Cleft lip and palate (CL/P) is a common birth anomaly and is seen in around 1 in 700 live births. It may occur with other birth anomalies or syndromes or occur in isolation. A number of studies have suggested that people with CL/P may have higher caries experience although others have suggested the reverse. Of two earlier review one suggested that CL/P patients had higher caries the other found the evidence inconclusive.
The aim of this review was to assess if children born with an orofacial cleft have a higher risk of dental caries than individuals without cleft.
Methods
Searches were conducted in the MEDLINE, Embase, AMED, Cochrane Library, Proquest, CINHAL, British Nursing Index, HMIC, PsychINFO, Health Business Elite and Google Scholar databases. Reference list of retrieved studies and the journals the Cleft Palate Craniofacial Journal; The American Cleft Palate-Craniofacial Journal and The Journal of Cleft Lip and Palate and Craniofacial Anomalies were hand searched. Studies involving comparisons between a cleft group and a non-cleft group were considered. Studies involving patients with syndromic CL/P were only included if they included less than 20% of the study group.
Initial study selection was carried out by a single reviewer with selected full-text articles being assessed by two reviewers for final inclusion. Data abstraction and an assessment of study quality was undertaken by two reviewers independently. A random effects meta-analysis was performed in order to obtain an overall summary estimate of the difference in caries experience between CL/P and non-CL/P groups
Results
- 24 studies were included.
- 11 studies were from Europe, 9 Asia, 3 South America and 1 North America.
- 6 studies used age and sex matched controls, 15 used comparisons from dental clinics, hospitals or schools in the same geographical area, 1 used siblings and 2 national data.
- Examiner training and clinical examination procedures varied considerably
- 22 studies were included in a meta-analysis
- The overall pooled mean difference in dmft was 0.63 (95%CI; 0.47 to 0.79) suggesting that individuals with CL/P have a greater dmft experience compared to individuals without cleft.
- The overall pooled mean difference in DMFT was 0.28 (95% CI: 0.22 to 0.34) suggesting that individuals with CL/P have a greater DMFT experience compared to individuals without cleft.
Conclusions
The authors concluded: –
the systematic review and meta-analysis suggest that individuals with CL/P experience more decayed, missing or filled teeth when compared to non-affected individuals. Preventing and treating dental caries in children born with a cleft is therefore important. Further research is needed to describe and evaluate different integrated models of care for individuals with cleft lip and palate.
Comments
This review covers a topic covered by two earlier reviews the most recent being published in 2013 (Dental Elf – 30th Oct 2013). All three reviews have taken different approaches to the inclusion and exclusion criteria and these differences form part of the discussion of this latest review. The meta-analysis for both dmft and DMFT demonstrated significant heterogeneity and many of the included studies did not report details of the examination procedure. The was also variation in the source of the controls which explained some of the between study heterogeneity. It is also unclear whether any of the original studies took into consideration potential confounders such as socioeconomic status (SES), geographical location, age and dentition, gender, cleft type and syndromes, orthodontic treatment and fluoride.
While the results suggest an increase in caries experience for patients with CL/P in both primary and permanent dentition the limited quality of the available studies means that we should view the findings cautiously.
Links
Primary paper
Worth V, Perry R, Ireland T, Wills AK, Sandy J, Ness A. Are people with an orofacial cleft at a higher risk of dental caries? A systematic review and meta-analysis. Br Dent J. 2017 Jul 7;223(1):37-47. doi: 10.1038/sj.bdj.2017.581. PubMed PMID: 28684841
Other references
Original review protocol on PROSPERO
Dental Elf – 30th Oct 2013
Review suggests cleft lip and or palate patients may have higher prevalence of caries
