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

Successful interdisciplinary retreatment after initial treatment failure in a cleft lip adolescent

BACKGROUND

Cleft lip and/or palate (CL/P) is the most common craniofacial birth defect. Patients with CL/P typically exhibit severe malocclusions in the transverse, vertical, and sagittal directions, and often have poor oral hygiene. Due to the complex nature of the disease, the dental treatment for CL/P patients presents considerable challenges, sometimes resulting in interrupted treatments and subsequent treatment failures.

CASE PRESENTATION

Here, we present an interdisciplinary retreatment for an adolescent with unilateral complete cleft lip (UCCL), who initially received an orthodontic treatment elsewhere but faced issues such as poor oral hygiene, deep overbite of anterior teeth, significant discrepancies in the width of posterior teeth, and persistent spaces resulting from the alveolar cleft. Throughout the retreatment, we employed tooth remineralization accompanied by strict oral hygiene instructions, various skilled orthodontic techniques, surgical interventions, and aesthetic prosthodontic work. The adolescent showed dramatic improvements in facial and dental aesthetics, as well as in dental occlusion and function after treatment.

CONCLUSIONS

In summary, this case report emphasizes the critical role of effective oral hygiene management and interdisciplinary teamwork among dental subspecialties in the treatment of CL/P patients.

Structural and functional changes in the oral microbiome of patients with craniofacial microsomia

Craniofacial microsomia (CFM) is the second most common congenital craniofacial deformity, presenting diverse clinical manifestations and treatments that may influence oral bacteria dysbiosis (OBD). However, research linking CFM to OBD is limited. Saliva samples were collected from 20 patients with CFM and 24 controls. We compared oral microflora and gene function using 16 S ribosomal RNA sequencing and metagenomics. We also evaluated the correlation between CFM clinical phenotypes and microbiota community structure. Patients with CFM demonstrated greater richness and evenness in their oral microflora. The dominant genera included several pathogenic species, such as Actinomyces, Fusobacterium, and Prevotella. Notably, the severity of CFM correlated positively with the abundance of Neisseria and Porphyromonas. Upregulated pathways were primarily linked to biotin and amino acid metabolism, such as Tryptophan metabolism and Lysine degradation, and further underscored the need for focused oral health interventions in this population. This study is the first to indicate that CFM patients exhibit unique oral bacterial dysbiosis, marked by a higher presence of opportunistic pathogens and increased pathways related to oral and systemic health. These findings highlight the importance of monitoring oral health in patients with CFM.

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.

Oral health in patients with cleft lip and palate: a systematic literature review and meta-analysis of periodontal and dental disease and oral microbiota (part 1)

INTRODUCTION

Orofacial cleft impacts jawbone and dental development and function, often with consequences for oral health. The first in this two-part systematic review of the literature on oral health in persons with cleft lip and/or palate focuses on periodontal parameters and composition of oral bacterial flora, while the second analyzes data on dental caries.

MATERIALS AND METHODS

Four databases (PubMed, Cochrane, Scopus, Web of Science) were searched for studies that compared periodontal parameters, caries index, and microbiota composition between persons with cleft lip and/or palate and healthy controls. The Newcastle-Ottawa scale and the Joanna Briggs Institute checklist were applied to evaluate study quality.

RESULTS

A total of 24 studies underwent systematic review, 18 of which entered meta-analysis. Twenty studies included a control group, while four included only persons with orofacial cleft. The first part (18 studies) compared periodontal parameters and oral microbiota.

CONCLUSIONS

Meta-analysis of periodontal parameters (plaque index, gingival index, bleeding index, probing pocket depth, clinical attachment level) revealed an association between orofacial cleft and greater risk for poor oral health and periodontal disease. Good oral health relies on correct home oral hygiene and regular visits to the dentist starting at an early age.

Periodontal and microbiological evaluation in cleft lip/palate patients undergoing orthodontic treatment: A cross-sectional study

BACKGROUND

The present cross-sectional study was undertaken to evaluate the periodontal and microbiological parameters in patients with surgically repaired unilateral cleft lip and palate (UCLP) undergoing orthodontic correction in comparison to patients without any cleft or orthodontic treatment.

METHODS

A total of 120 patients, out of initial 148 patients, between the age group 6 and 18 years were enrolled and divided into four groups with 30 patients each: non-cleft patients without orthodontic treatment in Group 1, non-cleft patients undergoing fixed orthodontic treatment in Group 2, patients with UCLP without any orthodontic treatment in Group 3, and patients with UCLP undergoing fixed orthodontic treatment in Group 4. Periodontal parameters including plaque index (PI), gingival index (GI), gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) index, pocket probing depth (PD), and tooth mobility were measured in all the groups. The subgingival plaque samples of all the patients were subjected to microbial evaluation using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) for clinical diagnosis.

RESULTS

The periodontal parameters were significantly raised in Group 4, followed by Group 3 and Group 2 in comparison to Group 1 (p < 0.01), thereby suggesting poor periodontal health in patients with UCLP undergoing orthodontic treatment. Statistically significant differences (p < 0.01) in counts of micro-organisms among the groups were observed for P. gingivalis, P. intermedia, Veillonella, and Capnocytophaga, with the highest proportions in Group 4, indicating a deteriorating oral health in these patients.

CONCLUSION

Poor periodontal and microbial health in patients with UCLP undergoing orthodontic treatment indicates a need for reinforcement of oral hygiene practices among these patients.

PLAIN LANGUAGE SUMMARY

Patients with clefts of lip extending to the palate are prone to a number of oral health issues and often undergo treatment with fixed braces for teeth alignment. This may compromise the oral hygiene practice and alter the microbial flora of the oral cavity. The present study evaluated the oral health and microbial flora in patients with cleft lip and palate undergoing treatment with fixed braces in comparison to patients without any cleft or any treatment for teeth alignment. A total of 120 patients were divided into four groups. Group 1 had normal healthy individuals without any cleft or treatment for teeth alignment; Group 2 had individuals without any cleft but undergoing treatment with fixed braces for teeth alignment; Group 3 had patients with cleft lip and palate but no treatment for teeth alignment, whereas the patients undergoing treatment with fixed braces were included in Group 4. All the groups were checked for indices assessing the oral health, and microbial evaluation was also done. Patients with cleft lip and palate undergoing treatment with fixed braces were found to have poor oral health along with elevated microbial counts, signifying a need for improving oral hygiene practices in these patients.

Speech Aid Prostheses For Patients With Cleft and Other Craniofacial Birth Conditions

Normal speech production is a complex mechanism requiring the coordination of several organs of the oral cavity. The lip, hard and soft palates, and teeth all play a role in normal speech production. In cases of craniofacial birth conditions such as cleft lip and palate or ectodermal dysplasia, one or more of these areas may be compromised. Surgical correction is the most ideal means to provide normalcy but surgery may not always be appropriate or possible. In such cases, a speech aid prosthesis may serve as an interim or definitive way to normalize speech. This article describes the several options that may be employed toward this end.

Characterization and functional prediction of the dental plaque microbiome in patients with alveolar clefts

Introduction

Alveolar cleft (AC) is a common congenital defect in people with cleft lip and palate (CLP). Alveolar bone grafting (ABG) is typically performed during adolescence, resulting in the fissure remaining in the mouth for a longer length of time. Patients with AC have a greater rate of oral diseases such as dental caries than the normal population, and the precise characteristics of the bacterial alterations caused by AC are unknown.

Methods

We recruited a total of 87 subjects and collected dental plaque samples from AC adolescents (AAP), post-operative ABG adolescents (PAP), healthy control adolescents (CAP), AC young adults (AYP), post-operative ABG young adults (PYP), and healthy control young adults (CYP). The sequencing of 16S rRNA genes was performed.

Results

The microbial composition of plaque from alveolar cleft patients differed significantly from age-matched healthy controls. Linear discriminant analysis effect size (LEfSe) analysis revealed that AAP was enriched for Neisseria, Haemophilus, Fusobacterium, Rhodococcus, Aggregatibacter, Gemella, and Porphyromonas, whereas AYP was enriched for Capnocytophaga, Rhodococcus, and Actinomyces-f0332. There were phenotypic differences in facultatively anaerobic, Gram-negative, Gram-positive, and oxidative stress tolerance between the AYP group with longer alveolar cleft and the healthy control group according to Bugbase phenotypic predictions. Alveolar bone grafting did not alter the functional phenotype of alveolar cleft patients but reduced the number of differential genera between alveolar cleft patients and healthy controls at both ages.

Conclusions

Our study systematically characterized the supragingival plaque microbiota of alveolar cleft patients, post-alveolar bone grafting patients, and matched healthy controls in two ages to gain a better understanding of plaque ecology and microbiology associated with alveolar clefts.

The state of systemic immunity in congenital cleft lip and palate patients with diseases of oral cavity tissues

OBJECTIVE

Aim: To determine the state of dental health and the state of systemic immunity in patients in congenital cleft lip and palate patients.

PATIENTS AND METHODS

Materials and Methods: The dental status and immunologic tests of 74 patients age 8-18 years old with congenital cleft lip and palate was analyzed: 43 children with unilateral and 31 children with bilateral complete combined cleft lip, alveolar process, hard and soft palate.

RESULTS

Results: Indicators of the prevalence and intensity of the caries process in patients with congenital congenital complete cleft lip, alveolar process, hard and soft palate were high, especially in children with bilateral cleft lip and palate - the decompensated course of caries was determined in 41.93% patients, with unilateral - 23.25%. Сhronic catarrhal gingivitis was the most common in both groups of patients - the average severity of gingivitis prevailed - 51.16% with congenital unilateral cleft lip and palate and 51.61% - with bilateral. Atopic cheilitis, glossitis and chronic recurrent aphthous stomatitis were common. This patients have significant changes in the cellular chain of the immune system with a deficiency of the main phenotypes of lymphocytes - CD4+ CD8+ and inflammatory bacterial changes in blood serum.

CONCLUSION

Conclusions: Patients of unilateral and bilateral complete combined cleft lip, alveolar process, hard and soft palate have significant changes in the dental status and in the cellular chain of the immune system. The level of manifestation of these changes is directly proportional to the extent of localization of the pathology - unilateral or bilateral.

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.

Oral Microbiome as a Tool of Systemic Disease on Cleft Patients: A New Landscape

The oral cavity microbiome comprises benign and pathogenic bacteria, with more than 700 species identified. However, the current literature regarding resident bacterial flora in the oropharyngeal cavities in cleft lip/palate (CLP) patients still needs to be completed. This review aims to evaluate the role of the oral microbiome of cleft patients as an indicator in systemic diseases for which cleft patients might be at higher risk in the short or long term. A literature review was performed in July 2020 using Biomedical Reference Collection Comprehensive, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Dentistry & Oral Sciences Source via Elton B. Stephens Company/Online Database (EBSCO), Turning Research into Practice (TRIP), and PubMed. The keywords used were "oral, bacteria, microbiome, biota, flora, cleft, palate." The resulting 466 articles were deduplicated using Endnote. The total amount of articles' abstracts without duplicates was filtered using a set criterion. The title and abstract filter criteria included 1) cleft lip (CL) and/or cleft palate (CP) patients, 2) changes in the oral microbiome in CL and/or CP patients, 3) male and female patients 0-21 years old, and 4) English language. The full-text filter criteria included 1) CL and/or CP patients vs. non-cleft control patients, 2) oral bacteria, 3) nonprocedural measurements of microorganisms, and 4) case-control studies. A Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) flow chart was created using the EndNote data results. The final five articles of the systematic search indicated that the oral cavity of cleft lip and/or palate patients resulted in 1) contradicting levels of Streptococcus mitis and Streptococcus salivarius; 2) lower levels of Streptococcus gordonii, Bordetella dentium, Fusobacterium nucleatum, Veillonella parvula, Bacillus and Lautropia when compared to the control group; 3) higher levels of Staphylococcus epidermidis and Methicillin-sensitive Staphylococcus aureus compared to the control group; 4) presence of Enterobacter cloacae 36.6%, Klebsiella pneumoni 53.3%, and Klebsiella oxytoca 76.6% vs. absence in the control non-cleft group. Patients with CL and/or CP are at higher risk for caries, periodontal diseases, and upper and lower respiratory infections. The results from this review indicate that relative levels of certain bacteria may be associated with these issues. The lower levels of S. mitis, S. salivarius, S. gordini, and F. nucleatum in the oral cavity of cleft patients could be linked as a possible cause of the higher incidence of tooth decay, gingivitis and periodontal disease as high levels of these bacteria are associated with oral disease. Further, the higher incidence of sinusitis in cleft patients might be linked to low levels of S. salivarius in the oral profile of these patients. Likewise, E. cloacae, K. oxycota, and K. pneumoni have been linked with pneumonia and bronchiolitis, both of which are increased in cleft patients. The oral bacterial dysbiosis of cleft patients observed in this review may play a vital function in the oral microbiome's diversity, which could play a role in disease progression and disease markers. The pattern seen in cleft patients potentially demonstrates how structural abnormalities can lead to the onset of severe infection.