A service evaluation of the dental and oral health of 5-year-old patients attending a specialised cleft centre

摘要

In the UK, cleft lip and/or palate (CLP) malformation occurs in 1 in 600-700 livebirths each year owing to the failure of fusion or migration in utero. Consequently, these defects are the most common craniofacial congenital abnormality. The aetiology of CLP is multi-factorial, and it can be attributed to both genetic and environmental factors. Cleft children suffer from a range of complications comprising hearing and speech difficulties, aesthetic concerns and psychological issues. More relevant to dentistry, it is well known that cleft patients are more likely to have a greater incidence of dental anomalies. A study of 162 patients with CLP showed 94% of the patients had at least 1 anomaly. These anomalies include hypodontia, presence of supernumerary teeth, hypoplasia and impacted teeth. As a result, the need for orthodontic treatment will be higher and both these factors combined contribute to an added challenge in achieving optimal oral hygiene. Furthermore, numerous studies have shown links between cleft patients and increased dental caries prevalence. A systematic review by Worth et al demonstrated a higher decayed/ missing/filled teeth (dmft) score in patients with CLP. Orthodontic treatment and poorer oral hygiene can also be conducive to an increased risk of dental caries in cleft patients. In England, a quarter of all children aged five years will have dental caries and among those aged 5-9 years, dental caries are the most common cause for hospital admission. All CLP patients fall into the high risk category for dental caries and are therefore expected to be registered with a general dental practitioner (GDP) and to attend for regular check-ups, as per the Delivering Better Oral Health toolkit.