Marcia Ribeiro Gomide

Dental Anomalies of the Permanent Lateral Incisors and Prevalence of Hypodontia Outside the Cleft Area in Complete Unilateral Cleft Lip and Palate

OBJECTIVE To determine in complete unilateral cleft lip and palate (UCLP) subjects the characteristics (location, shape) of the cleft-side lateral incisor. The presence of a supernumerary tooth at the cleft side and the prevalence of hypodontia outside the cleft area were evaluated. A comparison was made of the shape of the cleft side lateral incisor to its contralateral incisor. SETTING Hospital for Rehabilitation of Craniofacial Anomalies (HRCA), Sao Paulo, Brazil. PATIENTS Orthopantomograms of 203 subjects with UCLP and without syndromes were chronologically selected from the HRCA data bank, within an age range of 5 to 10 years. OUTCOME MEASURE Orthopantomograms were analyzed by the same observer according to established criteria. RESULTS There were no statistically significant differences between sexes for any of the criteria studied. The cleft-side lateral incisor was present in 50.2%, and it was more commonly located at the distal side (76.5%). The congenital absence of the cleft-side lateral incisor was observed in 49.8% of the sample, and its antimere was congenitally missing in 10.9%, this difference being statistically significant. The most commonly missing tooth outside the cleft area was the maxillary second premolar. CONCLUSIONS The high prevalence of hypodontia of the permanent lateral incisor in the cleft side showed that the cleft could play an important role in this absence. There were different patterns for the presence of the cleft-side lateral incisor.

Dental Development of Permanent Lateral Incisor in Complete Unilateral Cleft Lip and Palate

OBJECTIVE The objective of this retrospective study was to verify whether the root development of the permanent lateral incisor on the cleft side was delayed, compared with its contralateral tooth in subjects with complete unilateral cleft lip and palate. SETTING Craniofacial Anomalies Rehabilitation Hospital (HRAC)-University of São Paulo-Bauru, Brazil. PATIENTS A sample of 98 panoramic radiographs of HRAC patients with complete unilateral cleft lip and palate was selected, regardless of sex and race. MAIN OUTCOME MEASURE Panoramic radiographs were analyzed and the root development stage of the cleft-side permanent lateral incisor was compared with its contralateral tooth. RESULTS Overall, the permanent cleft-side lateral incisor was significantly delayed in root development in relation to the non-left side contralateral tooth (p <.05). However, no significant differences were observed between boys and girls. CONCLUSIONS Root development of the permanent cleft-side lateral incisor was delayed, compared with its contralateral tooth. The cleft itself may play an important role in this delay because the results from boys and girls were very similar.

Breast-feeding and sugar intake in babies with cleft lip and palate.

OBJECTIVE To investigate the pattern of breast-feeding and sugar intake among babies with cleft lip and palate. PARTICIPANTS Caretakers of 200 babies with cleft lip and palate enrolled at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. RESULTS A low prevalence of breast-feeding was found. The most reported reason was the sucking inability of the baby. Complete cleft lip and palate was the primary cause affecting sucking. The first contact with sugar occurred mainly through the baby bottle with milk during the first month of life. For nutritional supplement, the children were given sugar and fruit juices in the bottle. CONCLUSIONS It was observed that dietary habits in babies with cleft lip and palate are more risky. This highlights the role played by early education and constant oral hygiene follow-up for prevention in these patients.

Prevalence of Natal/Neonatal Teeth in Cleft Lip and Palate Infants

In the daily routine of the Hospital for Research and Rehabilitation of Cleft Lip and Palate, a high frequency of natal/neonatal teeth was observed. Therefore, this retrospective study was conducted to determine the prevalence of this anomaly in 692 patients with complete unilateral and 327 bilateral cleft lip and palate, who were less than 3 months old, without prior surgery, and registered at the Hospital from 1989 to 1994. A higher prevalence of such teeth was found in the complete bilateral cleft group (10.6%), than in the complete unilateral cleft group (2.02%). Both, however, were higher than that reported for noncleft groups. There were also different characteristics in the appearance of these teeth in cleft patients from those previously related in the literature for normal patients. The conclusion was that these differences constitute another particularity of the cleft lip and palate patient.

Prevalence of Intranasal Ectopic Teeth in Children with Complete Unilateral and Bilateral Cleft Lip and Palate

OBJECTIVE The objective of this study was to determine the prevalence of ectopic eruption of intranasal teeth. DESIGN This was a retrospective study, where records of children with repaired cleft lip and palate were analyzed. SETTING The study was conducted at a large craniofacial center, the Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru, São Paulo, Brazil. SUBJECTS The sample consisted of 815 records from patients with bilateral cleft lip and palate (BCLP) and 1,495 records from patients with unilateral cleft lip and palate (UCLP). The age of the subjects was 5 to 10 years old and the groups included both males and females. RESULTS The results showed that 0.61% of the children with BCLP and 0.40% of those with UCLP had an intranasal tooth. The prevalence of an intranasal tooth for the whole group was 0.48%, and it appeared to be more common in females.

Enamel Defects in Maxillary Central Incisors of Infants With Unilateral Cleft Lip

Objective: To evaluate the presence of enamel alterations in deciduous maxillary central incisors of infants with unilateral cleft lip and alveolar ridge, with or without cleft palate, and to compare the occurrence and location of these alterations between the central incisor adjacent to the cleft and the contralateral incisor. Design: Intraoral clinical examination was performed after tooth cleaning and drying by a single examiner with the aid of a dental mirror, dental probe, and artificial light, with the child positioned on a dental chair. The defects were recorded in a standardized manner according to the criteria of the Modified Developmental Defects of Enamel Index. Setting: Hospital for Rehabilitation of Craniofacial Anomalies (HRAC) at Bauru, São Paulo, Brazil. Patients: One hundred one infants were evaluated. All were white, of both genders, aged 12 to 36 months and had at least two thirds of the crowns of maxillary incisors erupted. Results: Demarcated opacity was the most common defect at both cleft and noncleft sides, followed by diffuse opacity. The occurrence of hypoplasia at the cleft side was 11.8%. Most defects affected less than one third of the crown. Conclusion: The occurrence of enamel defects in deciduous maxillary central incisors of patients with unilateral cleft lip was 42.6%, mainly affecting the cleft side as to both number and severity.

Clinical and microbiological evaluation of the periodontal status of children with unilateral complete cleft lip and palate.

Objective To compare periodontal conditions in children with and without cleft. Design Clinical examinations and microbiological analysis of 57 selected children, including 30 with unilateral complete cleft lip and palate (experimental group) and 27 without clefts (control group). Setting Hospital of Rehabilitation of Craniofacial Anomalies (HRCA) in Bauru, Sao Paulo, Brazil. Patients, Participants All children examined were healthy and between the ages of 5 and 6 years. Results The mean plaque index (PI) in the experimental group was higher (1.82 ± 0.3) than in the control group (1.63 ± 0.38), although this difference was not statistically significant. The mean gingival index (GI) in the experimental group (1.82 ± 0.38) was found to be significantly higher (p < .05) than that of the control group (0.79 ± 0.33). The cleft area in the experimental group, with a mean PI of 2.04 ± 0.58 and mean GI of 1.11 ± 0.26, compared with the posterior area, with a mean PI of 1.74 ± 0.37 and mean GI of 1.04 ± 0.26, showed a statistically significant difference only in the PI. Most of the children in both experimental and control groups presented a moderate PI degree (73.33% and 81.48%, respectively) and a high prevalence of mild gingivitis (53.33% and 70.37%, respectively). Analysis of the organisms showed that Prevotella nigrescens was detected in 16.67% of the experimental group and 11.11% of the control, whereas Porphyromonas gingivalis and Treponema denticola were not detected. Conclusion Children with clefts showed greater gingival inflammation, despite the same amount of plaque and prevalence of microorganisms.

Difference in the prevalence of enamel alterations affecting central incisors of children with complete unilateral cleft lip and palate.

Objective To evaluate the prevalence of enamel alterations affecting the deciduous and permanent central maxillary incisors of children with complete unilateral cleft lip and palate and to verify their characteristics. Design Cross-sectional. Setting Hospital for Rehabilitation of Craniofacial Anomalies–University of São Paulo, Bauru, São Paulo, Brazil. Patients A sample of 90 patients attending the Hospital for Rehabilitation of Craniofacial Anomalies, presenting with complete cleft lip and palate, of both genders, ages 2 to 11 years old. Methodology The buccal surfaces of the maxillary central incisors of patients were analyzed for observation of the presence of enamel defects, their type, number, and location. The prevalence of defects was compared between deciduous and permanent teeth and between the incisors at the cleft and noncleft sides. Results There was a higher frequency of defects among incisors on the cleft side for both deciduous and permanent dentitions compared with the noncleft side (p < .05); the permanent central incisor was more frequently affected than the deciduous. Evaluation of the types of defects for both incisors in both dentitions demonstrated a homogeneous distribution, except for a lower proportion of yellow opacity in the permanent dentition on the cleft side. In general, the most affected area in all dentitions was the incisal third. Conclusion The prevalence of enamel alterations affecting incisors adjacent to the cleft was higher than for incisors on the noncleft side. This difference also was present in the permanent dentition.

Prevalence, Cause, and Location of Palatal Fistula in Operated Complete Unilateral Cleft Lip and Palate: Retrospective Study

Objective To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors. Design Retrospective analysis of patient records and evaluation of preoperative initial photographs. Setting Tertiary craniofacial center. Participants Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007. Interventions The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate. Main outcome measures Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated. Results Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association (P ≤ .05) between the fistulas and initial cleft width (P = .0003), intraoperative problems (P = .0037), and postoperative problems (P = .00002). Conclusions The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.

Oral findings in patients with Apert Syndrome

Introduction: The Apert syndrome is a rare disorder of autosomal dominant inheritance caused by mutations in the FGFR2 gene at locus 10q26; patients with this syndrome present severe syndactyly, exophthalmia, ocular hypertelorism and hypoplastic midface with Class III malocclusion, besides systemic alterations. Most investigations available on the Apert syndrome address the genetic aspect or surgical management, with little emphasis on the oral aspects. Objective: to investigate the oral findings, including dental anomalies, ectopic eruption of the maxillary permanent first molars and soft tissue alterations, in subjects with Apert syndrome. Material and methods: clinical and radiographic examination of nine patients with Apert syndrome, aged 6 to 15 years, not previously submitted to orthodontic or orthognathic treatment. Results: dental anomalies were present in all patients, with one to eight anomalies per individual. The most frequent anomalies were tooth agenesis, mainly affecting maxillary canines, and enamel opacities (44.4% for both). Ectopic eruption of maxillary first molars was found in 33.3% of patients; lateral palatal swellings were observed in 88.8% of patients. Conclusions: The occurrence of typical lateral palatal swellings agrees with the literature. The high prevalence of dental anomalies and ectopic eruption may suggest a possible etiologic relationship with the syndrome.