Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2005  |  Volume : 23  |  Issue : 4  |  Page : 183--184

The status of oral hygiene in cleft lip, palate patients after surgical correction


SC Pandey1, RK Pandey2,  
1 Provincial Health and Medical Services of the state,Department of Pedodontics and Preventive Dentistry, King Georges Dental University, Lucknow, U.P, India
2 Department of Pedodontics and Preventive Dentistry, King Georges Dental University, Lucknow, U.P, India

Correspondence Address:
S C Pandey
DQPANDEYSDQ,B-83/B, Nirala Nagar,Lucknow - 226020, U. P.
India

Abstract

The cleft lip and palate patients usually present a number of problems viz. altered oral anatomy leading to changes in oral physiology diminishing the self-cleansing ability of individual. The handicapped children are unable to maintain their oral hygiene properly. The present study was formulated with the aim that does normalization of oral anatomy have its effect on improvement of oral hygiene? An assessment of oral hygiene index-simplified was performed between preoperative and postoperative values in the same patient at KGMU and KGDU. A total of 50 cases were recorded in two groups of 25 each: (i) < 6 years old and (ii) > 6 years. The observations are statistically analyzed by paired SQtSQ test to get the significance of results. Results: The data analyzed showed the significant decrease in oral hygiene indices observed in both groups. A relative significance in oral hygiene status following surgery was observed. Both groups expressed greater significance when compared pre and postoperatively which is indicative of considerable improvement of oral hygiene after surgical correction. The study concludes that oral hygiene improves more in older cleft lip-palate cases following reconstruction of palatal vault, premaxilla and anterior lip seal by secondary bone grafting method when compared with oral hygiene indices results in primary periosteoplasty cases. The surgical correction of cleft lip palate enhances self-cleaning ability and better compliance to maintain oral hygiene in children as the age advances.



How to cite this article:
Pandey S C, Pandey R K. The status of oral hygiene in cleft lip, palate patients after surgical correction.J Indian Soc Pedod Prev Dent 2005;23:183-184


How to cite this URL:
Pandey S C, Pandey R K. The status of oral hygiene in cleft lip, palate patients after surgical correction. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2019 Jul 19 ];23:183-184
Available from: http://www.jisppd.com/text.asp?2005/23/4/183/19006


Full Text

Cleft lip and palate is a well-known and common congenital deformity. The surgeon or pedodontist who deals with a clinical population of children with clefts of lip or palate is well aware that facial growth is often unsatisfactory and the children present aesthetic and functional problems which are difficult to overcome. Altered facial morphology may lead to a better understanding of facial problems and the potential success of therapeutic methods to overcome them.

Eldeeb et al.[1] observed a higher plaque index in the patients with cleft lip - palate compared to the orthodontic control patients. Mussig [2] performed a periodontal evaluation of teeth in the bone-grafting region. Their findings demonstrated that treatment which included osseous grafting before eruption of the canine resulted in satisfactory periodontal condition for teeth in cleft region. Andlin Soboki et al.[3] had confirmed the findings regarding the periodontal status of such teeth as stated by Mussig. Eldeeb et al . observed a higher plaque index in the patients with cleft lip-palate compared to the orthodontic control patients.

There is a paucity of literature regarding the changes in oral hygiene status after surgical correction. So the present study was undertaken to study the changes in oral hygiene status postoperatively in cleft lip palate patients.

 Materials and Methods



Simplified oral hygiene Index developed by Greene and Vermillion[4] was used to record the debris and calculus score. Grading was done according to criteria adapted by W.H.O. - Basic Methods. Oral Health Surveys, 1971. The patients were selected from the Departments of Plastic Surgery and Maxillofacial Surgery of King George's Medical/Dental University, Lucknow.

Changes in the oral hygiene status postoperatively after 6 months of suture removal was recorded in the index format. This index specially suits for recording the data's of oral hygiene in cleft lip palate patients. The advantage of using this index was that it permits the next tooth surface for evaluation if the prescribed tooth for observation is missing, which is frequent in cases of cleft lip palate. In cases of missing teeth the subsequent available anterior teeth was used, and in case of deciduous dentition (absence of permanent incisors and molars) the deciduous incisors and second molars were used for the study.

 Results



The preoperative and postoperative simplified oral hygiene indices were evaluated according, to Greene and Vermillion[4] for both the groups, viz. , up to 6 and above 6 years which is summarized in [Table 1].

The significance of OHI-S values preoperatively for the group up to 6 years ranged from 0.33 to 0.66, depicting a mean of 0.475 and standard deviation of 0.2166, while the postoperative values ranged from 0.00 to 0.33, with mean of 0.2658 and standard deviation of 0.1471. The P -value obtained from comparison of these values is 0.000. A significant ' t ' value of 5.060 was observed.

The preoperative values for the group above 6 years of age are recorded in the range of 0.16-1.16 with a mean of 0.5364 and standard deviation of 0.1280, while the postoperative OHI-S range 0.16-0.83 with a mean of 0.228 and standard deviation of 0.097. The P -value assessed for this group is found to be 0.000, which is highly significant. The ' t ' value of 24.98 is very highly significant.

 Discussion



The cleft lip and palate is most common congenital orofacial anomaly which can be associated with malnutrition, malocclusion, deficiency of malar and maxillary bone growth, eustachian tube malfunctioning leading to reduce air conduction in the middle ear, deafness and nasorespiratory obstruction. The management of such individual is aimed to habilitate them into normally appearing and functioning adults. The present investigation was envisaged to study palatal arch form, alveolus, dentition, oral habits and oral hygiene status in cleft lip palate patients.

Eldeeb et al. [1] concluded from their evaluation relating the repair of alveolar cleft defect with periodontal condition and confirmed that higher plaque index is found in patients of cleft lip and palate compared to orthodontic control patients expressing the self-cleansing ability of the oral structure in controls. The oral hygiene status in this study was recorded by simplified oral hygiene index as proposed by Greene and Vermillion.[1] The simplified oral hygiene index is the sum of debris index and calculus index. The advantage of OHI-S by Greene and Vermillion over other indices for oral hygiene was that the next tooth surface can be included for the study if the prescribed tooth for observation is absent. There is no other specific index of oral hygiene available in the current literature for assessing hygiene status in cleft lip and palate patients. Pre and postoperative oral hygiene index status of cleft lip and palate is recorded and analyzed in both the groups up to 6 years and above 6 years of age.

Our findings are concurrent with the findings of Eldeeb et al., which is evidenced by low plaque indices and highly significant P -values calculated by paired ' t ' test. Comparison of mean as 0.000 and 0.000 for both the groups up to six and above six, respectively, which suggest the improvement in periodontal health after the repair of cleft lip and palate in children.

It can be concluded that the status of oral hygiene improves more in the older cleft lip-palate cases following reconstruction of palatal vault, premaxilla and anterior lip seal by secondary bone grafting method and soft tissue repair. It also shows better compliance of oral hygiene maintenance instruction amongst older age group[Table 2].

References

1Eldeeb ME, Hinrich's JE, Waite DE, Bandt CL, Bevis R. Repair of alveolar cleft defects with autogenous bone grafting;periodontal evaluation. Cleft Palate Jour 1986;23;126-36.
2Mussig D. The adjustment of canine teeth adjacent to the cleft depending on the time of late primary periosteoplasty. Fortschr-Kieferorthop 1991;52;245-51.
3Andlin Soboki A, Eliasson LA, Paulin G. Periodontal evaluation of teeth in bone grafted regions with unilateral clefts. American Journal of Orthod. Dentofacial Orthop 1995;107:144-5.
4Greene & Vermillion. Basic Methods. Oral Health Surveys, WHO, 1971.