Oral health status among children with and without cleft lip and palate seen in Nairobi, Kenya

Abstract

Clefts of the lip and palate (CLP) are amongst the commonest craniofacial anomalies encountered by clinicians. Compared to many other anomalies, CLP is easily diagnosed and described. Due to this, it has been one of the most intensively studied congenital malformation worldwide. Anomalies of the face give rise to considerable morbidity which is psychologically traumatic to the parents. Thus the need to study the oral health status of children with cleft lip/palate (CLP) in a section of a Kenyan population. Type of study: A descriptive comparative cross-sectional study. Methods: A total of 89 children were clinically examined, 49 formed the study group (children with clefts) and 40 were the control group (children without clefts) ; age range, 2 to 15 years. Factors such as plaque, gingivitis, caries, missing teeth and stage of the dentition were recorded. Setting: Nairobi, Kenya. Results: Out of the 49 children in the study group, 55% had CLP and 33% had CLA while 6%had isolated CL. The prevalence of plaque was 96.27% in the 'study group while among the control group this was lower at 89.5% (p<0.05). This was reflected by the significant difference observed in the frequency of tooth brushing (x211.564 l df p=O.OOI). Children with clefts had a significantly increased number of units with gingivitis ranging from 79.2% for tooth 16 (p=0.04) to 51.6% for tooth 52 (p =0.264), although not statistically significant in the latter. The prevalence of caries in the study group was 11.8% (95% CI; 9.8%-13.8%) and the control group was 8% (95% CI; 6.2%-9.8%). This difference was significant (p<0.05). These children also showed an increased number of carious teeth in the posterior segments ranging from 16.7% for tooth 16 (p>O.05) to 41.2% for tooth 46 (p>O.05), while in the deciduous dentition it ranged from 22.6% for tooth 61 (p>O.05) to 36.7% for tooth75 ( p>O.05)and was not significant. The children with clefts also showed generally delayed eruption in both the permanent and the deciduous dentitions. This was significant for the lateral incisors in the deciduous dentition (p<O.05). The control group had earlier eruption times than the study group. The cleft group had an increased number of teeth with enamel hypoplasia and also had more supernumerary teeth but this was not significant(p>O.05). Conclusions: Children with clefts had generally poor oral hygiene and gingival health with an increased number of carious teeth compared to children without clefts. These children should be considered to have an increased risk of developing dental diseases and therefore,will require stringent oral hygiene instructions and regular reviews by dental professionals. Their treatment should involve preventive and curative services in order to maintain healthy primary and permanent dentitions.