Pattern of malocclusion and caries experience in unrepaired cleft lip and palate patients in Enugu

Clefts are common birth defects, usually accompanied by various malformations that include malocclusions, and may be associated with tooth decay. The aim of this study was to assess the malocclusion and caries status of the patients with unrepaired clefts who presented at the National Orthopaedic Hospital Enugu.

A cross-sectional, descriptive study was conducted among patients with unrepaired cleft lip and/or palate that presented at the National Orthopaedic Hospital, Enugu between January 2009 and December 2011. Detailed records of 140 patients with cleft deformities who presented to the hospital within the study period were analyzed for the cleft pattern, whereas those patients above 6 years of age (52 patients) were analyzed for malocclusion using the Angle's classification of malocclusion. Assessment for dental caries according to WHO guidelines was made for all the patients.

There were 74 males and 66 females. Cleft lip with or without alveolus involvement had equal prevalence (47.1%) (66 patients) with combined cleft lip and palate; eight patients had isolated cleft palate (4.71%). Angle's class 1 malocclusion was statistically significantly higher than other classes (P = 0.000). Class I malocclusion was seen in 38 patients (73.1%), whereas class 111 was seen in 8 patients (15.4%) and class 11 in 6 patients (11.5%). Eight patients (100%) who developed class 111 malocclusion all had a hard palatal defect. Proclining of maxillary anterior teeth (increased overjet) was the most common orthodontic anomalies, reported in 25 patients (48.1%) (P = 0.002). Caries prevalence of 12.9% was observed in this study. Caries experience was statistically significantly higher in deciduous than permanent teeth (P = 0.002).

The high prevalence of malocclusion in these cleft patients emphasizes the need for an interdisciplinary team approach and early inclusion of dental care especially oral hygiene to prevent tooth decays.