PERIODONTAL STATUS OF PATIENTS WITH CLEFT PALATE (CL) AND UNILATERAL CLEFT LIP, PALATE AND ALVEOLUS (UCLPA)-A COMPARATIVE STUDY.

Dr. Munaza Shafi And Dr. Nawal Khan. Department of Dentistry, SKIMS Medical College, Bemina, Srinagar. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 24 March 2019 Final Accepted: 26 April 2019 Published: May 2019

Facial clefts are ranked as the most common congenital malformations. Cleft lip and palate (CLP) are common congenital deformities that often affect speech, hearing, and facial esthetics and may at times lead to airway compromise. [1] CLP have an impact on multiple developmental and functional processes. Children and adults with cleft lip and palate are at increased risk for the development of gingival and periodontal diseases, which are associated with both anatomic defects and long-term orthodontic treatment. [2,3] Anatomic defects, delays in the formation and eruption of teeth, problems with orthodontic movement, and the presence of prosthetic restorations all contribute to reductions in bone levels in the areas adjacent to cleft regions. Dental and arch segment irregularities, orthodontic appliances, and persisting soft tissue folds before palatoplasty as well as the presence of scar tissue after cleft closure make oral hygiene control difficult. All of these factors enhance the progression of periodontal disease. [4,5,6] Even before the complete closure, the soft tissue folds making it difficult to access the areas with conventional cleaning techniques and may serve as a habitat for putative pathogens. This increases the risk of enhancing the intraoral translocation of pathogens, thereby increasing the risk of periodontal infection. [7] High incidence of bleeding on probing and plaque in individuals with cleft lip, palate and alveolus (CLAP) was reported, after the analysis of progression rate. [8] Cumulative periodontal destruction is more in teeth with long supracrestal connective tissue attachment and which is adjacent to the cleft. [9] 1161 Evaluation of periodontal conditions is often neglected or insufficiently documented, since the patients' major problems are related to reconstructive treatment and quality of life. [10,11] As a result, there are very few studies regarding the periodontal status in cleft patients. The aim of the study was to evaluate the periodontal status and oral hygiene in growing patients with bilateral cleft lip and palate and to compare the results with other studies.

Materials And Methods:-
The present study was conducted in 60 patients with age ranging from 10-18 years, who reported to the department of dentistry SKIMS. They were divided into two groups: Group 1 consisted of 30 patients with Cleft palate (CP) and Group 2 consisted of 30 patients with unilateral Cleft Lip Alveolus and Palate (UCLAP). The dental examinations were conducted in a dental chair using a mouth mirror and Williams probe. The following parameters were recorded:

Results:-
Among the 60 study subjects, 39 were males and 21 were females. Tables1, 2, 3and 4 show the mean difference of values between different parameters of two groups.

Discussion:-
There are only a few studies on periodontal conditions in growing patients with clefts. In fact the periodontal status may have important implications in the comprehensive treatment of these individuals. [12,13] Alveolar process deficiency has a negative impact on soft tissue appearance, causing functional and aesthetic problems in this area. Additionally, combined deficiencies of hard and soft tissues are particularly difficult to treat. [14,15,16,17] Most authors are consistent that patients with clefts are at an increased risk for the development of periodontal disease and carious lesions. However, the data are still limited. Patients with clefts are at high risk of progress of periodontal disease if no supportive periodontal therapy is provided in their early childhood. It has already been presented that adult 1162 patients with clefts, high plaque score and gingival inflammation had more periodontal tissue destruction. Moreover, the risk of periodontal disease and the level of tissue disorders increased with age. [13] Thus, it may be inferred from this study that subjects with CLPA are more prone for periodontal lesions. In case of neglected oral hygiene, these subjects are predisposed to periodontal disease in the direct vicinity of clefts, leading to premature pathological loosening of teeth. Thus, intensive oral hygiene measures taken by these subjects along with early interdisciplinary treatment are an effective way to prevent extensive periodontal disease.

Conclusion:-
From this study, it can be concluded that patients with UCLPA had a poor oral hygiene and periodontal status when compared with cleft palate patients. It seems essential to include regular periodontal examination and prophylaxis into comprehensive treatment in cleft patients. Further assessment of a large-sized group is necessary to establish the preventive protocol in multidisciplinary treatment.