The aim of the study was to analyze the caries protective factors, salivary parameters, and microbial counts in high caries risk children with cleft lip and/or palate (CL/P).
Design:
This was a cross-sectional study.
Setting:
This study was conducted in a tertiary health care teaching hospital in New Delhi, India.
Participants:
The study was conducted in 40 children, 20 with CL/P and 20 without aged between 5 and 12 years.
Methods:
Children with 2 or more caries lesions in both groups were included in this study. Demographic details, dental caries of affected teeth (World Health Organization criteria for Decayed Missing Filled Teeth [WHO-DMFT] and International Caries Detection and Assessment System [ICDAS II]), caries protective factors, salivary parameters, and microbial counts were recorded by one calibrated investigator.
Main Outcome Measures:
Caries protective factors, salivary parameters, and microbial profile.
Results:
The Chi-square (χ2) test and Pearson correlation were used for statistical analysis. All the children participating in the study brushed their teeth only once in a day and consumed sweets more than twice a day. None of the children had ever received fluoride varnish. Resting saliva had a low buffering capacity in 80% of children with CL/P and 95% of children without CL/P. Microbial assessment of stimulated saliva showed that with the increases in the numbers (DMFT scores ≥4) and severity (ICDAS codes from 1-2 to 5-6) of caries lesions, both Streptococci and Lactobacilli counts were ≥105 colony-forming units/mL of saliva in the both groups.
Conclusions:
Children with CL/P showed limited access to caries protective measures and low buffering capacity in resting saliva, along with elevated levels of salivary Streptococci and Lactobacilli in stimulated saliva.
AasJAGriffenALDardisSRLeeAMOlsenIDewhirstFELeysEJPasterBJ. Bacteria of dental caries in primary and permanent teeth in children and young adults. J Clin Microbiol. 2008;46(4):1407–1417.
2.
AhluwaliaMBrailsfordSRTarelliEGilbertSCClarkDTBarnardKBeightonD. Dental caries, oral hygiene, and oral clearance in children with craniofacial disorders. J Dent Res. 2004;83(2):175–179.
3.
AllamEWindsorLJStoneC. Cleft lip and palate: etiology, epidemiology, preventive and intervention strategies. Anat Physiol. 2014;4(3):1–6.
4.
American Academy of Paediatric Dentistry. Guideline on caries-risk assessment and management for infants, children, and adolescents. Pediatr Dent. 2013;35(5):E157–E164.
5.
BadetCThebaudNB. Ecology of lactobacilli in the oral cavity: a review of literature. Open Microbiol J. 2008;2(1):38–48.
6.
BaligaSMuglikarSKaleR. Salivary pH: a diagnostic biomarker. J Indian Soc Periodontol. 2013;17(4):461–465.
7.
BokhoutBHofmanFXVan LimbeekJKramerGJPrahl-AndersenB. Incidence of dental caries in the primary dentition in children with a cleft lip and/or palate. Caries Res. 1997;31(1):8–12.
8.
BokhoutBvan LoverenCHofmanFXBuijsJFvan LimbeekJPrahl-AndersenB. Prevalence of Streptococcus mutans and lactobacilli in 18-month-old children with cleft lip and/or palate. Cleft Palate Craniofac J. 1996;33(5):424–428.
9.
CaufieldPWSchönCNSaraithongPLiYArgimónS. Oral lactobacilli and dental caries: a model for niche adaptation in humans. J Dent Res. 2015;94(9):110S–118S.
10.
DahllofGUssisoo-JoandiRIdebergMModeerT. Caries, gingivitis, and dental abnormalities in preschool children with cleft lip and/or palate. Cleft Palate J. 1989;26(3):233–237.
11.
DixonMJMarazitaMLBeatyTHMurrayJC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet. 2011;12(3):167–178.
12.
DurhanMATopcuogluNKulekciGOzgentasETanbogaI. Microbial profile and dental caries in cleft lip and palate babies between 0 and 3 years old. Cleft Palate Craniofac J. 2019;56(3):349–356.
13.
ErdemVYıldızMErdemT. The evaluation of saliva flow rate, pH, buffer capacity, microbiological content and indice of decayed, missing and filled teeth in Behçet’s patients. Balkan Med J. 2013;30(2):211–214.
14.
FowlerPVCorbettALeeMThompsonJMD. A retrospective nationwide study of the dental caries experience of New Zealand children with orofacial cleft. Community Dent Oral Epidemiol. 2020;48(1):42–48.
15.
HanHHChoiEJKimJMShinJCRhieJW. The importance of multidisciplinary management during prenatal care for cleft lip and palate. Arch Plast Surg. 2016;43(2):153–159.
16.
HaraAZeroD. The caries environment: saliva, pellicle, diet, and hard tissue ultrastructure. Dent Clin North Am. 2010;54(3):455–467.
17.
HarrisRNicollADAdairPMPineCM. Risk factors for dental caries in young children: a systematic review of the literature. Community Dent Health. 2004;21(1):71–85.
18.
HemadiASHuangRZhouYZouJ. Salivary proteins and microbiota as biomarkers for early childhood caries risk assessment. Int J Oral Sci. 2017;9(11):e1.
19.
HicksJGarcia-GodoyFFlaitzC. Biological factors in dental caries: role of saliva and dental plaque in the dynamic process of demineralization and remineralization (part 1). J Clin Pediatr Dent. 2003;28(1):47–52.
20.
HumphreySPWilliamsonRT. A review of saliva: normal composition, flow, and function. J Prosthet Dent. 2001;85(2):162–169.
21.
JohnsenDC. Dental caries patterns in preschool children. Dent Clin North Am. 1984;28(1):3–20.
22.
JohnsenDCDixonM. Dental caries of primary incisors in children with cleft lip and palate. Cleft Palate J. 1984;21(1):104–109.
23.
KharbandaOPAgrawalKKhazanchiRSharmaSCSagarSSinghalMMathurNNHandaKKKabraMGuptaN, et al.Clinical profile and treatment status of the subjects with cleft lip and palate anomaly in India: preliminary report of a three-center study. J Cleft Lip Palate Craniofac Anom. 2014;1(1):26–33.
24.
LagerlöfFOlivebyA. Caries-protective factors in saliva. Adv Dent Res. 1994;8(2):229–238.
25.
Llena-PuyC. The role of saliva in maintaining oral health and as an aid to diagnosis. Med Oral Patol Oral Cir Bucal. 2006;11(5):E449–E455.
26.
LucasVSGuptaROloladeOGelbierMRobertsGJ. Dental health indices and caries associated microflora in children with unilateral cleft lip and/or palate. Cleft Palate Craniofac J. 2000;37(5):447–452.
27.
MaheshDRKomaliGJayanthiKDineshDSaikavithaTVDineshP. Evaluation of salivary flow rate, pH and buffer in pre, post & post menopausal women on HRT. J Clin Diagn Res. 2014;8(2):233–236.
28.
MarshPD. Dental plaque as a biofilm and a microbial community - implications for health and disease. BMC Oral Health. 2006;6(1):S14.
29.
MednickLSnyderJSchookCBloodEABrownSEWeatherley-WhiteRC. Causal attributions of cleft lip and palate across cultures. Cleft Palate Craniofac J. 2013;50(6):655–661.
30.
MerrittL. Part 1. Understanding the embryology and genetics of cleft lip and palate. Adv Neonatal Care. 2005;5(2):64–71.
31.
MoritsukaMKitasakoYBurrowMFIkedaMTagamiJ. The pH change after HCl titration into resting and stimulated saliva for a buffering capacity test. Aust Dent J. 2006;51(2):170–174.
32.
MosseyPLittleJ. Addressing the challenges of cleft lip and palate research in India. Indian J Plast Surg. 2009;42(suppl):S9–S18.
33.
NewbrunEMatsukuboTHooverCIGravesRCBrownATDisneyJABohannaHM. Comparison of two screening tests for streptococcus mutans and evaluating their sustainability for mass screenings and private practice. Community Dent Oral Epidemiol. 1984;12(5):325–331.
34.
OginniFAdenekanA. Prevention of oro-facial clefts in developing world. Ann Maxillofac Surg. 2012;2(2):163.
35.
PaulTBrandtRS. Oral and dental health status of children with cleft lip and/or palate. Cleft Palate Craniofac J. 1998;35(4):329–332.
36.
PittsNEkstrandK, ICDAS Foundation. International Caries Detection and Assessment System (ICDAS) and its international caries classification and management system (ICCMS) - methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol. 2013;41(1):e41–e52.
37.
PittsNBStammJW. International consensus workshop on caries clinical trials (ICW-CCT)—final consensus statements: agreeing where the evidence leads. J Dent Res. 2004;83(1 suppl):125–128.
38.
SanghviRVaidyanathanMBhujelN. The dental health of cleft patients attending the 18-month-old clinic at a specialised cleft centre. Br Dent J. 2019;227(3):199–202.
39.
SundellALMarcussonA. A comparison of orofacial profiles in 5- and 10-year-old Swedish children with and without cleft lip and/or palate. Clin Oral Investig. 2019;23(3):1341–1347.
40.
SundellALUllbroCDahlénGMarcussonATwetmanS. Salivary microbial profiles in 5-year old children with oral clefts: a comparative study. Eur Arch Paediatr Dent. 2018;19(1):57–60.
41.
SundellALUllbroCMarcussonATwetmanS. Comparing caries risk profiles between 5- and 10- year-old children with cleft lip and/or palate and non-cleft controls. BMC Oral Health. 2015;15(1):85.
42.
TanzerJMLivingstonJThompsonAM. The microbiology of primary dental caries in humans. J Dent Educ. 2001;65(10):1028–1037.
43.
TenovuoJ. Salivary parameters of relevance for assessing caries activity in individuals and populations. Community Dent Oral Epidemiol. 1997;25(1):82–86.
44.
TolarovaMM. Global health issues related to cleft lip and palate: prevention and treatment need to team together. Indian J Dent Res. 2016;27(5):455.
45.
ToobaieAYousefYBalvardiSSt-LouisEBairdRGuadagnoEPoenaruD. Incidence and prevalence of congenital anomalies in low- and middle-income countries: a systematic review. J Pediatr Surg. 2019;54(5):1089–1093.
46.
VeigaKAPortoANMatosFZde BritoPCBorgesAHVolpatoLEAranhaAM. Caries experience and periodontal status in children and adolescents with cleft lip and palate. Pediatr Dent. 2017;39(2):139–144.
47.
WehbyGLCassellCH. The impact of orofacial clefts on quality of life and healthcare use and costs. Oral Dis. 2010;16(1):3–10.
48.
World Health Organization. Oral Health Surveys: Basic Methods. 3rd ed. World Health Organization; 1987:39–44.
49.
WorthVPerryRIrelandTWillsAKSandyJNessA. Are people with an orofacial cleft at a higher risk of dental caries? a systematic review and meta-analysis. Br Dent J. 2017;223(1):37–47.
