|Year : 2022 | Volume
| Issue : 1 | Page : 36-40
Prevalence of dental anomalies in different cleft lip and palate groups: A survey
Ritu Sanjaykumar Somani, Dolly Patel, Mahesh Jain
Department of orthodontics and Dentofacial Orthopeadics, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
|Date of Submission||11-Aug-2021|
|Date of Acceptance||09-Sep-2021|
|Date of Web Publication||01-Jan-2022|
Dr. Ritu Sanjaykumar Somani
B-1, 6/2, Patel Colony, “Snehdhara” Apartment, Nr Jain Derasar, Jamnagar - 361 008, Gujarat
Source of Support: None, Conflict of Interest: None
Introduction: Patients with orofacial clefts are usually associated with various dental anomalies. These dental aberrations pose a clinical challenge in treatment planning. Thus, this investigation intends to find the prevalence rate of different types of dental anomalies and their correlation among nonsyndromic cleft patients. Methodology: Orthodontic records of 129 cleft patients classified into different cleft groups were assessed to evaluate the presence of different dental anomalies. Results: The most frequent dental anomaly found in Cleft patients was rotations followed by maxillary lateral incisor agenesis with a prevalence rate of 90.4% and 59.2%, respectively. Maxillary second premolar agenesis, peg-shaped laterals, mandibular second premolar agenesis, and supernumerary teeth showed prevalence rates as 25%, 21%, 7%, and 5%, respectively. There were significant differences in the overall distribution of maxillary lateral incisor agenesis and rotations between patients with Unilateral Cleft Lip and Cleft Palate, Bilateral Cleft Lip and Cleft Palate, Cleft Lip (CL), and Isolated Cleft Palate (ICP). Conclusion: There is a high prevalence of dental anomalies like rotations and maxillary lateral incisor agenesis in different CL and palate patients, which were statistically significant. The presence of such anomalies can deteriorate the already existing functional problem and hence, the study of these anomalies and their treatment is an important step in the rehabilitation of such patients.
Keywords: Cleft groups, dental anomalies, missing teeth, peg-shaped laterals, prevalence, rotations, supernumerary teeth
|How to cite this article:|
Somani RS, Patel D, Jain M. Prevalence of dental anomalies in different cleft lip and palate groups: A survey. J Cleft Lip Palate Craniofac Anomal 2022;9:36-40
|How to cite this URL:|
Somani RS, Patel D, Jain M. Prevalence of dental anomalies in different cleft lip and palate groups: A survey. J Cleft Lip Palate Craniofac Anomal [serial online] 2022 [cited 2022 Jul 6];9:36-40. Available from: https://www.jclpca.org/text.asp?2022/9/1/36/333645
| Introduction|| |
Cleft lip (CL) and/or palate and isolated cleft palate (ICP) are the most frequent congenital abnormalities occurring in the craniofacial region. Although they frequently occur together, these are developmentally distinct entities., The causes of both defects include genes, environment, and their interaction., It has been proposed that individuals with clefts present significantly more dental anomalies than individuals without clefts. Similarly, the severity of anomalies appears to be directly related to cleft severity.,, This suggests that the embryologic development of lip, palate, and tooth is controlled by common genetic factors. These cleft anomalies are often associated with numerous dental defects such as tooth agenesis, hypodontia, supernumerary teeth, peg laterals, rotated teeth, microdontia, taurodontism, crown malformations, or delay in eruption.
Worldwide, oral clefts occur in about one in every 700 live births. The occurrence rate of orofacial clefts varies depending on the population. Overall, higher rates have been seen in Asians and American Indians (one in 500 births), and lower rates have been reported in African-derived populations (one in 2500 births). ICP is more common in females than in males with a ratio of 2:1. In contrast, there is a 2:1 male-to-female ratio for CL with or without cleft palate.
Several authors have reported that the congenital absence of the lateral incisor on the cleft side is the most common finding in cleft patients followed by the presence of supernumerary tooth in the cleft area., Tooth number anomalies, shape and structure alterations, the timing of teeth formation, and dental eruption were frequently investigated in cleft patients, but there are few studies that analyzed the presence of ectopic and rotated teeth inside the cleft area. Hence, there is little data available about the relationship between different types of cleft and various dental anomalies.
Thus, this survey was aimed to investigate the prevalence of dental anomalies like tooth agenesis, supernumerary teeth, rotations, and peg-shaped lateral incisors, among nonsyndromic CL and palate patients and to determine if any correlation exists between different types of clefts with different magnitude of severity and different dental anomalies.
| Methodology|| |
This retrospective study was carried out using orthodontic records of cleft patients with different types of clefts like UCLCP, BCLCP, CL, and ICP who had reported to the department from the year 2013–2019 with age >6 years. These records included Orthopentomograms, maxillary occlusal Xrays, and study models. Orthodontic records of 150 patients were assessed, of which only 129 were included in the study owing to inclusion and exclusion criteria.
Inclusion criteria include all groups of nonsyndromic CL and palate patients with age >6 years. Exclusion criteria include syndromic CL and palate patients, patients with age <6 years, and subjects with insufficient and incomplete records.
The parameters assessed using orthodontic records were the type of cleft, number and type of missing teeth, rotated teeth, peg laterals, supernumerary teeth, and any other anomaly. The most commonly missing tooth, rotated tooth, and location of the supernumerary tooth was determined. The presence and frequency of occurrence of these anomalies on the cleft side and noncleft side were noted. An ethics and research committee approval was also obtained from the Institutional Review Board.
Data collected were subjected to statistical analysis using the Kruskal–Wallis test and Chi-square test for continuous and categorical variables, respectively. The overall prevalence of dental anomalies was reported as a percentage and 95% exact confidence intervals. Statistical significance was assessed for P < 0.05. Data were analyzed using SPSS software (IBM version 20.0., IL, Chicago, USA).
| Results|| |
The median age of cleft patients with UCLCP was of 10 years (range 6–34), BCLCP was of 9 years (range 6–26), CL was of 15 years (range 12–18), and ICP was of 11 years (range 7–24). Separate consideration for males and females has not been taken because there are no statistically significant differences between the two genders in the context of dental alterations in the cleft area [Table 1].
[Table 2] and [Table 3] report the overall distribution of dental anomalies and the distribution of dental anomalies by cleft groups, respectively. 90.4% of the sample showed rotations, whereas 59.2% showed maxillary lateral incisor agenesis. This was then followed by maxillary second premolar agenesis, peg-shaped laterals, mandibular second premolar agenesis, and supernumerary teeth accounting for 25%, 21%, 7%, and 5% prevalence rates, respectively.
There were highly significant differences in the overall distribution of maxillary lateral incisor agenesis and tongue tie and significant difference in the overall distribution of rotations between patients with UCLCP, BCLCP, CL, and ICP [Table 3].
[Table 4] shows the proportion of missing teeth on the cleft side compared to the noncleft side. It was found to be significantly higher on the cleft side than the noncleft side.
|Table 4: Proportion of missing teeth on cleft side and noncleft side in unilateral cleft lip and cleft palate cleft patients|
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| Discussion|| |
The prevalence of dental anomalies in cleft patients is much higher in comparison to the healthy population., Many authors have reported statistically significant differences in the prevalence of different types of anomalies in each cleft type.
There was a statistically significant difference in the prevalence of rotations between different cleft groups (P < 0.05). In the present study, rotations were found to be the most common dental anomaly. The left maxillary central incisor was the most commonly rotated tooth (64%) followed by the right maxillary central incisor (40.8%). Larson et al., in their study, found lateral incisor rotation in 25% of the UCLCP and 52.9% and 27% of BCLCP and UCL patients, respectively. Surgical repair of the cleft was considered to be the cause of tooth rotations. However, this cannot be confirmed because there were no patients with nonoperated clefts.
The second-most common dental anomaly in this study was found to be maxillary lateral incisor agenesis with a prevalence rate of 59.2%, most commonly seen in UCLCP (67.05%) patients followed by BCLCP (55.17%) and CL (50%). These findings were in conjunction with another study where maxillary lateral incisor agenesis was the most common anomaly in all cleft types. Previous studies have reported a prevalence rate of maxillary lateral incisor agenesis ranging from 45.3% to 58.6% for UCLCP patients and 45% to 48.1% for BCLCP patients., The etiology for congenital absence of maxillary lateral incisor may be severe deficiency of mesenchymal mass, a deficiency of blood supply, or surgical treatment in the cleft area.,
The present study showed a high, statistically significant difference for maxillary lateral incisor agenesis among UCLCP, BCLCP, CL, and ICP patients. A similar study, however, shows no statistically significant difference for this anomaly between various clefts groups. The prevalence of hypodontia was found to be 77% in children with CL, CP, or both, excluding the third molars. Shapira et al. found an incidence of 74% for missing maxillary lateral incisors and 18% for missing second premolars in children with CL, cleft palate, or both.
In our study, the proportion of missing teeth in UCLCP on the cleft side and the noncleft side was also measured, and it was found that in 61.17% of cases, one or more teeth were missing on the cleft side, while only 45.53% of patients had missing tooth or teeth on the noncleft side [Table 4]. These findings are following the previous study, where the percentage of missing teeth on the cleft side was reported to be 20.7%, and on the noncleft side to be 15.7%.
In the present study, 20% of the cleft patients showed maxillary 2nd PM agenesis with occurrence in decreasing order of 20%, 24.13%, and 11.12% in UCLCP, BCLCP, and ICP, respectively, and it was absent in CL patients. However, agenesis of maxillary 2nd PM was estimated to be 1.4%–1.6%, and that of mandibular 2nd PM was found to be 2.9%–3.2% in previous studies., In the study by Rullo et al., the maxillary 2nd PM was absent in 5.6% of UCLCP patients and 5.4% of CL patients, while anomaly being absent in BCLCP patients. Tortora et al. found missing maxillary 2nd PM in 25% of BCLCP patients.
This study showed mandibular 2nd PM agenesis in 5.6% of the cleft patients with the prevalence rate of 5.88% and 6.89% in UCLCP and BCLCP groups, respectively. Whereas, it was absent in CL and ICP groups. There were no statistically significant differences in the prevalence rates of maxillary or mandibular 2nd PM agenesis among different cleft groups. Some previous studies have reported mandibular 2nd PM to be the most commonly missing tooth with a frequency of 3.4%.
Supernumerary teeth are the second most common dental anomaly in cleft patients, distal to the cleft region. The present study found supernumerary teeth in 4% of total cleft patients, with a prevalence of 3.52% of UCLCP patients, 6.89% of BCLCP patients, while being absent in CL and ICP patients. The study by Rullo et al. found a prevalence of supernumerary teeth in 25% of UCCP, 23.5% of BCLCP, and 37.8% of UCL subjects.
In cleft patients, anomalies in teeth size and shape, like malformed and peg-shaped teeth are commonly reported., A correlation exists between tooth agenesis and microdontia in the same patients. The present study found the prevalence rate for peg-shaped lateral to be 16.8% of the total sample size, 18.82% of the UCLCP group, and 17.24% of the BCLCP group, and absence of peg-shaped laterals in CL and ICP groups. Researches did previously show that the prevalence of microdontia varies from 1.5% to 2% in the general population and 1.9%–2.4% for the UCLCP cleft group. Rullo et al. found the prevalence rate of lateral incisor microdontia to be 5.6% for UCLCP, 11.8% for BCLCP, and 2.7% for UCL children. The percentage of shape anomaly of lateral incisor was 22.2% for the UCLCP group, 29.4% for the BCLCP group, and 27% for the UCLCP group.
Ectopic eruption in cleft patients can be attributed to local as well as systemic causes., In this study, the prevalence of ectopic eruption was found to be 30.2% of the total sample size, 27.05% of UCLCP, 13.79% of BCLCP, 50% of CL, and 44.45% of ICP patients. The most common ectopically erupted tooth was the right maxillary lateral incisor, followed by the left maxillary second PM. Rullo et al. in their study showed that 18.9% of the sample (UCLCP 22.2%, BCLCP 29.4%, UCL 10.8%) showed an ectopic tooth in the anterior region of the cleft area. However, a very less percentage of the general population shows the presence of this anomaly. The percentage of this anomaly was found to be 6% of all patients in a previous study.
The prevalence of dilacerations was found to be 6.4% of the total sample in the present study, with 3.52% in UCLCP and 17.24% in BCLCP. The prevalence of impacted teeth was investigated to be 25.6% of the total sample size, 8.23% of UCLCP patients, 10.34% of BCLCP patients, 11.2% of ICP patients, and was absent in CL patients. The prevalence of odontome was found to be 0.8% of the total sample population and 3.4% of BCLCP patients, whereas it was absent in the rest of the cleft groups. The prevalence of transposition was found to be 2.4% of the total sample size and 3.52% of UCLCP patients. However, transpositions were absent in BCLCP, CL, and ICP patients. The prevalence of tongue-tie was found to be 0.8% of the total sample, 11.12% of ICP patients, and it was absent in UCLCP, BCLCP, and CL patients. Out of these five anomalies, high, statistically significant differences were found between different cleft groups only in Tongue-tie. The prevalence of these has not been studied much in different cleft patients. The prevalence of supernumerary tooth and transposition was found to be 10% and 3% of the total sample by W. Nicholls.
| Conclusion|| |
There is a high prevalence of dental anomalies in UCLCP, BCLCP, CL, and ICP groups. A statistically significant difference was observed between these groups, only in the case of maxillary lateral incisor agenesis, rotations, and tongue tie. The most commonly occurring anomaly is the presence of rotations (most commonly left maxillary central incisor-64%), followed by maxillary lateral incisor agenesis (more frequent in UCLCP) in cleft patients. The presence of such anomalies can deteriorate the already existing functional problem, and hence, the study of these anomalies and their treatment is an important step in the rehabilitation of such patients.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]