Epidemiologic trends of infants with orofacial clefts in a multiethnic country: a retrospective population-based study.

Cleft births surveillance is essential in healthcare and prevention planning. Data are needed in precision medicine to target upstream management for at-risk individuals. This study characterizes Singapore's population-based orofacial cleft topography by ethnicity and gender, and establishes the cleft cohort's infant mortality rate. Data, in the decade 2003 to 2012, were extracted by the National Birth Defects Registry. Trend testing by linear regression was at p < 0.05 significance level. Prevalence per 10,000 for population-based cleft live births was 16.72 with no significant upward trend (p = 0.317). Prevalence rates were 8.77 in the isolated cleft group, 7.04 in the non-isolated cleft group, and 0.91 in the syndromic cleft group. There was significant upward trend in infants with non-isolated clefts (p = 0.0287). There were no significant upward trends in infants with isolated clefts and syndromic clefts. Prevalence rates were sexually dimorphic and ethnic-specific: male 17.72; female 15.78; Chinese group 17.17; Malay group 16.92; Indian group 10.74; and mixed ethnic origins group 21.73. The overall infant mortality rate (IMR) was 4.8% in the cohort of 608 cleft births, which was more than double the population-based IMR of 2.1% in the same period. Infants with non-isolated and syndromic clefts accounted for 96.6% of the deaths.

Dental Subphenotypes in Infants With Orofacial Clefts-A Longitudinal Population-Based Retrospective Radiographic Study of the Primary and Secondary Dentitions.

OBJECTIVES: To determine the developmental patterns of primary and secondary dentitions in infants with orofacial clefts. DESIGN: Retrospective, longitudinal, population-based cohort study. MATERIALS: Longitudinal records and radiographs of 192 nonsyndromic Northern European infants with isolated unilateral cleft lip (UCL, n = 111) and isolated cleft palate (CP, n = 81). METHODS: Radiographic assessments of primary and secondary dentition anomalies and dental maturation, by gender and cleft severity for comparisons between the groups and with historical controls. RESULTS: In infants with UCL, the frequencies of dental anomalies were high in both primary (38.7%) and secondary (18.0%) dentitions. Primary and secondary dentition anomalies were not observed in infants with CP and different in the UCL group (P = .003). Risk differences involved primary supernumerary teeth (P = .0001) and talon cusp formation (P = .0001), and secondary tooth agenesis (P = .001) of the maxillary lateral incisor on the side of the cleft lip. Delayed primary and secondary dental maturation occurred in the UCL and CP groups, greater in infants with UCL (P < .0001). Primary and secondary dental maturation featured sexual dimorphism with greater delay in males (UCL, P < .0001; CP, .0001 > P = .001). The effect of cleft severity on dental maturation was significant in infants with UCL (P = .0361) and CP (P = .0175) in the primary but not in the secondary dentition. CONCLUSIONS: There were different dental anomalies in the primary and secondary dentitions in operated infants with UCL and no dental anomalies in unoperated infants with CP. Dental maturation was delayed in infants with UCL and CP with greater delay in males compared to females.

Temporomandibular disorders in prospective orthodontic patients.

OBJECTIVES: To determine the prevalence and severity of temporomandibular disorders (TMDs) in prospective orthodontic patients. The association between TMDs and malocclusion severity as well as the impact of TMDs on oral health-related quality of life (OHRQoL) were also examined. MATERIALS AND METHODS: A total of 350 consecutive patients seeking orthodontic treatment were invited to participate in the study. The presence of TMDs was established with the Fonseca Anamnestic Index (FAI), while malocclusion severity and OHRQoL were evaluated using the Peer Assessment Rating (PAR) index and Oral Health Impact Profile-14 (OHIP-14), respectively. Data were analyzed using chi-square, Kruskal-Wallis, and Mann-Whitney U tests and Spearman's correlation (P < .05). RESULTS: Of the 350 patients, 164 consented to participation. Data from 26 participants were excluded because of incomplete entries, and that from 138 subjects (mean age 21.02 ± 5.45 years) were examined. TMD-related symptoms were present in two-thirds of the subjects, with 20.3% experiencing moderate/severe TMDs. While no significant difference in PAR scores were observed between the group with no TMDs and those with TMDs, subjects with TMDs had significantly higher OHIP-14 summary/domain scores than those without TMDs. Although a moderately strong correlation was observed between the FAI and summary OHIP-14 scores (rs = 0.57), no association was observed between FAI and PAR index scores. CONCLUSIONS: The prevalence of TMD-related symptoms in prospective orthodontic patients was high, emphasizing the importance of screening the masticatory system before initiating orthodontic therapy. Although the presence of TMDs was not associated with malocclusion severity, it had a significant negative impact on OHRQoL.

Deep orofacial phenotyping of population-based infants with isolated cleft lip and isolated cleft palate.

Isolated orofacial clefts (OFC) are common with poorly understood aetiology. Heterogeneous phenotypes and subphenotypes confound aetiological variant findings. To improve OFC phenome understanding, population-based, consecutive, pre-treatment infants with isolated unilateral cleft lip (UCL, n = 183) and isolated cleft palate (CP, n = 83) of similar ancestry were grouped for deep phenotyping. Subphenotypes stratified by gender and cleft severity were evaluated for primary dental malformations and maturation using radiographs. We found that cleft severity and tooth agenesis were inadequate to distinguish heterogeneity in infants with UCL and CP. Both groups featured slow dental maturity, significantly slower in males and the UCL phenotype. In 32.8% of infants with UCL, supernumerary maxillary lateral incisors were present on the cleft lip side, but not in infants with CP, suggesting a cleft dental epithelium and forme fruste cleft dentoalveolus of the UCL subphenotype. The findings underscored the importance of deep phenotyping to disclose occult OFC subphenotypes.

Oral Appliances in the Management of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP). Although effective, oral appliances are less predictable in managing OSA compared with CPAP therapy. Measures can be taken to improve predictability of oral appliance treatment.

Secondary dentition characteristics in an ethnic Chinese orthodontic population: A retrospective cross-sectional study.

AIM: To determine the prevalence of dental anomalies and its association with gender. METHODS: This retrospective cross-sectional study was conducted using radiographs, photographs and clinical records of patients who attended the Department of Orthodontics at the National Dental Centre Singapore. Records of 2508 ethnic Chinese orthodontic patients aged 14-25 years were examined for the prevalence of dental anomalies in the permanent dentition, excluding third molars. Statistical analyses were performed using SAS version 9.4 (SAS Institute Inc.). Logistic regression was used to determine the association between gender and the occurrence of various dental anomalies. Kappa coefficients were calculated to test for intra-examiner reproducibility. Statistical significance was set at P < 0.05. RESULTS: Prevalence of dental anomalies was 5.7% hyperdontia, 11.1% hypodontia, 5.5% peg-shaped upper lateral incisors, 21.9% impacted teeth, 1.3% transposition and 0.4% double teeth. There was no significant gender difference in the occurrence of the anomalies except hyperdontia, with males having significantly higher odds of hyperdontia compared with females (odds ratio, 1.488; 95% confidence interval, 1.062-2.085; P = 0.021). CONCLUSION: Occurrence of hyperdontia is greater in males than females, while no significant gender differences were noted for hypodontia, peg-shaped upper lateral incisors, impacted teeth, transposition and double teeth.

Oral Appliances in the Management of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP). Although effective, oral appliances are less predictable in managing OSA compared with CPAP therapy. Measures can be taken to improve predictability of oral appliance treatment.

Secondary Dentition Characteristics in Children With Nonsyndromic Unilateral Cleft Lip and Palate: A Retrospective Study.

OBJECTIVE: Children with cleft lip and palate are reported to be commonly associated with higher prevalence of dental anomalies such as hypodontia, supernumeraries, and abnormalities in tooth size, shape, and position. This study investigated the prevalence of dental anomalies in a longitudinal cohort of children with unilateral cleft lip and palate (UCLP). DESIGN: The study was a retrospective analysis of radiographs, study models, and treatment notes. PATIENTS: Sixty patients with repaired UCLP aged 13 years old with complete dental records dating from 5 years of age were included. METHODS: Study casts, dental panoramic, anterior maxillary occlusal, and periapical radiographs of the patients were examined for cleft-sidedness, congenitally missing permanent teeth, supernumerary teeth, microdontic, and macrodontic teeth in the anterior maxillary region, presence of malformed permanent cleft-sided lateral incisor and its morphology (peg-shaped, conical shaped, canine-formed), positions of the permanent lateral incisors relative to the cleft side and presence of rotated cleft-sided central incisors. RESULTS: Of the 60 patients studied, 63.3% had hypodontia, 21.7% had supernumerary teeth, 69.6% had microdontia, and 12.5% had macrodontia. All of the cleft-sided permanent lateral incisors had associated anomalies, with a large proportion (43.1%) missing; and when present in 31 subjects, the majority (90.3%) was positioned distal to the cleft. Most of the cleft-sided permanent central incisors were rotated if present, and prevalent at 86.7%. CONCLUSION: A high prevalence of dental anomalies was observed in this sample of children with UCLP.

Corrigendum to "A Study of Success Rate of Miniscrew Implants as Temporary Anchorage Devices in Singapore".

[This corrects the article DOI: 10.1155/2015/294670.].

Dental maturation of unilateral cleft lip and palate.

Cleft lip and palate (CLP) is the most common craniofacial abnormality and the fourth most common birth defect in Singapore. Many reports suggest that CLP children have delayed dental development and asymmetrical timing of tooth-pair formation. The aim of this study was to investigate the timing of development of permanent teeth in unilateral CLP (UCLP) children and to compare the findings with non-CLP children in Singapore. A total of 60 UCLP children aged between 5 and 9 years (mean 6.64 ± 0.90 years) and a non-CLP control group matched for age, gender, and race were investigated and compared. Dental records and radiographs were studied and the dental maturation was determined using the Demirjian's method (1973). The dental maturation of UCLP children were delayed compared with non-CLP children by a mean of 0.55 ± 0.75 years and the delay was statistically significant (P < 0.001). The UCLP group also had significantly higher risk of asymmetrically developing tooth pairs than the control group (P < 0.001). The most commonly delayed tooth in development was the maxillary cleft-sided lateral incisor. In conclusion, the UCLP children in Singapore demonstrated delayed dental maturation and a higher occurrence of asymmetrical tooth-pair formation than the non-CLP children.

Computer prediction of hard tissue profiles in orthognathic surgery.

The purpose of this retrospective study was to analyze the accuracy of computer predictions by CASSOS (Computer-Assisted Simulation System for Orthognathic Surgery) 2001 software (2000 SoftEnable, Technology). Forty adult patients who had undergone orthognathic surgery were evaluated. Pre- and postsurgical lateral cephalographs were scanned into the computer, and 71 landmarks for each cephalograph were digitized. Digitization error was assessed from repeated digitizations. A customized cephalometric analysis consisting of 14 measurements was used in this study. Predicted and actual postsurgical hard tissue landmarks were compared using the Student t test. Results showed good correlation between repeated digitization for all measurements. There were no statistically significant differences in 10 of the 14 measurements. The differences that were statistically significant were in angular measurements for SNA angle, upper incisor to maxillary plane angle (U1-MxP), interincisal angle (U1-L1), and upper incisor to anterior cranial base angle (U1-SN). The greatest mean difference measured was the interincisal angle (U1-L1) which, although statistically significant, was clinically insignificant. This investigation showed that CASSOS 2001 software provides accurate hard tissue prediction for orthognathic surgical procedures.