ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Patients With Cleft Lip, Alveolus And Palate May Be Predisposed To Periodontal Disease, Especially In Teeth Adjacent To The Cleft
Clinical Question Do patients with repaired cleft lip, alveolus, and palate have increased risk of periodontal disease compared to normal subjects?
Clinical Bottom Line While studies suggest that patient with cleft lip, palate and alveolus are predisposed to periodontal disease, especially in teeth near the cleft, further studies are required given lack of definitive evidence. Oral hygiene was also found to be poor in a majority of patients with cleft lip, alveolus, or palate, emphasizing the importance of good oral hygiene and close followup with these patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19732188Perdikogianni/200941 children w/ cleft lip or palateCase-Control Study
Key resultsCompared with controls, more patients with cleft lip or palate (31%) had 3.5 - 5.5 mm of probing depth for teeth in or neighboring the cleft than the maxillary incisors and canines in normal controls (5%, no p value given). There was no statistically significant difference (no p value given) between pocket probing depth for teeth in the cleft (2.23 +/- 0.55 mm for unilateral cleft lip and palate (UCLP), 2.2+/- 0.42 mm for bilateral cleft lip and palate (BCLP)) and neighboring the cleft (2.19 +/- 0.49 mm for UCLP, 2.14 +/- 0.38 mm for BCLP) in patients with cleft lip or palate. Furthermore, patients with cleft lip or palate had a greater average probing depth than controls (2.22 +/- 0.49 vs 1.85 +/- 0.38; p<0.007) as well as greater number of teeth with grade 1-3 mobility (35-65% based on type of defect vs 0% in controls, no p value given). Finally, patients with cleft lip or palate had a significantly higher plaque index on all maxillary anterior teeth (values vary by tooth, p< 0.005).
#2) 19703238Huynah-Ba/200920 children w/ cleft deformityProspective Cohort
Key resultsBoth patients with cleft lip, alveolus and palate (CLAP) as well as cleft lip or palate (CL/P) had a statistically significant decrease (p<0.05) in clinical attachment level (1.52 +/- 0.12 mm and 1.66 +/- 0.15 mm, respectively). However, only the CL/P patients had a statistically significant (p<0.05) increase in mean probing pocket depth (0.35 +/- 0.12 mm) while CLAP patients only had a non-statistically significant increase (p=0.60) in mean probing pocket depth (0.09 +/- 0.11 mm). Compared with control sites away from the cleft, cleft sites had a statistically significant (p<0.05) increase in probing pocket depth ( 0.92 +/- 1.13 mm at cleft sites vs 0.17 +/- 0.76 mm at sites away from the cleft). However, there was no significant difference (p=0.36) in clinical attachment loss between cleft sites and sites away from the cleft (2.71 +/- 1.46 mm vs 2.27 +/- 1.62 mm, respectively). With regards to oral hygiene, plaque control record scores significantly (p<0.05) increased in patients with cleft deformities on cleft associated sites (increased from 62% to 92%) over the 25 year period while sites distant from the cleft had stable scores (increased from 65% to 72%, p=0.36).
#3) 10102554Gaggl/199980 young adults w/ various celft deformitiesCase Series
Key resultsThe investigators found overall poor oral hygiene in groups with unilateral cleft lip, palate and alveolus (UCLPA), bilateral cleft lip, palate and alveolus (BCLPA), and cleft palate (CP). There was a mean loss of periodonatal attachment in the UCLPA, BCLPA, and CP groups of 4.3 mm, 3.9 mm, and 2.9 mm, respectively (no confidence intervals reported for the overall mean). There was a statistically significant difference (p<0.05) between the ULCPA and CP groups as well as the BCLPA and CP groups with regard to attachment loss. Plaque index measured on all teeth for patients w/UCLPA, BCLPA, and CP ranged from 65% to 73% corresponding to tendencies for poor oral hygiene. The authors note that there was no increase in periodontal disease in patients with only cleft palate compared to the general population, though patients w/ UCLPA and BCLPA were predisposed to deep periodontal destruction of teeth adjacent to the cleft.
Evidence Search "Cleft Palate"[Mesh] AND "Cleft Lip"[Mesh] AND "Periodontal Diseases"[Majr]
Comments on
The Evidence
All of the studies had a low number of patients. In the study by Perdikogianni H., et. al., while they did have a control group, they presented no p-values or confidence intervals in several of their comparisons. Furthermore, there was no comment on how patients were selected or other patient characteristics that may have biased the data. While Huynah-Ba G., et. al., results suggest that teeth adjacent to the cleft are more at risk for periodontal disease in normal subjects, one must use caution in generalizing this to compare with normal patients as there was no comparison to normal patients in this study. Nevertheless, significant progression of periodontal disease was noted within the groups over time. Gaggl et. al., also found that teeth close to the cleft are at risk of periodontal disease when compared to the general population, however, it is not cited in the article what data they are using for the general population, nor do they report p-values or confidence intervals when making this comparison.
Applicability The patients in the studies were all children and young adults with cleft deformities. This would apply to young adults who come to the periodontics clinic with cleft deformities for treatment.
Specialty/Discipline (Pediatric Dentistry) (Periodontics)
Keywords Cleft Lip, Cleft palate, periodontal disease, oral hygiene
ID# 2160
Date of submission: 10/07/2011spacer
E-mail Maldonadoalf@livemail.uthscsa.edu
Author Katherine Maldonado Alfandari
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
by Zachary Landgraf, Nicholas Aboud (San Antonio, TX) on 12/03/2017
A PubMed and TRIP search was performed in November 2017. More recent studies do not all agree, and therefore the effect of cleft lip and palate on periodontal disease incidence and severity needs to be further investigated. A case control study by de Almeida in 2012 (PMID: 21534842) found no correlation between gingival recession and cleft lip and palate. This is contradictory to other studies showing that there is a difference in various periodontal conditions in cleft patients compared to non-cleft patients. A case control study by Zhu in 2013 (PMID: 23452970) found that gingival recession and incisor proclination was worse in cleft vs. non-cleft patients. Celikoglu/2017 (PMID: 28962728) found in a case control study that bilateral cleft lip and palate patients had higher incidence of dehiscence (61.11% & 48.41%; maxillary & mandibular) compared to non-cleft patients (7.78% & 16.67% ; maxillary & mandibular). Presence of fenestrations was also found to be higher in cleft patients. Of note, this CAT question states “repaired cleft lip & palate”; however, the cited articles are all investigating patients with non-repaired clefts (i.e., the articles do not specify “repaired” CLAP/CP/CL).
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