Publication: Investigation of skeletal relationships, tooth abnormalities, and biochemical composition of saliva in cleft lip and palate patients
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Date
2023-09
Authors
Qadeer, Mustafa
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Abstract
Cleft lip and palate (CLP) that affects many neonates annually, is one of the
most common birth deformities and has been found to be linked with various other
orofacial abnormalities including dental enamel hypoplasia and skeletal defects.
Several studies have investigated some dental anomalies associated with CLP patients.
However, details of the internal tooth structure (enamel thickness, enamel density and
dentine thickness) as well as biochemical composition of saliva in patients with CLP
are not available. The overall goal of this study is to assess skeletal relationships, tooth
structures, tooth size and biochemical composition of the saliva in patients with CLP.
A retrospective record review was conducted in the Department of Orthodontics and
Oral Radiology, CMH-Lahore Medical College and Institute of Dentistry. 4152 cone
beam computed tomography (CBCT) data sorting was performed and 73 patients with
cleft were included to identify skeletal relationships in different cleft-types.
Meanwhile, 84 ‘non-syndromic’ CLP patients (41 unilateral cleft lip and palate
(UCLP) and 43 bilateral cleft lip and palate (BCLP)) and 39 non cleft subjects were
selected to identify tooth abnormalities. Enamel thickness, enamel density, dentin
thickness, and tooth size of the permanent maxillary incisors and canines were
measured from their CBCT scans. Two-way ANOVA with interaction effect was
applied to examine if gender has an effect in addition to cleft on various measurements
of teeth. A cross-sectional study was conducted where saliva samples were collected from 27 individuals with UCLP, 27 individuals with BCLP, and 27 non-cleft
individuals. Precipitate and supernatant of this saliva samples were analised by using fourier transform infrared (FTIR) spectroscopy and scanning electron
microscopy/energy-dispersive X-ray (SEM/EDX). Results of the skeletal relationships
showed that the skeletal class III were found to be predominant in both sexes, followed
by class II and class I (p ˃ 0.05). For tooth abnormalities, the enamel thickness, enamel
density, mesiodistal width, crown height, root length and tooth length were
significantly smaller in patients with CLP compared to non-cleft individuals (p < 0.05)
while dentine showed no significant difference in most of teeth measured (p ˃ 0.05).
Missing lateral incisor (81.4%) was found to be more common in BCLP. Atypical root
shape was more prevalent in right lateral incisor in BCLP (p < 0.05). FTIR analysis
of saliva showed the presence of inorganic phosphates, proteins, lipids, and hormone
in the samples tested. Visible difference between FTIR spectra of cleft and non-cleft
individuals, specifically in bands of inorganic phosphates, amide I, and amide II were
observed. SEM results revealed interconnected filamentous network in the saliva of
normal individuals whereas this filamentous network was not present in patients with
CLP. In addition to variation in tooth sizes and decreased enamel density, abnormal
biochemical composition as well as surface morphology of saliva may contribute to
increase caries susceptibility in patients with CLP. Implementation of early oral health
care prevention strategy to improve oral health status are essential in patients with
CLP.