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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 603-607

Dental anomalies prevalence in cleft lip and palate patients: An observational study


1 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
2 Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
3 Department of Orthodontics, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India

Date of Submission24-Aug-2021
Date of Decision15-Sep-2022
Date of Acceptance23-Sep-2022
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. S R Ashwinirani
Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_317_21

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  Abstract 


Background: Dental anomalies are a common finding in patients with cleft lip (CL) and cleft lip with palate (CLP). CL and CLP are congenital disorder that occurs in newborns and will have a physical defect throughout life if not treated. The variety of dental anomalies reported are peg laterals, tooth agenesis, taurodontism, hypoplasia, and ectopic eruptions. The purpose of this study was to analyze the prevalence of various dental anomalies in CL and CLP patients. Methodology: A descriptive cross-sectional study was conducted among 80 patients of CL and CLP. Patients were selected by convenience sampling technique, from the department of oral medicine and radiology. Oral examination and dental panoramic radiographs were assessed. The diagnosis was arrived as per the findings of the clinical and radiographic evaluation. The findings of the study were reported as frequency and percentage. Results: Out of the 80 patients, the majority were males accounting for 55% and 45% were females. All the patients were diagnosed with one or the other dental anomaly. Tooth agenesis was the most commonly observed anomaly accounting for 70%. Patients with bilateral CL with palate (BCLP) had a higher percentage of tooth agenesis (96.5%) compared to patients with unilateral CL with palate (72.9%) (UCLP). Conclusion: One or more dental anomalies were observed in CL and CLP patients. Tooth agenesis, taurodontism, hypoplasia, and ectopic eruptions were the most prevalent anomalies. BCLP patients had more dental anomalies than UCLP patients.

Keywords: Cleft lip, cleft palate, taurodontism, tooth abnormalities


How to cite this article:
Ashwinirani S R, Suragimath G, Mane P. Dental anomalies prevalence in cleft lip and palate patients: An observational study. J Datta Meghe Inst Med Sci Univ 2022;17:603-7

How to cite this URL:
Ashwinirani S R, Suragimath G, Mane P. Dental anomalies prevalence in cleft lip and palate patients: An observational study. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 1];17:603-7. Available from: http://www.journaldmims.com/text.asp?2022/17/3/603/360210




  Introduction Top


Cleft lip (CL) and CL with palate (CLP) are congenital disorders that occur in newborn infants. They sometimes extend to the face resulting in oral, facial, and craniofacial deformity resulting in functional and esthetic problems.[1] CL/CLP may present as a single entity without syndromes (nonsyndromic) or sometimes with syndromes. CL/CLP patients are nonsyndromic in about 70% of cases and the rest 30% of patients suffer from other associated developmental anomalies.[2] CL/CLP can also occur as unilateral or bilateral on both sides of the face.

Patients with CL and CLP defects suffer from an increased incidence of dental anomalies compared to normal individuals.[3] The dental anomalies include hypodontia, transposition, supernumerary tooth, and microdontia, which occur mostly localized to the area or side of the cleft defect. Other anomalies observed are morphological anomalies of deciduous and permanent teeth, delay in tooth development and eruption of permanent maxillary incisors, tooth agenesis, and taurodontism.[4],[5],[6],[7]

Thorough knowledge regarding the identification of CL/CLP patients and the dental anomalies prevalent among them is a prerequisite for rendering appropriate treatment. With this background, this study was conducted to assess the dental anomalies prevalence among CL/CLP patients.


  Methodology Top


Study settings

This cross-sectional observational study was undertaken during the period from January 2019 to December 2021 at the School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University (KIMSDU), Karad, Maharashtra, India. The approval of the Institutional ethical committee was obtained before commencing the study (KIMSDU/IEC/06/2018 Protocol number 0131/2018-2019). All participants were explained the objectives of the research and enrolled in the study after receiving written informed consent. The study was conducted among 80 CL/CLP patients recruited conveniently from the outpatient section of the oral medicine department.

The detailed history of all participants was recorded as per the protocol. A complete clinical oral examination was carried out among all the patients. Digital panoramic radiographs of patients were captured using the Sirona machine. The radiographs were assessed for dental anomalies in these patients. All the panoramic radiographs were examined by a senior radiologist to diagnose the anomalies such as tooth agenesis, supernumerary tooth, dilacerations, transposition, and microdontia.

The diagnosis of different types of CL like unilateral or bilateral CLP which included unilateral CL with palate (UCLP) and bilateral CL with palate (BCLP) was recorded.

Diagnostic criteria

Tooth agenesis was diagnosed after clinical and panoramic radiographic examinations. Third molars were not considered for tooth agenesis in this study. Supernumerary teeth were diagnosed when multiple/excess teeth existed on the panoramic radiographs, and in cases of ambiguity, periapical radiographs were also taken into consideration. A taurodont tooth was diagnosed when apically displaced the pulp chamber without the constriction of the dental pulp tissue in the cementoenamel junction area. The finding of transposition of teeth was arrived when two teeth interchanged their positions. Dilaceration was considered in a tooth with a sharp bend or curve along the length of the root.

Statistical analysis

The data obtained were analyzed using the Statistical Package for the Social Sciences, version 23 (SPSS Inc., Chicago, IL). Descriptive statistics were expressed as percentages and frequencies.


  Results Top


Out of 80 patients studied, the majority were males 44 (55%) and 36 (45%) were females. In our study, 15 cases were diagnosed with only CL, 37 patients with UCLP, and 28 patients suffered from BCLP.

All the subjects in our study suffered from one or more dental anomalies. Patients having CLP had more dental anomalies than patients with CL only. The dental anomaly, i.e., tooth agenesis was the most commonly prevalent accounting for 70%, followed by taurodontism (61.2%), microdontia (42.5%), ectopic eruption, and hypoplasia of teeth (33.7%), and the least was supernumerary tooth (13.7%). The distribution of different anomalies is tabulated and represented [Table 1] and [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Table 1: Distribution of dental anomalies in cleft lip and cleft palate patients

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Figure 1: Cleft lip with palate on the left side

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Figure 2: Intraoral photograph showing missing lateral incisor and canine on the right side

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Figure 3: Intraoral photograph showing microdontia of the left lateral incisor

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Figure 4: Panoramic radiograph showing bilaterally missing canines, right lateral incisor, and transposed left central and lateral incisor

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Gender-wise distribution of dental anomalies showed that anomalies mainly tooth agenesis, ectopic eruption, dilacerations, and hypoplasia were observed predominantly in females than in males with no statistically significant differences. Anomalies such as taurodontism, microdontia, hypodontia, and transposition of teeth were seen more in males. Gender-wise distribution of different anomalies is tabulated [Table 2].
Table 2: Gender-wise distribution of dental anomalies

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A comparison of CL and CLP patients with dental anomalies revealed that the majority of anomalies were observed in BCLP patients than in the patients with UCLP [Table 3].
Table 3: Dental anomalies distribution in different cleft palate patients

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  Discussion Top


CL/CLP patients have difficulty while feeding, speech, and hearing difficulties, and hence their treatment involves a multidisciplinary approach.[8] The incidence of CL/CLP is maximum in American Indians and Asians (1:500), average in Casucasians population (1:1000), and least among Africans (1:2500).[9],[10] The occurrence of CL/CLP varies in a population as per gender, ethnicity, race, geographical location, and socioeconomic status.[11] Advanced maternal age, habit of smoking and alcohol during pregnancy, history of consanguineous marriage, environmental factors, and genetic factors play a key role in the increase in the incidence of CL/CLP.[1],[12]

CL and CLP may cause major functional, esthetic, and psychological problems in patients. The functional issues suffered by these patients are due to dental anomalies such as microdontia, hypoplasia, and tooth agenesis. Thorough knowledge of CL and CLP etiology and the occurrence of dental anomalies among them is a necessity for proper treatment and management.

The current study showed oral clefting was observed in 55% of males and 45% of females. All the patients (100%) were diagnosed with one or more dental anomalies. Tooth agenesis (70%) was the most common dental anomaly observed, followed by taurodontism (61.2%), microdontia (42.5%), hypoplasia (33.7%), and ectopic eruptions (33.7%). The majority of agenesis was found in the anterior region of the maxilla concerning the lateral incisor. Patients with BCLP showed more dental anomalies than UCLP subjects.

At least one dental anomaly was diagnosed in 96.7% of CL/CLP patients according to Akcam et al., the most common dental anomaly observed was anterior teeth agenesis on the side of the cleft defect (70.8%).[3] The results of previous literature are similar to the present study. The earlier study has shown a significant prevalence of tooth agenesis on the cleft side in the UCLP group and impaction of anterior teeth on the cleft side.[3]

The findings of Germec Cakan et al.'s study are in accordance with the present study, who concluded that tooth agenesis was maximum prevalent, followed by microdontia and supernumerary teeth. Agenesis of lateral incisors was seen in 18% of CLP patients, 78% in the BCLP group, and 69% in the UCLP group, these findings are similar to the present study. A significant association of lateral incisor agenesis to the side of clefting was also observed by Germec Cakan et al., which was also true for bilateral clefting.[13]

In a study to detect the dental anomalies in CL and CLP patients using cone-beam computed tomography concluded that tooth agenesis was maximum in CLP patients and was observed in 92.5% in the UCLP group and 86.4% in the BCLP group. The cleft side in the UCLP group had 75.0% of tooth agenesis and 35.7% of canine impaction, which were significantly more than on the normal side.[14] The results were in accordance with our study with respect to tooth agenesis.

A recent study conducted by Yezioro-Rubinsky et al., in Colombian children with CP and CLP, reported a significant risk of maxillary lateral incisors agenesis, microdontia, supernumerary teeth, and tooth rotation on the side of clefting.[15] Impaction of teeth (28.4%) was the most observed dental anomaly in patients treated with fixed orthodontic appliances.[16]

A prevalence of 13.7% of supernumerary teeth was observed in the current study. A study conducted among European noncleft patients reported a prevalence of 1% to 2.2% of supernumerary teeth.[17] The results of our study in relation to supernumerary teeth were in accordance with studies of Al-Kharboush et al. (12.5%), Al Jamal, et al.'s study (16.7%), and Tereza et al.'s study (12%).[18],[19],[20] Various other studies also have concluded the varied prevalence of supernumerary teeth in different cleft groups ranged from 4.6% to 42%.[21],[22]

Limitations of the study

The small sample sizes restricted the scope of our study. The inclusion of a healthy control group could have enabled the intergroup comparison.

Future prospective

Studies with larger sample sizes and the use of advanced radiographs like cone-beam computed tomography to measure the cleft palate dimensions can be carried out further the knowledge and understanding of CL and CLP.


  Conclusion Top


One or more dental anomaly is always observed in CL and CLP patients. BCLP patients had more dental anomalies than UCLP patients. Tooth agenesis was the most commonly observed dental anomaly and the least was supernumerary teeth. Tooth agenesis, ectopic eruption, dilacerations, and hypoplasia were more commonly seen in female patients, whereas taurodontism, microdontia, hypodontia, and transposition were observed more in males. A multidisciplinary treatment approach involving a dentist can improve the quality of life among CL and CLP patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mossey P, Little J. Addressing the challenges of cleft lip and palate research in India. Indian J Plast Surg 2009;42:S9-18.  Back to cited text no. 1
    
2.
Rahimov F, Jugessur A, Murray JC. Genetics of nonsyndromic orofacial clefts. Cleft Palate Craniofac J 2012;49:73-91.  Back to cited text no. 2
    
3.
Akcam MO, Evirgen S, Uslu O, Memikoğlu UT. Dental anomalies in individuals with cleft lip and/or palate. Eur J Orthod 2010;32:207-13.  Back to cited text no. 3
    
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Rullo R, Festa VM, Rullo R, Addabbo F, Chiodini P, Vitale M, et al. Prevalence of dental anomalies in children with cleft lip and unilateral and bilateral cleft lip and palate. Eur J Paediatr Dent 2015;16:229-32.  Back to cited text no. 4
    
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Mangione F, Nguyen L, Foumou N, Bocquet E, Dursun E. Cleft palate with/without cleft lip in French children: Radiographic evaluation of prevalence, location and coexistence of dental anomalies inside and outside cleft region. Clin Oral Investig 2018;22:689-95.  Back to cited text no. 5
    
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Nicholls W. Dental anomalies in children with cleft lip and palate in Western Australia. Eur J Dent 2016;10:254-8.  Back to cited text no. 6
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7.
Ajami S, Pakshir H, Samady H. Prevalence and characteristics of developmental dental anomalies in Iranian orofacial cleft patients. J Dent (Shiraz) 2017;18:193-200.  Back to cited text no. 7
    
8.
Stanier P, Moore GE. Genetics of cleft lip and palate: Syndromic genes contribute to the incidence of non-syndromic clefts. Hum Mol Genet 2004;13:R73-81.  Back to cited text no. 8
    
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Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: Understanding genetic and environmental influences. Nat Rev Genet 2011;12:167-78.  Back to cited text no. 9
    
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Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet 2009;374:1773-85.  Back to cited text no. 10
    
11.
Murray JC, Daack-Hirsch S, Buetow KH, Munger R, Espina L, Paglinawan N, et al. Clinical and epidemiologic studies of cleft lip and palate in the Philippines. Cleft Palate Craniofac J 1997;34:7-10.  Back to cited text no. 11
    
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Silva CM, Pereira MC, Queiroz TB, Neves LT. Can parental consanguinity be a risk factor for the occurrence of nonsyndromic oral cleft? Early Hum Dev 2019;135:23-6.  Back to cited text no. 12
    
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Germec Cakan D, Nur Yilmaz RB, Bulut FN, Aksoy A. Dental anomalies in different types of cleft lip and palate: Is there any relation? J Craniofac Surg 2018;29:1316-21.  Back to cited text no. 13
    
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Celikoglu M, Buyuk SK, Sekerci AE, Cantekin K, Candirli C. Maxillary dental anomalies in patients with cleft lip and palate: A cone beam computed tomography study. J Clin Pediatr Dent 2015;39:183-6.  Back to cited text no. 14
    
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Yezioro-Rubinsky S, Eslava-Schmalbach JH, Otero L, Rodríguez-Aguirre SA, Duque ÁM, Campos FM, et al. Dental anomalies in permanent teeth associated with nonsyndromic cleft lip and palate in a group of Colombian children. Cleft Palate Craniofac J 2020;57:73-9.  Back to cited text no. 15
    
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Korolenkova MV, Starikova NV, Udalova NV. The role of external aetiological factors in dental anomalies in non-syndromic cleft lip and palate patients. Eur Arch Paediatr Dent 2019;20:105-11.  Back to cited text no. 16
    
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Jamilian A, Jamilian M, Darnahal A, Hamedi R, Mollaei M, Toopchi S. Hypodontia and supernumerary and impacted teeth in children with various types of clefts. Am J Orthod Dentofacial Orthop 2015;147:221-5.  Back to cited text no. 17
    
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Al-Kharboush GH, Al-Balkhi KM, Al-Moammar K. The prevalence of specific dental anomalies in a group of Saudi cleft lip and palate patients. Saudi Dent J 2015;27:75-80.  Back to cited text no. 18
    
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Al Jamal GA, Hazza'a AM, Rawashdeh MA. Prevalence of dental anomalies in a population of cleft lip and palate patients. Cleft Palate Craniofac J 2010;47:413-20.  Back to cited text no. 19
    
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Tereza GP, Carrara CF, Costa B. Tooth abnormalities of number and position in the permanent dentition of patients with complete bilateral cleft lip and palate. Cleft Palate Craniofac J 2010;47:247-52.  Back to cited text no. 20
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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