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Children with orofacial clefts: dental caries and health-related quality of life
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit. The Institute for Postgraduate Dental Education, Department of Paediatric Dentistry, Jönköping, Sweden.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. The current understanding on caries and enamel developmental defects prevalence and frequency, caries risk, health-related quality life (HRQoL) and stress response in young children with cleft lip and/or palate (CL/P) are sparse. In this thesis these aspects were investigated in 5- and 10- year-old children with CL/P in comparison to non-cleft children in the same ages.

Design. The studies in this thesis have a cross-sectional case-control design. Participants. The study group consisted of 139 children with CL/P (80 children aged 5 years and 59 aged 10 years) and 313 non-cleft controls (144 children aged 5 years and 169 aged 10 years).

Method. Caries was scored according to International Caries Detection and Assessment System (ICDAS II) and developmental enamel defects were measured as presence and frequency of hypoplasia and hypomineralization. Oral hygiene was assessed using Quigley-Hein plaque index. Stimulated saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rates. Information regarding children’s oral hygiene routines, dietary habits and fluoride exposure were collected with questionnaires. Caries risk was evaluated with algorithm-based software, Cariogram while HRQoL was perceived with KIDSCREEN-52. Stress response was analyzed with cortisol concentration in saliva at three different time points using a commercial competitive radioimmunoassay.

Results. Caries prevalence (36% versus 18%) and caries frequency (1.2 dmfs versus 0.9 dmfs) was significantly higher in 5-year-old children with CL/P in comparison to non-cleft controls. In 10-yearolds no significant difference was found between children with CL/P and non-cleft controls in caries prevalence (47% versus 38%) or in caries frequency (0.7 DMFS versus 0.5 DMFS). Children with CL/P had significantly higher prevalence of enamel defects, higher counts of salivary lactobacilli and less good oral hygiene. The odds of being categorized with high caries risk were elevated in children with CL/P. Children with CL/P had similar HRQoL and salivary cortisol concentrations as non-cleft controls. However, 10-year-old boys with CL/P had significantly higher cortisol concentrations in the evening than non-cleft boys.

Conclusions. Preschool children with CL/P seem to have more caries in the primary dentition than non-cleft controls. Children with CL/P had increased odds of being categorized as high caries risk individuals compared to controls. Some of the contributing factors seem to be higher prevalence of enamel defects, impaired oral hygiene and elevated salivary lactobacilli. Furthermore, as measured with the help of cortisol concentrations in saliva, children with CL/P were not more stressed than noncleft controls and their HRQoL was comparable to a European norm population. It appears that regular comprehensive preventive oral care in children with CL/P is effective in preventing caries development in permanent teeth. However, children with CL/P are at risk of caries development and preventive oral care should be implemented and started earlier than today.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 68 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1547
Keyword [en]
Children, cleft lip and/or palate, dental caries, caries risk, hypomineralization, hypoplasia, health-related quality of life, cortisol in saliva, stress.
National Category
Dentistry Otorhinolaryngology Pediatrics Public Health, Global Health, Social Medicine and Epidemiology Surgery Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:liu:diva-132623DOI: 10.3384/diss.diva-132623ISBN: 9789176856567 (Print)OAI: oai:DiVA.org:liu-132623DiVA: diva2:1047249
Public defence
2016-12-09, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-11-17 Created: 2016-11-17 Last updated: 2016-11-21Bibliographically approved
List of papers
1. Caries prevalence and enamel defects in 5-and 10-year-old children with cleft lip and/or palate: A case-control study
Open this publication in new window or tab >>Caries prevalence and enamel defects in 5-and 10-year-old children with cleft lip and/or palate: A case-control study
Show others...
2016 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, 90-95 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keyword
Cleft palate; cleft lip and palate; dental caries; hypomineralization; hypoplasia
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-124077 (URN)10.3109/00016357.2015.1044562 (DOI)000366811600002 ()25972142 (PubMedID)
Note

Funding Agencies|FORSS Medical Research Council of Southeast Sweden; Futurum Academy of Health and Care Jonkoping County Council; Swedish Dental Association; Swedish Society of Paediatric Dentistry

Available from: 2016-01-25 Created: 2016-01-19 Last updated: 2016-11-17
2. Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls
Open this publication in new window or tab >>Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls
2015 (English)In: BMC Oral Health, ISSN 1472-6831, Vol. 15, no 85Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. Methods: The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the childs oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low". Results: Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p less than 0.05) and displayed less good oral hygiene (p less than 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67 % but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95 % CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. Conclusion: Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keyword
Cleft lip; Cleft palate; Cleft lip and/or palate; Caries risk; Cariogram; Children
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120739 (URN)10.1186/s12903-015-0067-x (DOI)000358428000002 ()26208495 (PubMedID)
Note

Funding Agencies|FORSS - Medical Research Council of Southeast Sweden, Futurum, - Academy of Health and Care Jonkoping County Council; Swedish Dental Association; Swedish Society of Paediatric Dentistry

Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2016-11-17
3. A comparison of health-related quality of life in 5- and 10-year-old Swedish children with and without cleft lip and/or palate
Open this publication in new window or tab >>A comparison of health-related quality of life in 5- and 10-year-old Swedish children with and without cleft lip and/or palate
2016 (English)In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Background The current understanding on health-related quality of life (HRQoL) in young Swedish children with cleft lip and/or palate (CL/P) is sparse, and therefore, research on impact of CL/P on HRQoL in children is needed.

Aims To investigate HRQoL in 5- and 10-year-old Swedish children with CL/P in comparison with non-cleft controls. Also to analyse whether there were any differences in HRQoL between children with cleft lip (with or without cleft palate, CL ± P) and cleft palate only (CP) and/or gender differences. Design A total of 137 children with CL/P and 305 non-cleft controls participated. HRQoL was measured with KIDSCREEN-52.

Results All children in the study exhibited HRQoL within or above the age-matched reference interval of the method with similar results in both groups; however, in the dimension ‘social support and peers’, the 10-year-old children with CL/P perceived lower HRQoL than the non-cleft controls, but it did not reach statistical significance. Type of cleft or gender did not influence HRQoL.

Conclusions Both 5- and 10-year-old Swedish children with CL/P had HRQoL in the normal reference interval. Their general life situations were well adjusted to their clefts, but the older children with CL/P felt more excluded and less supported by peers.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
National Category
Surgery Dentistry
Identifiers
urn:nbn:se:liu:diva-132622 (URN)10.1111/ipd.12253 (DOI)27464906 (PubMedID)
Available from: 2016-11-17 Created: 2016-11-17 Last updated: 2016-11-22Bibliographically approved

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