Prevalence of tooth agenesis and supernumerary teeth related to different Thai cleft lip and cleft palate populations.

BACKGROUND: Pattern of dental anomalies encountered in cleft patients shows subtle signs of genetic involvement. This study aimed to evaluate the prevalence and pattern of tooth agenesis and supernumerary teeth in Thai cleft population according to the cleft type. METHODS: Data collected from patients with cleft lip and palate, who had been treated at Tawanchai Cleft Center, Khon Kaen University, Thailand, available during year 2012-2022, were investigated. Records from 194 patients with non-syndromic clefts met the inclusion criteria. Standard dental records, and at least either orthopantomogram (OPG) or cone beam computed tomography (CBCT), were examined. Statistical analysis was performed using chi-square and binominal test (p ≤ 0.05). RESULTS: Prevalence of tooth agenesis was higher (77.3%) than that of supernumerary teeth (5.7%) and was more common in bilateral cleft lip and palate (BCLP) (88.1%) than in unilateral cleft lip and palate (UCLP) (72.6%) (p = 0.017). The upper lateral incisor was more frequently affected (46.4%), followed by the upper second premolar. The number of missing teeth observed on the left side was significantly higher. Patients with left UCLP (ULCLP) had the highest prevalence of tooth agenesis. A total of 41 tooth agenesis code (TAC) patterns was found. The prevalence of supernumerary teeth was comparable with 6.6% of ULCLP, 5.1% of BCLP, and 4.5% of URCLP. Tooth-number anomalies were observed more often in the BCLP and were most likely to occur on the left side of the maxilla. Both types of anomalies could be featured in a small proportion of cleft patients. CONCLUSIONS: More than half of the patients with non-syndromic cleft lip and palate in this study, presented with tooth-number anomalies. Tooth agenesis was approximately 10-time more prevalent than supernumerary teeth. Tooth agenesis was likely to appear on the left-side of the maxilla regardless of the laterality of the cleft.

Maternal micronutrient biomarkers and risk of non-syndromic cleft lip/palate: A case-control study.

OBJECTIVE: This case-control study investigated the associations between maternal plasma vitamin B12, homocysteine, and red blood cell (RBC) folate levels and the risk of cleft lip with or without cleft palate (CL/P) in offspring. SUBJECTS AND METHODS: The study compared 94 mothers and children with non-syndromic CL/P from a teaching hospital in Thailand to 94 mother-infant controls from local well-baby clinics, frequency-matched by birth date and mother's education. Data included anthropometric measurements, blood sample analyses, and a questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) estimated the associations through multiple logistic regression, adjusting for confounders. RESULTS: Mothers with higher plasma vitamin B12 levels had a lower risk of having a child with CL/P compared to those in the lowest quartile. This association was more pronounced among mothers without a family history of orofacial clefts and those who were not underweight. Conversely, elevated homocysteine levels, a marker of impaired B vitamin metabolism, increased the risk of CL/P. No association was found between RBC folate and CL/P. CONCLUSION: Higher maternal vitamin B12 levels are associated with a reduced risk of CL/P, while elevated homocysteine levels may increase the risk.

Maternal Metabolic Status and Orofacial Cleft Risk: A Case-Control Study in Thailand.

OBJECTIVES: Metabolic syndrome (MetS) has been suggested to play a role in congenital defects. This study investigated the association of MetS and its components with orofacial clefts (OFCs). METHODS: We conducted a case-control study in Northeast Thailand. Ninety-four cases with cleft lip, with or without cleft palate, were frequency matched with 94 controls on the infant's age and mother's education. We administered a mother's health questionnaire and collected anthropometric measurements and blood samples. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses were performed among infants without a family history of OFCs, mothers who were not currently breastfeeding, and mothers who were >6 months postpartum. RESULTS: When compared to mothers of normal weight, the OR associated with OFCs were 2.44 (95% CI, 1.04-5.76, P = .04) in overweight mothers, and 3.30 (95% CI, 1.14-9.57, P = .03) in obese mothers. Low HDL-C raised the risk of OFCs 2.95 times (95% CI, 1.41-6.14, P = .004) compared to normal HDL-C levels. Mothers with 4 or 5 features of MetS were 2.77 times as likely to have the affected child than those who did not (95% CI, 0.43-17.76), but this difference was not statistically significant (P = .28). Subgroup analyses showed similar results, uncovering an additional significant association between underweight mothers and OFCs. CONCLUSIONS: The results indicate a robust association between underweight and overweight/obese maternal body mass index and increased OFC risk. Additionally, low HDL-C in mothers is linked to an elevated risk of OFCs. Further research is needed to evaluate if promoting strategies to maintain optimal body weight and enhance HDL-C levels in reproductive-age and pregnant women icould contribute to a reduction of the risk of OFCs in their progeny.

Effectiveness of the Nasal Creator Device after Cheiloplasty in Patients with Cleft Lip and Palate as Measured by 3D Stereophotogrammetry.

OBJECTIVE: To evaluate nostril morphology post-cheiloplasty after patients with unilateral cleft lip and palate (UCLP) use of the nasal creator device. STUDY DESIGN: This is a prospective study. Sixteen patients with nonsyndromic UCLP treated at Khon Kaen University underwent cheiloplasty and then wear the nasal creator device for 6 months. Three-dimensional images were taken, from which 5 lines and 8 landmark points were evaluated prior to (T0) and 1 day (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after cheiloplasty. A Repeated Measure ANOVA was used to evaluate nostril changes between time periods and a paired t-test was used to compare values between the affected and non-affected side at T4 (P < .05). RESULTS: On the affected side, the nostril height significantly increased from T0 (2.46±0.89 mm) to T4 (4.22±1.03 mm), and the nostril width significantly decreased from T0 (9.46±2.57 mm) to T4 (7.34±1.41 mm). On the non-affected side, the nostril height significantly increased from T0 (3.39±0.78 mm) to T4 (4.65±1.07 mm), and the nostril width was not significantly different from T0 (6.00±1.25 mm) to T4 (6.59±0.95 mm). The alar base width was not significantly different between T0 (30.18±2.72 mm) and T4 (29.82±1.69 mm). Nostril height and width were not significantly different by T4 when comparing the affected and non-affected sides. CONCLUSION: Using nasal creator device for 6 months significantly increased the nostril height and decreased nostril width and alar base width after cheiloplasty.

In vitro resorbability and granular characteristics of 3D-printed hydroxyapatite granules versus allograft, xenograft, and alloplast for alveolar cleft surgery applications.

Three-dimensionally printed hydroxyapatite (3DP HA) was investigated in regards to its functional properties supporting bone regeneration and tooth movement in alveolar cleft applications. Commercially available bovine xenograft (BXG), biphasic calcium phosphate alloplast (BCP), and two types of freeze-dried bone allograft granules (FDBA and FDBA-CMC) were employed as control samples. Degradability was studied by submerging the samples in pH 7.4 buffered solution at 37°C for 28 days and determining subsequent weight loss percentage. The wicking property and granular agglomeration were evaluated by putting the granules in contact with deionized water, blood, and phosphate-buffered saline (PBS). Both of FDBA and FDBA-CMC showed the greatest weight loss at 28 days followed by 3DP HA. In contrast, 3DP HA showed significantly greater wicking ability than other samples for all liquid types. FDBA-CMC exhibited the greatest granular agglomeration for all liquid types followed by 3DP HA. 3DP HA was found to be a favorable candidate for bone grafting in alveolar cleft treatment.

Function of Nasoalveolar Molding Devices in Bilateral Complete Cleft Lip and Palate: A 3-Dimensional Maxillary Arch Analysis.

OBJECTIVE: This study aimed to observe and analyze the effects of nasoalveolar molding (NAM) on maxillary arch dimensions in patients with bilateral complete cleft lip and palate (BCLP) using 3-dimensional analyses. DESIGN: Retrospective case series. MATERIALS AND METHODS: Seventeen infants were treated using modified Khon Kaen University presurgical nasoalveolar molding devices (KKU-NAM). Dental casts were evaluated 3 dimensionally at 3 time points: pretreatment (T1), after using modified KKU-NAM for 2 weeks (T2), and before cheiloplasty (T3). Repeated-measures analysis of variance and Friedman test were used to compare the maxillary arch dimensions between time points. RESULTS: Both sides of the cleft width, premaxilla deviation, and premaxilla protrusion had significantly reduced with the use of KKU-NAM. Premaxillary rotation had significantly improved, whereas the arch depth did not change significantly. Premaxilla width, posterior arch width, alveolar length, and height had significantly increased. The anterior arch width, intercanine width, and lateral sulcus width showed no significant changes. The intraclass correlation coefficient used to test the measurements indicated substantial reliability. CONCLUSION: The modified KKU-NAM is an effective device for reducing the severity of bilateral cleft deformities, especially in the premaxilla area.

Evaluation of Postorthodontic Changes in the Treatment of Cleft Lip and Palate Patients Using the PAR Index.

OBJECTIVE: To evaluate dental changes in cleft patients after undergoing orthodontic treatment for at least 2 years. HYPOTHESIS: The dental change would decline significantly after 2 years of completing orthodontic treatment. DESIGN: This is a retrospective study. PATIENT: Eighteen repaired cleft lip and palate patients from the Faculty of Dentistry, KhonKaen University, Thailand, participated in this study. MEAN OUTCOME MEASURES: A dental model with before treatment (T0), completed treatment (T1), and retention period (T2) data was analyzed using the peer assessment rating (PAR) index. RESULT: The results showed that the PAR score improved enormously after treatment; from T0 to T1, it was 34.00 ± 10.01 to 4.67 ± 2.47, and there was a reversion in the retention period. There was statistical significance between T0, T1, and T2, with P values <.001, .005, and <.001 when comparing T0 with T1, T1 with T2, and T0 with T2, respectively. CONCLUSION: Occlusion in cleft lip and palate patients changed from the time of completing treatment to the final results after the retention period. To sustain satisfactory results, orthodontists should plan carefully for the retention period before performing the treatment.

Evaluation of the Effects of Cheiloplasty on Maxillary Arch in UCLP Infants Using Three-Dimensional Digital Models.

OBJECTIVE: To analyze and identify changes in the maxillary dental arch before and after cheiloplasty in a group of unilateral complete cleft lip and palate (UCLP) infants. DESIGN: This is a cohort study. MATERIAL AND METHOD: Study models from 16 infants with nonsyndromic UCLP, who were treated at Khon Kaen University, were taken before (T1) and after cheiloplasty (T2). The dental models underwent a process of scanning through a 3D scanner, from which 9 linear and 2 angular landmarks were evaluated. Paired t test was used to compare the measurement statistically between T1 and T2. RESULTS: Alveolar cleft gap (G-L), anterior basal angle (∠GC-CC'), and anterior arch curvature angle on greater segment (∠GIC) were significantly decreased (P < .05). Contrarily, anterior ridge length of greater segment (C-I), anterior ridge length of lesser segment (L-C'), and posterior arch width (T-T') were significantly increased (P < .05) after cheiloplasty. While, anterior portion of greater segment (I-G), anterior arch width (C-C'), anterior arch depth (I⊥CC'), arch length (G⊥TT'), and arch circumference (T-C-I-G-L-C'-T') showed no significant difference. The measurements were tested using the Intraclass correlation coefficient. The coefficients indicated high reliability. CONCLUSION: Cleft gap significantly decreased after lip repair, and the anterior part of maxillary dental arch was also bent palatally after cheiloplasty without any other intervention except cheiloplasty. More studies are needed to assess the amount of lip pressure. If any convincing force is presented, an appliance to prevent undesirable pressure is indicated.

Maternal exposures and risk of oral clefts in South Vietnam.

BACKGROUND: Oral clefts are among the most common congenital anomalies. Most studies on risk factors of oral clefts have been carried out in developed countries. We investigated the associations between maternal exposures in the first trimester and oral clefts in South Vietnam. METHODS: We conducted a hospital-based case-control study during October 2014-November 2015. Cases included 170 patients with nonsyndromic cleft lip with or without cleft palate and those with cleft palate only. Controls were 170 children without oral clefts, matched to each case by age and gender. Mothers were interviewed using structured questionnaire. We performed conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Passive smoking was associated with increased risk of oral clefts in univariate analysis, but not in multivariable analysis (adjusted OR [aOR] = 1.68; 95% CI, 0.53-5.37). No association was observed between liver intake and oral clefts. Compared with nondrinkers, mothers who reported consumption of caffeine-containing beverages were more likely to have an infant with oral cleft (aOR = 5.89; 95% CI, 1.08-32.00). Periconceptional use of folic acid and multivitamins supplementation was associated with reduced risk of oral clefts (aOR = 0.01; 95% CI, 0.00-0.09 and aOR = 0.03; 95% CI, 0.01-0.13, respectively). CONCLUSIONS: The results suggest no associations of maternal passive smoking or liver intake with oral clefts. Periconceptional use of folic acid or multivitamins may protect against oral clefts. Further studies are warranted to examine the roles of caffeine consumption in pregnant mothers on occurrence of oral clefts in offspring.

Xylitol-containing Chewing Gum for Caries Prevention in Students with Disabilities: A Randomised Trial.

PURPOSE: This cluster randomised controlled trial evaluated the effectiveness of a school-based xylitol chewing-gum programme on caries prevention among students with visual or hearing impairment. MATERIALS AND METHODS: The study compared xylitol gum plus oral health education (intervention group, n = 93) with oral health education alone (control group, n = 81) among students aged 7-18 years in special needs schools in Khon Kaen, Thailand. The primary outcome was caries onset rate measured as the change in caries onset on tooth surfaces. The secondary outcome was plaque index. Between-group differences were determined using generalised estimated equations and a general linear model under the intention-to-treat approach. RESULTS: After 1 year, there was a significantly lower caries rate in the primary dentition among the intervention group compared to the control group (0.08 vs 0.12 surfaces per surface-year, respectively; adjusted relative risk = 0.64, 95% confidence interval 0.44-0.96; p = 0.03), but there was no significant difference in the caries rates for the permanent dentition. Remineralisation also occurred more in the intervention vs the control group in the primary dentition only. Oral hygiene was significantly improved in the intervention but not in the control group (p = 0.001). CONCLUSION: This programme reduced the caries rate and enhanced remineralisation in primary dentition, and improved oral hygiene in students with disabilities.

Case-control study of nutritional and environmental factors and the risk of oral clefts in Thailand.

BACKGROUND: One infant in 700 is born with an oral cleft. Prior studies suggest low micronutrient status is associated with an increased risk of oral clefts. Environmental factors such as passive smoke exposure or supplement use may also affect oral cleft risk. We examined nutrition and environmental related risk factors for oral clefts. METHODS: We conducted a case-control study in Northeast Thailand in 2012 to 2013. We enrolled 95 cases and 95 controls. We recruited cases with a nonsyndromic cleft lip with or without a cleft palate (CL±P) less than 24 months old. Cases were matched to controls on age and place of conception. We collected survey data, a food frequency questionnaire, and measured zinc concentrations in toenail trimmings. We calculated descriptive statistics by case and control status. We used conditional logistic regression to estimate unadjusted and adjusted associations, 95% confidence intervals (CIs), and p-values. RESULTS: Any liver intake (adjusted OR [aOR] for ≥1/week versus none), 10.58; 95%CI, 1.74-64.37, overall p = 0.02) and the presence of food insecurity (aOR, 9.62; 95% CI, 1.52-61.05; p = 0.02) in the periconceptional period increased CL±P risk. Passive smoke exposure increased the risk of CL±P (aOR, 6.52; 95% CI, 1.98-21.44; p < 0.01). Toenail zinc concentrations were not associated with CL±P risk. CONCLUSION: Our findings add to a growing body of knowledge of environmental risk factors for oral clefts from low- and middle-income countries. Our findings on liver are contradictory to prior results. Large multisite studies are needed to identify environmental and genetic risk factors for oral clefts. Birth Defects Research (Part A) 106:624-632, 2016. © 2016 Wiley Periodicals, Inc.

Oral Health-Related Quality of Life in Children and Young Adolescent Orthodontic Cleft Patients.

OBJECTIVE: To evaluate and compare the oral health-related quality of life (OHRQoL) in Thai patients with cleft lip and palate and to evaluate parents' and their children perceptions. MATERIAL AND METHOD: Child Oral Health Impact Profile (COHIP) questionnaire was used to evaluate OHRQoL of the patients and parents' perceptions of patients' OHRQoL. The subjects consisted of 140 cleft patients (aged 8-15 years) and their parents who visited the Department of Orthodontics, Khon Kaen University. RESULTS: COHIP scores in cleft patients were relatively high. No statistically significant differences were found for overall and subscales COHIP scores between gender and age groups (aged 8-11 and 12-15 years) of patients. Comparison among cleft types, overall COHIP and functional well-being subscales scores showed statistically significant differences (p = 0.01 and p = 0.002, respectively). Cleft lip with or without alveolus (CL/A) had higher overall and functional well-being subscale scores than unilateral and bilateral cleft lip and palate patients (CLP). Only self-image subscale scores were statistically significant differences between patients and parents at p<0.001. CONCLUSION: Young and adolescent patients with cleft lip and palate had generally positive oral health-related quality of life. Impacts of gender and age of patients on OHRQoL were similar CL/A patients had more positive in overall oral health-related quality of life and functional well-being domains than CLP patients did. Parents had higher perceptions of self-image shown by their children than the children themselves.

Correlations between Cervical Vertebral Maturation (CVM) and Dental Development in Thai Cleft Patients.

OBJECTIVE: To examine correlations between cervical vertebral maturation stages (CVMs) and dental development stages, and cervical vertebral maturation (CVM) stage 6 and completion of root formation of mandibular third molar in Thai cleft patients. MATERIAL AND METHOD: Lateral cephalograms of 366 cleft subjects aged 7-9 years were assessed for CVMs using Baccetti method. Calcication stages of all left mandibular teeth within each CVMs were assessed from panoramic films using Demirjian method. RESULTS: Spearman rank correlation coefficients comparing CVMs and teeth were 0.51-0.79 (p<0.001). Second molar had the highest and central incisor had the lowest correlations. In CVMs 6, 2.9% of third molars had completed root formation. However, only CVMs 6 could be predicted from third molar stage G that had a high likelihood ratio (30.94). CONCLUSION: Dental development was highly correlated with CVM in clefts. Third molar stage G could predict completed growth of mandible in individual patients, but it should be combined with other maturation indicators.

Oral health status and oral impacts on quality of life in early adolescent cleft patients.

OBJECTIVE: To determine the levels of dental caries, periodontal disease and oral health-related quality of life in children with cleft lip and/or cleft palate compared to non-cleft controls. MATERIAL AND METHOD: This cross-sectional study was conducted in Khon Kaen, Thailand. Subjects included 68 oral cleft and 118 non-cleft individuals aged 10-14 years, who were interviewed using the Child-Oral Impacts on Daily Pemformance (Child-OIDP) index and received oral examinations. RESULTS: Decayed, missing and filled teeth (DMFT) index in permanent teeth, plaque index (PI), and gingival index (GI) scores were significantly higher in the children with cleft than in the controls. However, there was no significant difference in caries prevalence and decayed, missing and filled teeth (dmnft) index inprimaly teeth between comparison groups. The prevalence of oral impacts on Speaking and Smiling was significantly higher in the cleft children than non-cleft controls. The mean impact score between both groups were not significantly different, but the cleft children with impacts had a significantly higher mean impact score (11.9) than did the controls (8.6). The impact score in the cleft children was high for speaking (4.5), emotion control (4.2), eating (3.4) and relaxing (3.4) activities. The main causes of these impacts included having oro-nasalftstula, having orthodontics appliance, position of teeth and deformity of mouth or face. CONCLUSION: The cleft children had higher levels ofdental caries and gingivitis, and poorer oral hygiene than the controls. They also had lower quality of life than the controls in most pelformances with different perceived causes.