Ó 2015 Eur J Oral Sci

Eur J Oral Sci 2015; 123: 254–259 DOI: 10.1111/eos.12195 Printed in Singapore. All rights reserved

European Journal of Oral Sciences

Dental treatment need and dental general anesthetics among preschoolage children with cleft lip and palate in northern Finland Lehtonen V, S andor GK, Ylikontiola LP, Koskinen S, Pesonen P, Harila V, Anttonen V. Dental treatment need and dental general anesthetics among preschool-age children with cleft lip and palate in northern Finland. Eur J Oral Sci 2015; 123: 254–259. © 2015 Eur J Oral Sci Cleft lip and palate incidence is high in northern Finland. This study aimed to investigate the proportion of children in need of restorative dental treatment among cleft lip and palate patients in northern Finland, as well as their need for dental treatment under general anesthesia. The records of 183 cleft lip and palate patients, treated in Oulu University Hospital from 1997 to 2013, were reviewed. Data on dental caries were analyzed in association with cleft type, considering also the presence of syndromes. The frequency of dental general anesthetic (DGA) use, and of treatments, were also analyzed. Dental treatment need was most frequently observed, in this rather limited study population, in patients with the most severe deformities, namely bilateral cleft lip and palate, of whom 60% had caries. Among the study population, 11.5% (n = 21) had a syndrome. Of those, 57.1% had dental caries at the age of 3 or 6 yr, and only four could be treated without a DGA. Dental treatment under general anesthesia was performed in 14.8% of cleft patients without a syndrome, but in 38.1% of those with a syndrome. General anaesthesia is required for the provision of dental care more often in cleft (17.5%) than in noncleft (0.2%) patients, and especially for those with a syndrome.

Cleft lip and/or palate is the most frequent congenital anomaly occurring in the craniofacial region (1). Clefts are divided into three groups: cleft lip (CL); cleft lip and palate (CLP); or isolated cleft palate (CP). Cleft lip can be unilateral or bilateral. The incidence of clefts varies between countries and racial or ethnic groups (2). The incidence of clefts is estimated to be between 1 and 2.21/1,000 live births (3). In England, the incidence of clefts is 1.42/1,000 infants (4). A recent study in Taiwan found a birth rate of 3.2/1,000 facial cleft deformities in newborns (5). The overall incidence of clefts in Finland is 2.56/1,000 live births and abortions. The incidence of isolated cleft palate in Finland is amongst the highest on the globe, at 1.36/1,000 (6). The respective figure is about 1/2,000 births among Black people, 1/800 births among White people, and 1/500 births in Indian or Japanese people. Cleft lip and palate is more frequent in male infants, but CP most frequently affects female infants (7, 8). Patients with CLP may experience feeding, swallowing, speech, hearing, and cosmetic problems, as well as poor dental health (9). The successful treatment of a cleft patient consists of multidisciplinary surgical and nonsur-

Ville Lehtonen1, George K. ndor2,3, Leena P. Ylikontiola2,3, Sa Sari Koskinen4, Paula Pesonen5, Virpi Harila3,6, Vuokko Anttonen1,3 1

Department of Cariology, Paedodontics and Endodontology, Institute of Dentistry, University of Oulu, Oulu; 2Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu; 3Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu; 4Oulu University Hospital, Oulu; 5Institute of Dentistry, University of Oulu, Oulu; 6 Department of Oral Development and Orthodontics, Institute of Dentistry, University of Oulu, Oulu, Finland

Vuokko Anttonen, DDS, PhD, Assistant Professor, Institute of Dentistry, University of Oulu, POB 5281, 90014 Oulu, Finland E-mail: [email protected] Key words: cleft; dental caries; dental general anaesthesia; dental treatment Accepted for publication April 2015

gical care that is performed from birth to adulthood (4). The goal of the cleft-related surgical treatments is to ensure normal development, facial growth, and appearance for the patient, as well as normal hearing and speech and a normal upper respiratory tract (10). In Finland, dental treatments involving cleft patients are funded by the government. Surgical treatment starts before the child reaches 1 yr of age. A cleft lip is normally repaired at the age of 3–6 months, and a cleft palate at the age of approximately 9 months. However, the exact timing of surgical treatments varies with each case (11). In Finland, all children are entitled to free dental care up to the age of 18 yr, inclusive. Yet, about onethird of 5-yr-old children and one-half of 12-yr-old children have dental caries-related tooth damage with approximately 0.5 caries lesions/individual (or 500 caries lesions/1,000 individuals) (12, 13). The proportion of children with cleft lip and/or palate, 6–36 months of age with dental caries lesions, was recently reported to be 18.9% in an article assessing Brazilian children (14). A study in West Scotland found that the prevalence of dental caries was more common in children with clefts than in healthy children (15).

Cleft children need of dental care and DGAs

Our initial hypothesis was that a larger proportion of northern Finnish children with clefts have dental caries than do non-cleft Finnish children, possibly because of difficulty in maintaining an appropriate level of dental hygiene as a result of cleft anatomy and scar tissue, making access challenging. Our second hypothesis was that caries is more common among cleft patients with a syndrome compared with non-syndromic cleft patients. Our third hypothesis was that a large proportion of cleft children require dental care under general anesthesia as a result of dental caries. The aim of this study was to investigate the proportion of northern Finnish cleft children needing dental treatment, considering the age and gender of the subjects, as well as the cleft type and existence of a syndrome. Another aim was to investigate the number of dental general anesthetics (DGAs) which were required for dental treatment in the study population.

Material and methods Material for this retrospective data-based follow-up study was collected from the Oulu University Hospital patient registry, comprehensively covering a period of 15 yr (1997– 2013) during the time that cleft patients were treated, and monitored in Oulu. The practice in Oulu University Hospital is to examine all cleft patients at the time of their referral and to provide follow-up according to the Eurocleft protocol (6). Data on patients who had received treatment in other centres, such as Helsinki, or outside Finland, were not available. The data were collected in Oulu during 2011– 2013 by the author V.L. and were analyzed by all the authors. In total, 183 patients with clefts were treated in Oulu University Hospital, Finland, during the period 1997– 2013. The treatment records of these patients were analyzed. The following variables were recorded: date of birth; gender; and occurrence of dental-caries lesions needing restorations (yes/no) at 3 yr and at 6 yr of age. The caries occurrence of the cleft group was compared with a control population of similarly aged non-cleft children from Kallio, a community near Oulu, using the Archives of Kallio Municipal Health and Welfares Services. The clefts were divided into nine groups: hard palate cleft; soft palate cleft; right side lip and palate cleft; left side lip and palate cleft; bilateral lip and palate cleft; lip and alveolar cleft; complete lip cleft; incomplete lip cleft; and submucous cleft. Logistic regression analysis was carried out to investigate the association of different variables (cleft type, syndrome, and gender) with the existence of dental caries. The dates of the DGAs were recorded, as well as their associated diagnoses [International Classification of Diseases, 10th revision (ICD 10)] and the procedures performed. As this study was retrospective and based on patient records, calibration was not carried out before the treatments. All diagnoses and treatments were accomplished by one author, an experienced paediatric dentist (S.K.). Those children with at least one tooth requiring restorative treatment were considered as having dental caries. Ethical considerations The study was carried out using the Oulu University Hospital patient registry data (permission number 10/2012).

255

The data were analyzed without personal identifying details, so no separate authorization from the Ethical Committee was required. Permission from the registry holder (Oulu University Hospital and Kallio Municipal Health and Welfares Services) was considered, by the Research Ethics authorities of the hospital and municipality, to be sufficient in Finland for this type of retrospective register-based study. The data were treated in accordance with the Helsinki Declaration. Statistics The frequencies and proportions of different types of clefts were determined. Existence of dental caries lesions was registered using the cut-off points of 3 and 6 yr of age. Gender, cleft-type, and existence of a cleft-related syndrome were considered. The number of DGAs per patient was analyzed from the data relative to the age and the gender of the child, cleft type, and presence of a cleftrelated syndrome. The association of the clefts and the occurrence of dental caries was evaluated using the chisquare test or Fisher’s exact test. Differences between the groups were considered as statistically significant with P < 0.05. The number of DGAs was presented as mean with SD. The diagnoses leading to DGAs were presented as frequencies, as were the procedures performed under DGAs. Logistic regression analysis was performed to investigate the association of different variables (cleft type, syndrome, and gender) with the existence of dental caries at 3 and 6 yr of age. Statistical analyses were performed using SPSS version 20.0 (SPSS, Chicago, IL, USA).

Results Dental treatment need was more common among the 6-yr-old cleft children than among the 3-yr-old cleft children (Table 1). Syndromes were present in 11.5% (n = 21) of the cleft patients. In this study, cleft patients with a cleft-related syndrome had dental caries lesions significantly more often than did patients without a syndrome. Of the syndrome patients, 33.3% had need for dental treatment of dental caries at 3 yr of age, whereas among those without a syndrome, only 14.2% in the same age group needed dental treatment of dental caries. A similar trend was observed among the 6-yr-old children, of whom 52.4% of those with a syndrome had dental caries compared with 28.4% of those without a syndrome (Table 2). Syndromes that were present included the Pierre Robin sequence, Treacher Collins syndrome, Fragile X syndrome, Blepharo-cheilo-dontic syndrome, Kabuki syndrome, Apert syndrome, CATCH 22 syndrome, and Down syndrome. In comparison, in 2014, in the non-cleft control population from Kallio, a Finnish rural community near Oulu with 34,000 inhabitants, 83% of the 5-yr-old children, 49% of the 12-yr-old children, and 22% of the 15-yr-old adolescents were found to have sound dentitions. The 3-yr-old children had, on average, 0.2 caries lesions (minimum = 0; maximum = 7; SD = 0.94) and the 6-yr-old children had 0.1 lesions (min 0, max 4, SD 0.36) in the permanent dentition; the respective value

256

Lehtonen et al. Table 1 Frequencies and proportions of children with dental treatment need according to gender Dental caries (3 yr) n (%)

Dental caries (6 yr) n (%)

Gender

No

Yes

P

No

Yes

P

Total (n)

Male Female Total

72 (81.8) 81 (85.3) 153 (83.6)

16 (18.2) 14 (14.7) 30 (16.4)

0.439

58 (65.9) 68 (71.6) 126 (68.9)

30 (34.1) 27 (28.4) 57 (31.1)

0.428

88 95 183

Table 2 Frequencies and proportions of children with dental treatment need according to existence of a syndrome Dental caries (3 yr) n (%) Syndrome No Yes Total

Dental caries (6 yr) n (%)

No

Yes

P

No

Yes

P

139 (85.8) 14 (66.7) 153 (83.6)

23 (14.2) 7 (33.3) 30 (16.4)

0.015

116 (71.6) 10 (47.6) 126 (68.9)

46 (28.4) 11 (52.4) 57 (31.1)

0.017

for caries lesions in 12-yr-old children was 0.7 (minimum = 0; maximum = 7; SD = 1.27). When both 3- and 6-yr-old children with all cleft types had dental caries, the proportion of those afflicted by caries was greatest among children with bilateral cleft lip and palate and unilateral cleft lip and palate in both age groups (Table 3). Children with less common cleft types, such as submucous cleft, were less frequently afflicted by dental caries at 6 yr of age; however, the actual number of these children was small. At 3 yr of age, the difference in dental treatment need between the cleft types was not statistically significant (P = 0.33), whereas the opposite was true at the age of 6 yr (P = 0.018; Table 3). According to the logistic regression analysis, the existence of a syndrome at 3 yr of age of had the strongest statistically significant association with dental caries (OR = 3.3; 95% CI: 1.11– 10.07), whereas the respective values at 6 yr of age were OR = 2.6 (95% CI: 0.98 to 6.97), followed by left and right lip palatal clefts (OR = 3.9; 95% CI: 0.96–15.90 and OR = 2.9; 95% CI: 0.96 to 9.07, respectively). Dental treatment under general anesthesia was performed on 32 (17.5%) patients among the study group. Dental treatment under general anesthesia was performed on 14.8% (n = 24) of the cleft patients without a syndrome, but on 38.1% (n = 8) of those with a syndrome. Altogether, 12 of 21 cleft children with a syndrome had dental caries at 3 or 6 yr of age, and only four could be treated without DGA. The most common procedures performed under DGA were extractions of carious teeth (27 patients) followed by restorations (25 patients). Eight children had pulpotomies and 10 had stainless steel crowns. Sealants were placed for 11 patients, three had periodontal treatment, and two had orthodontic treatment under DGA. Most of the treatments under DGA were received by children with clefts involving the palate, especially the most

Total (n) 162 (100) 21 (100) 183

severe clefts, such as hard palate cleft and unilateral and bilateral cleft lip and palate (Table 4).

Discussion This study investigated dental treatment need in patients with clefts in northern Finland, according to the age and gender of the subject, as well as their cleft types. The results indicated that about one-third of the 6-yr-old cleft children in the study had dental treatment need, which is in agreement with the outcome reported by JINDAL et al. (16). This is almost two-fold more than that noted in non-cleft 5-yr-old children from Kallio. The present study group was slightly dominated by female patients; of the 183 patients, 95 were girls and 88 were boys. Restorative treatment need, however, was more common among boys than among girls, which is also true among the population-based studies involving Finnish adults (17). The difference between genders is the opposite of that suggested by JINDAL et al. (16), who showed that female subjects were more likely to experience dental caries during their lifetime than male subjects. These results suggest that dental caries is quite common in Finland in children with clefts, especially in those with an increased degree of cleft severity. For instance, in patients with bilateral cleft lip and palate, an alarming two-thirds of 6-yr-old subjects have dental caries lesions; however, it should be borne in mind that the number of participants in the study was limited. This observation is supported by the results of a Vietnamese study, which analyzed 4- to 6-yr-old children with clefts. The Vietnamese authors observed that cleft lip and palate patients have dental caries lesions significantly more often compared with patients with an isolated cleft palate or lip (18). The current authors’

257

Cleft children need of dental care and DGAs Table 3 Distribution of children with different cleft types according to their dental treatment need Dental caries at 3 yr n (%) Type of cleft

No

Hard palate Lip and palate (right) Lip and palate (left) Lip and palate (bilateral) Lip and alveolus Complete lip Submucous Soft palate Partial lip Total

77 4 14 8 8 6 11 15 10 153

Dental caries at 6 yr n (%)

Yes

(77.8) (66.7) (93.3) (80.0) (88.9) (100.0) (100.0) (93.8) (90.9) (83.6)

22 2 1 2 1 0 0 1 1 30

No

(22.2) (33.3) (16.7) (20.0) (11.1) (0.0) (0.0) (6.2) (9.1) (16.4)

71 4 7 4 6 5 5 13 11 126

Yes

(71.7) (66.7) (46.7) (40.0) (66.7) (83.3) (45.5) (81.3) (100.0) (68.9)

28 2 8 6 3 1 6 3 0 57

(28.3) (33.3) (53.3) (60.0) (33.3) (16.7) (54.5) (18.7) (0.0) (31.1)

Total n (%) 99 6 15 10 9 6 11 16 11 183

(54.1) (3.3) (8.2) (5.5) (4.9) (3.3) (6.0) (8.7) (6.0) (100.0)

Table 4 Distribution of dental procedures provided under general anesthesia to 32 cleft patients, according to cleft type, dichotomized to those with (a) and without (b) a syndrome Palate cleft Procedure during the DGA (a) with a syndrome Restoration Sealant Stainless steel crown Pulpotomy EUA Orthodontics Extraction for dental caries Removing calculus Total n (%) (b) without a syndrome Restoration Sealant Stainless steel crown Pulpotomy EUA Orthodontics Extraction for dental caries Removing calculus Total n (%)

Hard

Soft

With uni- or bilateral lip cleft

6 5 0 1 2 1 0 5 0 14 15 (88.2) 8 7 2 3 3 0 0 8 1 24 63 (90.0)

0 0 0 0 0 0 0 0 0 0

1 1 0 0 0 0 0 0 0 1

0 0 0 0 0 0 0 0 0 0

12 10 6 6 3 0 2 10 2 39

Cleft lip (Complete or partial) 0 0 0 0 0 0 0 0 0 0 0 (0.0) 2 0 1 0 0 0 0 2 0 3 6 (8.6)

Cleft lip and alveolus 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 3

Submucous 1 1 0 1 0 0 0 0 0 2 2 (11.8) 1 0 0 0 0 0 0 1 0 1 1 (1.4)

Total n (%) 8/32 7 0 2 2 1 0 5 0 17

(25.0) (41.2) (0.0) (11.8) (11.8) (5.9) (0.0) (29.4) (0.0) (100.0)

24/32 18 10 9 6 0 2 22 3 70

(75.0) (25.7) (14.3) (12.9) (8.6) (0.0) (2.9) (31.4) (4.3) (100.0)

EUA, examination under anesthesia.

data show that patients with bilateral cleft lip and palate and patients with unilateral cleft lip and palate are at increased risk for developing caries lesions. The more severe the cleft deformity, the more frequently children require dental treatment. A severe cleft lip and palate may also require multiple surgical procedures, orthodontic treatment, and speech therapy (19). Milder cases, such as isolated cleft lip, may not require any other operation except a lip closure. During the extensive treatment, a patient with a severe cleft may find it difficult to perform adequate daily oral hygiene. For example, the surgical site may be sensitive for a long period of time, making toothbrushing unpleasant.

Also, orthodontic treatment may make it difficult to clean all areas. From a dental care perspective, a cleft patient requires the same, if not more, preventive and restorative dental treatment compared with a healthy child. Again, those with bilateral clefts may require even further attention. Careful oral health-risk evaluation followed by caries control ensures a healthy dentition for cleft children. Some children only require preventive treatment, whereas others require additional restorative treatment, or even extractions. In addition to the risk for dental caries, clefts of greater severity also increase the risk for other oral health problems, such as malpositioned teeth, occlusal

258

Lehtonen et al.

problems, and jaw-growth disturbances. In the current study, the proportion of syndromic children with clefts was 11.5% of the study population, similar to that reported in Ireland (14.8%) (20). According to the results of the current study, clefts among children with syndromes were not more complex than clefts in nonsyndromic children, but the prevalence of dental caries was different for the two groups. In syndromic cleft patients, 54.5% had dental caries lesions compared with those without a syndrome, for whom only 28.6% had dental treatment need. A Vietnamese study also found that dental caries was more common in cleft children 4–6 yr of age with a syndrome than in cleft patients without an associated syndrome. Thus, syndromic patients with cleft deformities are at increased risk for dental caries (18). Studies have shown a variable prevalence of dental caries in patients with Down syndrome. SHARATH et al. (21) noted that 38.1% of 0- to 5-yr-old Indian children with Down syndrome had dental caries. Portuguese children with Down syndrome, on the other hand, have been shown to have lower dental caries prevalence rates than healthy children. It is presumed that the reason for this is a heightened concern by the parents for the child’s dental health, with a lower threshold for taking the child for dental care (22). In contrast, CATCH 22 patients have been found to have a negative attitude towards oral hygiene, which adds to their potential dental-caries risk in this unique group of patients (23). The present study investigated the number of dental treatments required under general anesthesia in cleft patients in northern Finland. Both cleft and non-cleft patients may be uncooperative, either because of the sheer magnitude of the dental work required, or as a result of psychological or emotional immaturity (24). Such patients may present a scenario where routine dental care is more difficult, if not impossible, to deliver without sedation or even general anesthesia. Sedative premedication and/or nitrous oxide/oxygen sedation may be used as the first line of treatment (25). In more difficult cases, dental care is performed under general anaesthesia (24). Generally, comprehensive dental care of the entire dentition is performed when using general anaesthesia. In the current study, 17.5% of the cleft patients required dental care under general anaesthesia for the provision of their dental treatment. Of those patients with a syndrome and dental caries (n = 12), only four (33.3%) could be treated without DGA. In 2010, approximately 160,000 non-cleft patients were treated in the public sector in Helsinki, Finland, with 0.22% of these patients receiving care under general anaesthesia (26). Almost the same number was reported in the city of Oulu, Finland, in 2014, when 2/1,000 (0.2%) children in this age group were treated under DGA; there were 18,791 children 0–6 yr of age, of whom 46 were treated under DGA (statistics from the City of Oulu). These values are significantly lower compared with the 17.5% of patients in this study who required DGAs. It may be speculated that the threshold for referring cleft patients for DGA is lower than for non-cleft patients. In Finland, cleft patients,

especially those with bilateral or unilateral cleft lip and palate, are treated under general anesthesia more often than are healthy children. The treatments comprise mainly restorative treatments and extractions for dental caries. The combination of increased caries prevalence in the more severely deformed cleft patients or in those cleft patients with syndromes, plus the increased requirement of DGAs in cleft patients, underscore the increased burden of care that these patients face. The provision of DGAs is an important service for this patient group. The information from this study can be useful for future resource management and planning that is required for this special patient group. One deficiency in the study protocol is missing information at the tooth level, such as decayed, missing, or filled teeth (DMFT) scores, caries status, and the presence of restorations. On the basis of this study it can be concluded that the existence of orofacial clefts does not, in itself, have a direct association with dental treatment need. The need, however, increases as the cleft severity increases, one inevitable cause being challenges in oral hygiene caused by anatomy. Those cleft patients with a syndrome are at greatest risk. In Finland, cleft patients receive dental treatment under general anaesthesia more often than do non-cleft children. Caries control must be an essential part of the management among healthy, as well as cleft, patients. Acknowledgements – We appreciate the help of the cleft-team with this work, especially the nurse-in-charge, Suvi Tainijoki. We also want to express our gratitude to the staff in the IT patient archives. We are grateful to Dr Marja-Liisa Laitala for providing data on caries rates from Kallio Municipal Health and Welfares Services, Finland, and Dr P€aivi Rajavaara from the City of Oulu, Finland. Conflicts of interest – The authors declare no conflicts of interest.

References 1. KHAN M, ULLAH H, NAZ S, IQBAL T, ULLAH T, TAHIR M, ULLAH O. A revised classification of the cleft lip and palate. Can J Plast Surg 2013; 21: 48–50. 2. SCHUTTE BC, MURRAY JC. The many faces and factors of orofacial clefts. Hum Mol Genet 1999; 8: 1853–1859. 3. DERIJICKE A, EERENS A, CARELS C. The incidence of oral clefts: a review. Br J Oral Maxillofac Surg 1996; 34: 488–494. 4. FITZSIMONS KJ, COPLEY LP, DEACON SA, VAN DER MEULEN JH. Hospital care of children with a cleft in England. Arch Dis Child 2013; 98: 970–974. 5. LEI RL, CHEN HS, HUANG BY, CHEN YC, CHEN PK, LEE HY, CHANG CW, WU CL. Population-based study of birth prevalence and factors associated with cleft lip and/or palate in Taiwan 2002–2009. PLoS One 2013; 8: e58690.  GK. Frequency of 6. LITHOVIUS RH, YLIKONTIOLA LP, SANDOR pharyngoplasty after primary repair of cleft lip and palate in Northern Finland. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117: 430–434. 7. DAMLE SG. Textbook of pediatric dentistry, 2nd edn. New Delhi, India: Arya Publishing House, 2002; 415–426. 8. MATTHEWS JL, ODDONE-PAOLUCCI E, HARROP RA. The epidemiology of cleft lip and palate in Canada, 1998 to 2007. Cleft Palate Craniofac J 2014. [Epub ahead of print].

Cleft children need of dental care and DGAs 9. BIAN Z, DU M, BEDI R, HOLT R, JIN H, FAN M. Caries experience and oral health behaviour in Chinese children with cleft lip and/or palate. Pediatr Dent 2001; 23: 431–434. 10. PEARSON GD, KIRSCHNER RE. Surgery for cleft palate and velopharyngeal dysfunction. Semin Speech Lang 2011; 32: 179–190. 11. RAUTIO J, SOMER M, PETTAY M, KLOCKARS T, ELFVING-LITTLE U, € E, HELIOVAARA € € A. Treatment of cleft lip and palate A HOLTT in Finland. Med Rev Duodecim 2010; 126: 1286–1294. € E, SUND R. Association of 12. SUOMINEN-TAIPALE AL, WIDSTROM examination rates with children’s national caries indices in Finland. Open Dent J 2009; 3: 59–67. € € € JYM. Prevalence and polariA, PAKKIL A 13. TANNER T, KAMPPI zation of dental caries among young, healthy adults: Crosssectional epidemiological study. Acta Odontol Scand 2013; 71: 1436–1442. 14. MOURA AM, ANDRE M, LOPEZ MT, DIAS RB. Prevalence of caries in Brazilian children with cleft lip and/or palate, aged 6 to 36 months. Braz Oral Res 2013; 27: 336–341. 15. BRITTON KF, WELBURY RR. Dental caries prevalence in children with cleftlip/palate aged between 6 months and 6 years in the West of Scotland. Eur Arch Paediatr Dent 2010; 11: 236–241. 16. JINDAL A, MCMEANS M, NARAYANAN S, ROSE EK, JAIN S, MARAZITA ML, MENEZES R, LETRA A, CARVALHO FM, BRANDON CA, RESICK JM, MEREB JC, POLETTA FA, LOPEZ-CAMELO JS, CASTILLA EE, ORIOLI IM, VIEIRA AR. Women are more susceptible to caries but individuals born with clefts are not. Int J Dent 2011; 2011: 454532. 17. SUOMINEN-TAIPALE AL, NORDBLAD A, VEHKALAHTI M, AROMAA A (eds). Oral health in the Finnish adult population. Health 2000 survey. Helsinki: Publications of the National Public Health Institute B, 2003.

259

18. BESSELING S, DUBOIS L. The prevalence of caries in children with a cleft lip and/or palate in Southern Vietnam. Cleft Palate Craniofac J 2004; 41: 629–632. 19. CAMERON A, WIDMER RP. Handbook of pediatric dentistry, 3rd edn. St. Louis, MO: Mosby, 2008; 379. 20. MCDONNELL R, OWENS M, DELANY C, EARLEY M, MCGILLIVARY A, ORR DJ, DUGGAN L. Epidemiology of orofacial clefts in the east of Ireland in the 25-year period 1984–2008. Cleft Palate Craniofac J 2014; 51: 63–69. 21. SHARATH A, MUTHU MS, SIVAKUMAR N. Dental caries prevalence and treatment needs of Down syndrome children in Chennai, India. Indian J Dent Res 2008; 19: 224–229. 22. AREIAS CM, SAMPAIO-MAIA B, GUIMARAES H, MELO P, ANDRADE D. Caries in Portuguese children with Down syndrome. Clinics (Sao Paulo) 2011; 66: 1183–1186. € S. Oral manifestation and 23. KULAN P, PEKINER FN, AKYUZ dental management of CATCH 22 syndrome. Marmara Dent J 2013; 1: 46–48. 24. SARI ME, OZMEN B, KOYUTURK AE, TOKAY U. A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities. Niger J Clin Pract 2014; 17: 361–365.  GK. Nitrous oxide oxy25. HULLAND SA, FREILICH MM, SANDOR gen or oral midazolam for pediatric outpatient sedation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 643– 646. 26. SAVANHEIMO N, SUNDBERG SA, VIRTANEN JI, VEHKALAHTI MM. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service. BMC Oral Health 2012; 12: 45.

Dental treatment need and dental general anesthetics among preschool-age children with cleft lip and palate in northern Finland.

Cleft lip and palate incidence is high in northern Finland. This study aimed to investigate the proportion of children in need of restorative dental t...
99KB Sizes 2 Downloads 13 Views