The role of external aetiological factors in dental anomalies in non-syndromic cleft lip and palate patients.

AIM: The hypothesis tested was whether proper tooth development in cleft lip and palate (CLP) patients is affected by early orthopaedic treatment (EOT), primary surgical interventions and palatal defects after primary palatoplasty.

METHODS: The prospective study groups comprised 369 CLP children (aged 11.0 ± 4.5 years) and 500 healthy children (aged 11.1 ± 3.8 years) aged > 6 years without any diseases associated with increased risk of dental anomalies. Patients were examined clinically and radiologically. Primary treatment details and outcomes were extracted from the hospital records registry and analysed to evaluate the role of possible external aetiological factors in dental abnormalities.

RESULTS: Selective tooth aplasia was the commonest dental abnormality with upper lateral incisors missing in 33.9% of CLP patients and 3.4% of controls. Central incisor agenesis was restricted to early primary periosteoplasty cases. Lateral incisor aplasia on the cleft side was significantly associated with palatal defect (P = 0.0003) and primary lip surgery type (P = 0.008). The prevalence of developmental enamel defects (DEDs) correlated with primary surgical procedure (P = 0.002), palatal defect and lack of EOT (P = 0.03 and 0.04, respectively).

CONCLUSIONS: Surgical trauma during early primary periosteoplasty, reduced blood supply associated with palatal defects and absence of EOT significantly increase the prevalence of frontal tooth anomalies. The prevalence of dental abnormalities in CLP patients depends on treatment protocol.