ABSTRACT
OBJECTIVE: Children with cleft lip and palate (CLP) present high incidence of oral health problems, namely those associated with the accumulation of dental plaque. The objective of this systematic review was to verify if there is any solution to improve the hygiene of the cleft area. MATERIALS AND METHODS: A structured systematic review was performed based on articles published in several electronic databases: PubMed, Web of Science, Cochrane Library and Scopus in the last 20 years. The MeSH terms used were cleft lip, palate, harelip, oral hygiene and toothbrush. RESULTS: From 270 potentially relevant articles, 39 articles were selected, corresponding to a total of 3226 CLP patients and 914 matched controls. The selected studies exhibited great heterogeneity regarding the type of the study, study population (average range 0 -49 years old; sampling sizes 15-400 CLP patients), evaluation periods, reported variables and oral hygiene routines. Consensual outcomes were the presence of high plaque indexes, high prevalence of dental caries and worse oral hygiene patterns in CLP patients. Additionally, poor education in oral health and low motivation to integrate regular hygiene routines in the daily family life were also evident. CONCLUSION: There is a clear need to improve the oral hygiene care of CLP children, but few studies were focused on specific preventive approaches. Development of devices especially designed to the hygiene of the cleft area and implementation of standardized prevention and control programmes targeting education, motivation and compliance would contribute to improve oral health in CLP children.
Subject(s)
Cleft Lip , Cleft Palate , Dental Caries/prevention & control , Dental Plaque/prevention & control , Oral Health , Oral Hygiene/methods , Patient Education as Topic , Adolescent , Adult , Child , Child, Preschool , Cleft Lip/psychology , Cleft Palate/psychology , Databases, Bibliographic , Female , Humans , Infant , Male , Middle Aged , Motivation , Toothbrushing , Young AdultABSTRACT
BACKGROUND: The anatomical and morphological alterations associated with cleft lip and palate (CLP) favour the buildup of dental plaque. AIM: To assess the efficacy of a new add-on to regular toothbrush-the Cleft Toothbrush, in removing the dental plaque of CLP patients, compared to a regular toothbrush. DESIGN: Forty-five children with CLP were randomly organized into two groups: A (n = 26, 2-6 years old) and B (n = 19, 7-12 years old). They were evaluated at days 0, 15, 30, and 60. After brushing their teeth with a regular toothbrush or with the Cleft Toothbrush, the dental plaque was recorded using an adapted Plaque Index (aPI). Data analyses were performed in IBM SPSS(c) , and all statistic inference comparisons were made using non-parametric tests. RESULTS: In the first 15 days, children used a new regular toothbrush and aPI-C (teeth adjacent to the cleft) was recorded. The Cleft Toothbrush, used by all children from day 15 to day 30, showed high efficacy in removing dental plaque in the cleft area, evidenced by significantly lower aPI-C values, compared to those observed with the regular toothbrush (P < 0.001). When given free option of brushing technique, from day 30 to day 60, most of the children (38 out of 45) chose the Cleft Toothbrush. CONCLUSIONS: The Cleft Toothbrush showed high efficacy in removing dental plaque in the cleft area, and presented high level of acceptance by parents and children, compared to a regular toothbrush. This is expected to improve the health status of the local adjacent tissues, a requirement for their rehabilitation.
ABSTRACT
This cohort study aimed to characterize the oral microbiome of children with CLP, from two different age groups, and evaluate the effect of supervised or unsupervised toothbrushing on the microbiome of the cleft over time. Swab samples were collected from the cleft area at three different time points (A; no brushing, B; after 15 days and C; after 30 days) and were analyzed using next-generation sequencing to determine the microbial composition and diversity in these time points. Overall, brushing significantly decreased the abundance of the genera Alloprevotella and Leptotrichia in the two age groups examined, and for Alloprevotella this decrease was more evident for children (2-6 years old). In the preteen group (7-12 years old), a significant relative increase of the genus Rothia was observed after brushing. In this study, the systematic brushing over a period of thirty days also resulted in differences at the intra-individual bacterial richness.