underscores the need for additional research and clinical attention in this field.

Quality analysis of the clinical practice guidelines for management of impacted maxillary central incisors: a systematic review

PURPOSE

To assess the quality of clinical practice guidelines (CPG) for management of impacted central incisors.

METHODS

Search was performed in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane databases, and guideline-focused databases/repositories on 15-09-2022 without any limitations and was updated on 15-07-2023. Grey literature search was also performed. Two independent reviewers were involved in the study selection and data extraction. Quality assessment of the included CPG was performed by four independent appraisers using the AGREE-II instrument. The degree of agreement among the appraisers was calculated using the intraclass correlation coefficient (ICC).

RESULTS

Five CPG were included in the review. The Ministry of Health, Malaysia (MHM) guideline obtained the highest scores in all six domains of AGREE-II and an overall score of 73% demonstrating the "highest" quality. The remaining four guidelines obtained overall "low-quality" scores ranging from 34.57-37.52%. The ICC scores ranged from 0.530 to 0.990 for various domains of AGREE-II.

CONCLUSION

MHM guidelines demonstrated high-quality scores in domains of 'scope and purpose', 'clarity of presentation', 'applicability domain', and 'editorial independence', while others were found to have moderate or low quality. This review identified areas that can be addressed by future guideline developers to avoid these discrepancies.

Proposal of a hybrid workflow to create a device treating the nutritional disability of an infant with cleft lip and palate: Case report

INTRODUCTION

Cleft lip-palate is the most common craniofacial congenital anomaly. Patients with Cleft lip palate require treatment with a multidisciplinary approach from birth to enable independent feeding and physiological growth. In the past, the fabrication of therapeutic devices for a child with a cleft lip palate was executed through conventional dental impression materials , with the risk of suffocation. The use of a digital workflow minimizes impression-related risks and streamlines procedures.

METHODS

This study aims to propose a hybrid workflow that can combine the advantages of digital workflow with the advantages of analog workflow that can be applied daily by clinicians treating cleft lip-palate-affected patients.

RESULTS

The device created was immediately accepted by the patient allowing autonomous nutrition. Evaluation of the effectiveness of the device was done by body weight assessment every 15 days.

CONCLUSION

The patient had growth comparable to that of a child born healthy.

Evidence Mapping and Quality Analysis of Systematic Reviews on Various Aspects Related to Cleft Lip and Palate

BACKGROUND

Management of cleft lip and palate is interdisciplinary. An evidence-mapping approach was envisaged to highlight the existing gaps in this field, using only the highest level of evidence.

OBJECTIVES

To conduct evidence mapping and quality analysis of systematic reviews and meta-analyses related to any aspect of cleft lip and palate.

SEARCH METHODS

The cleft lip and palate field was divided into 9 domains and 50 subdomains and a method of categorization of systematic reviews was established. A comprehensive search strategy was carried out in seven databases along with the search of gray literature and references of included articles.

SELECTION CRITERIA

Systematic reviews related to any aspect of cleft lip and palate, conducted by a minimum of two reviewers, with a comprehensive search strategy and adequate quality analysis were included.

DATA COLLECTION AND ANALYSIS

A self-designed, pre-piloted data-extraction sheet was used to collect information that was analyzed through an expert group discussion. Quality analysis was performed using ROBIS-I, AMSTAR 2, and the PRISMA checklist.

RESULTS

A total of 144 systematic reviews published between 2008 and 2022 were included. The largest number of these could be categorized in the therapeutic domain (n = 58). A total of 27% of the studies were categorized as inconclusive, 40% as partially conclusive, and 33% as conclusive. As per ROBIS-I, 77% of reviews had high risk of bias while 58% were graded as critically low in quality as per AMSTAR 2. The majority of systematic reviews showed low reporting errors.

CONCLUSIONS

The majority of systematic reviews related to cleft lip and palate relate to therapeutic and prognostic domains and show high risk of bias and critically low quality regardless of the source journal. The results of this paper might serve as a starting point encouraging authors to carry out high-quality research where evidence is lacking.

REGISTRATION

A multidisciplinary expert-group formulated an a priori protocol, registered in Open Science Framework (DOI 10.17605/OSF.IO/NQDV2).

Current Perspectives on Cleft Lip and Palate and Children's Health

Orofacial clefts are the most prevalent craniofacial congenital anomalies, affecting the lip, with or without involvement of the palate, or solely the palate [...].

Provision of rehabilitation for congenital conditions

Considerable progress has been made in saving the lives of children younger than 5 years. Nevertheless, these advances have failed to help all children thrive, particularly children with disabilities. We describe the increasing prevalence of disability among children and adolescents. We evaluate the current situation regarding children with disabilities and rehabilitation in the context of health systems, particularly those in low- and middle-income countries. Within the newborn health agenda, congenital anomalies often require early intervention and rehabilitation. We provide Argentina as an example of a country where rehabilitation for congenital anomalies is integrated into the health system. We argue that congenital anomalies that require rehabilitation have the potential to strengthen rehabilitation systems and policies by: strengthening coordination between primary care and rehabilitation; identifying and understanding pathways that allow families to engage with services; providing human resources for rehabilitation; and building systems and resources that support assistive technology and rehabilitation. We propose ways for countries to prioritize and integrate early identification, referral and care for children with congenital anomalies to strengthen health systems for all. We identify opportunities to expand policy and planning and to design service delivery and workforce strategies through World Health Organization guidelines and frameworks for rehabilitation. We argue that the global health community must act to ensure that rehabilitation services to support functioning from birth are well established, accepted and integrated within health systems, and that disability is prioritized within child health. These steps would strengthen health systems, ensure functioning from birth and make rehabilitation accessible to all.

Current Treatment of Cleft Patients in Europe from a Provider Perspective: A Cross-Sectional Survey

The latest Eurocleft study reported several discrepancies in cleft care. Since then, no critical assessment has been performed. This study aimed to better understand the main strengths and inefficiencies of cleft care within Europe. The Google documents platform was used to create an online survey to investigate several aspects, i.e., provider characteristics, patient profile, services offered, and treatment protocols and complications. Descriptive statistics were calculated. The association between categorical variables was performed using Fisher's exact test. The significance level chosen was 0.05. A total of 69 individuals from 23 European countries completed the survey. Centralized care was the preferred system, and the majority of the countries have an association for cleft patients and professionals (53.6%). The largest percentage of patients was seen in the university hospital environment (Fisher's exact test p < 0.001). The majority of responders (98.6%) reported that an orthodontist was involved in cleft treatment, and 56.5% of them spend 76-100% of their time treating these patients. Despite cleft care having been reconfigured in Europe, a better consensus among the various centers regarding provider characteristics, services offered, and treatment protocols is still required. There is a need for better coordination between clinicians and national/international regulatory bodies.

Clinical Practice Guidelines on the Treatment of Patients with Cleft Lip, Alveolus, and Palate: An Executive Summary

Significant treatment variation exists in the Netherlands between teams treating patients with cleft lip, alveolus, and/or palate, resulting in a confusing and undesirable situation for patients, parents, and practitioners. Therefore, to optimize cleft care, clinical practice guidelines (CPGs) were developed. The aim of this report is to describe CPG development, share the main recommendations, and indicate knowledge gaps regarding cleft care. Together with patients and parents, a multidisciplinary working group of representatives from all relevant disciplines assisted by two experienced epidemiologists identified the topics to be addressed in the CPGs. Searching the Medline, Embase, and Cochrane Library databases identified 5157 articles, 60 of which remained after applying inclusion and exclusion criteria. We rated the quality of the evidence from moderate to very low. The working group formulated 71 recommendations regarding genetic testing, feeding, lip and palate closure, hearing, hypernasality, bone grafting, orthodontics, psychosocial guidance, dentistry, osteotomy versus distraction, and rhinoplasty. The final CPGs were obtained after review by all stakeholders and allow cleft teams to base their treatment on current knowledge. With high-quality evidence lacking, the need for additional high-quality studies has become apparent.