Chronology of Deciduous Teeth Eruption in Children With Cleft Lip and Palate

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1 Chronology of Deciduous Teeth Eruption in Children With Cleft Lip and Palate CRISTIANE DUQUE GISELE DA SILVA DALBEN ANDREZA MARIA FÁBIO ARANHA CLEIDE FELíCIO DE CARVALHO CARRARA, M.SC. MARCIA RIBEIRO GOMIDE, PH.D. BEATRIZ COSTA, PH.D. Objective: To determine the chronology and sequence of eruption of the deciduous teeth in children with complete unilateral cleft lip and palate. Design: Cross-sectional study. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil. Sample: A total of children aged 0 to months who presented with complete unilateral cleft lip and palate. Results: All teeth on the cleft side in both jaws for both sexes presented a higher mean age of eruption than their homologues at the noncleft side. This difference was statistically significant for the maxillary lateral incisor, maxillary cuspid, and mandibular lateral incisor. There was a statistically significant sex difference regarding the mean age of eruption only for the maxillary second molar for the girls and mandibular cuspid for the boys. The maxillary lateral incisor on the cleft side was the last tooth to erupt, thus modifying the sequence of eruption of the deciduous teeth. Conclusions: The results suggest the interference of the cleft on the chronology of eruption of the deciduous teeth that are directly related to it. KEY WORDS: cleft lip and palate, tooth eruption The period of eruption of the deciduous teeth varies among individuals and may be related to sex (Lysell et al., ; Demirjian and Levesque, ), gestational period (Seow, ), disease (Galili et al., ), and general growth and possible nutritional status (Infante and Owen, ). It is also well known that the mean age of eruption varies among races (Lavelle, ; Magnüsson, ). On this basis, a number of studies have been conducted to determine the chronology of eruption of deciduous and permanent teeth in several populations. Nevertheless, considerable differences regarding the timing and sequence of eruption have been noticed, which may reflect improper methods, inadequate sample selection, or even confounding variables such as local and/or systemic factors (Loevy and Aduss, ). Among these systemic conditions, Ms. Duque and Ms. Aranha are postgraduation students in Pedodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRCA-USP), Bauru, Sao Paulo, Brazil. Dr. Dalben is a Pedodontist. Dr. Carrara and Dr. Costa are Pedodontists, HRAC-USP, Bauru, Sao Paulo, Brazil. Dr. Gomide is coordinator of the postgraduation course in Pedodontics, HRAC- USP, Bauru, Sao Paulo, Brazil. Submitted July 00; Accepted June 00. Address correspondence to: Profa. Dra. Beatriz Costa, HRAC-USP Setor de Odontopediatria, Rua Silvio Marchione, -0 Vila Universitária, -00, Bauru, SP, Brazil. biacfd@uol.com.br. cleft lip and palate must be taken into account, since many factors related to this anomaly may influence dental development and formation (Bailit et al., ; Fishman, ; Haring, ; Pöyry and Ranta,, ; Pöyry, ; Loevy and Aduss, ). Pöyry and Ranta () evaluated dental casts of children with cleft lip and/or palate aging to months old and found that there was no significant difference between the mean ages of eruption of the deciduous teeth of these children in relation to noncleft children, neither between sexes nor between the different types of clefts, despite the existence of an asymmetry in eruption limited to the maxilla in children who present with complete unilateral cleft lip and palate. Pöyry () analyzed the timing of eruption of the deciduous central incisors in children with cleft lip and palate and observed a slight delay in the eruption of the maxillary central incisor on the cleft side. On the other hand, Kramer et al. () evaluated the eruption of deciduous incisors and revealed a delay in the eruption of the lateral incisor on the cleft side of months in cases with cleft lip and alveolus and months with cleft lip and palate, when the tooth was located distal to the cleft. Furthermore, there was an additional delay of months when the tooth was situated in the premaxilla. Kramer et al. () studied the eruption of the deciduous cuspids and molars and observed a delay in the eruption of

2 Cleft Palate Craniofacial Journal, May 00, Vol. No. TABLE Distribution of the Sample According to Sex Age, mo Boy Girl Total Total TABLE Mean, SD, and SEM Age (in months) of Eruption of the Maxillary Deciduous Teeth for.00.* 0.0* * Significant (p.0) cleft versus noncleft side difference the first molars on the cleft side, both in the maxilla ( months) and the mandible ( month), in children with complete unilateral cleft lip and palate. Since individual and environmental factors, characteristic of the different populations, may affect the timing of tooth eruption (Lysell et al., ) and due to the large variability observed in previous studies, the purpose of this study was to determine the chronology and sequence of eruption of the deciduous teeth in white, Brazilian children with complete unilateral cleft lip and palate. MATERIAL AND METHODS In this cross-sectional study, a total of consecutive white children with complete unilateral cleft lip and palate (Table ) attending the Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC/USP), Bauru, Sao Paulo, Brazil, for routine treatment were examined ( boys and girls; age range, 0 to months). Syndromic children were not included in this study because of possible influences on tooth eruption inherent to the syndrome. This research project was approved by the ethics committee of the hospital. A previously trained single observer (CD) performed the examination under natural light. The teeth were considered as erupted whenever there was any portion of the crown across the gingival barrier. Those teeth that were not present in the oral cavity were regarded as unerupted unless the child s caretaker provided information on tooth extraction. After data collection, the children were assigned to age and sex groups. The mean ages of eruption were calculated for each sex and arch. The right and left sides of the maxilla and mandible were analyzed separately to evaluate the possible influence of the cleft on chronology and sequence of tooth eruption. The cleft side was regarded as the side of the maxilla comprising the minor segment and the central incisor on the same side. The same criterion was used for the mandible. The mean age of eruption for each tooth was calculated using the Kärber method, as modified by Hayes and Mantel (). Statistical analysis was performed using Student s t test, with a significance level of.0, to assess possible differences between sexes and the dental sides, in relation to the mean ages of eruption, for both the maxilla and the mandible. RESULTS The obtained results for the mean ages of eruption of the deciduous teeth are presented in Tables through. All teeth on the cleft side, in both sexes, presented a higher mean age of eruption than their homologues on the noncleft side. This difference was statistically significant for the maxillary lateral incisor, maxillary cuspid, and mandibular lateral incisor for both sexes (Tables through ), maxillary second molar for the girls (Table ), and mandibular cuspid for the boys (Table ).

3 Duque et al., TOOTH ERUPTION IN CLEFT PATIENT TABLE Mean, SD, and SEM Age (in months) of Eruption of the Mandibular Deciduous Teeth for TABLE Mean, SD, and SEM Age (in months) of Eruption of the Mandibular Deciduous Teeth for Girls..* 0.* * * Significant (p.0) cleft versus noncleft side difference. * Significant (p.0) cleft versus noncleft side difference. In Tables through, the results of the comparisons between the mean ages of eruption between sexes can be observed. There was no difference in the mean ages of eruption of the deciduous teeth between boys and girls (Tables through ), except for the maxillary cuspids for both sides (Tables and ) and the mandibular cuspids at the noncleft side (Table ). The sequence of eruption obtained for the deciduous teeth in the subjects with complete unilateral cleft lip and palate for each sex is shown in Table. Neonatal and natal teeth were not found. DISCUSSION Due to the lack of data regarding the mean ages of eruption of the deciduous teeth in children with complete unilateral cleft lip and palate, the results were compared with each other within this study, regarding the sides and sexes. The differences between the mean ages of eruption of the deciduous teeth in the cleft and noncleft sides for both the maxilla and the mandible are comparable to the findings obtained by Pöyry and Ranta () in the group of unilateral cleft lip and palate, yet the differences they observed were not statistically significant. It is generally accepted that tooth eruption in children with orofacial clefts may be affected by causes, including structural malformations and/or delay in dental development (Ranta, ; Brouwers and Kuijpers-Jagtman, ). Odontogenesis in patients with clefts is initiated at the same time on both sides, yet it takes place more slowly on the cleft side, bringing about an asymmetric development between the homologous teeth (Pöyry and Ranta, ; Ranta, ). Another important factor for the delayed eruption is the insufficient space for tooth eruption at the alveolar process due to the lack of supporting bone, because the maxilla in patients with complete unilateral cleft lip and palate is approximately -mm smaller than the maxilla of noncleft individuals (Peterka et al., ). One further contributing factor for the delay in the eruption of the deciduous teeth, especially at the cleft area, may be related to the presence of a surgical scarring that may make tooth emergence close to the cleft area more difficult. The traumatic effect of the surgery, along with the deficient blood supply in this area, may also play a role in the altered timing of tooth eruption at the cleft area (Pöyry and Ranta, ). In this study, the association between the cleft and the chronology of tooth eruption could be verified in both jaws for particular teeth. This phenomenon may be explained by the more superior and posterior location of the maxillary minor segment, which yields a smaller masticatory force on the cleft side, which in turn might provoke a delay in tooth eruption, due to functional factors, in both the maxilla and the mandible (Kramer et al., ). The more remarkable asymmetry observed among the mean ages of eruption of the teeth on each side was for the maxillary lateral incisors. According to Kramer et al. (), in whose study this phenomenon was also observed, an apical displacement of the tooth bud of the lateral incisor takes place in the complete cleft lip and palate, in which the nasal floor and alveolar process are involved. For that reason, the pathway of eruption of this tooth becomes longer. It is also believed that the delay in eruption of the maxillary lateral incisor close to the cleft area may be associated with its morphological changes, such as duplication, shape alterations, or even the absence of this tooth (Peterka et al.,, ). It is important to highlight that the present study did TABLE Mean, SD, and SEM Age (in months) of Eruption of the Maxillary Deciduous Teeth for Girls TABLE Comparison of the Mean Ages of Eruption of the Maxillary Deciduous Teeth on the for Girls Versus..*.*..* *.. * Significant (p.0) cleft versus noncleft side difference. * Statistically significant difference (p.0).

4 Cleft Palate Craniofacial Journal, May 00, Vol. No. TABLE Comparison of the Mean Ages of Eruption of the Maxillary Deciduous Teeth on the for Girls Versus * Statistically significant difference (p.0) *.. TABLE Comparison of the Mean Ages of Eruption of the Mandibular Deciduous Teeth on the for Girls Versus TABLE Comparison of the Mean Ages of Eruption of the Mandibular Deciduous Teeth on the for Girls Versus * Statistically significant difference (p.0) *.. TABLE Sequence of Eruption of the Deciduous Teeth in children with Cleft Lip and Palate* Boy N N NC-st m C-st m NC-nd m C-nd m Maxilla Girl N N C-st m NC-st m NC-nd m C-nd m Boy N N NC-st m C-st m C-C NC-nd m C-nd m Mandible Girl N N C-st m NC-st m NC-nd m C-nd m *C cleft; NC noncleft; ci central incisor; li lateral incisor; c cuspid; st m first molar; nd m second molar. not use radiographs, which would have revealed tooth agenesis but were not possible due to the age range of the sample. Patients with complete cleft lip and palate present a high occurrence of tooth agenesis, especially of the deciduous lateral incisor adjacent to the cleft area. According to Suzuki et al. (), % of the lateral incisors close to the cleft area are congenitally missing in the deciduous dentition of patients with cleft lip and palate. Thus, it is likely that the classification of an absent tooth as unerupted may have influenced the high mean age of eruption (. months for boys and. for girls) for the maxillary lateral incisor at the cleft side, which is the most frequently affected tooth by the presence of the cleft. No difference in the mean ages of eruption of the deciduous teeth between boys and girls were observed, except for the maxillary cuspids on both sides and the mandibular cuspids on the noncleft side. These teeth erupted significantly earlier in boys, but the difference was not relevant from a clinical standpoint. This is consistent with studies comprising children with cleft lip and palate (Pöyry and Ranta, ; Pöyry and Ranta, ; Pöyry, ) and noncleft Brazilian children (Vono et al., ). In this study, the sequence of eruption of the deciduous teeth for the mandible was similar to that observed in noncleft children. On the other hand, there was an alteration in the sequence of eruption on both sides of the maxilla because the maxillary lateral incisor was the last tooth to erupt in the oral cavity. In conclusion, the results suggest that the cleft affects the chronology of eruption of the primary teeth that are directly related to it. The knowledge on the standard chronology and sequence of eruption of deciduous teeth in individuals with complete unilateral cleft lip and palate allows us to provide orientation to the parents as to the characters inherent to these patients. On this basis and because this study was restricted to children with complete unilateral cleft lip and palate, the need for studies on the chronology of tooth eruption in other types of clefts is suggested so that its peculiarities may be revealed. REFERENCES Bailit HL, Doykos JD, Swanson LT. Dental development in children with cleft palate. J Dent Res. ;:. Brouwers HJ, Kuijpers-Jagtman AM. Development of permanent tooth length in patients with unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop. ;:. Demirjian A, Levesque GY. Sexual differences in dental development and prediction of emergence. J Dent Res. ;:. Fishman LS. Factors related to tooth number, eruption time, and tooth position in cleft palate individuals. J Dent Child. ;:0 0. Galili G, Rosenzweig KA, Klein H. Eruption of primary teeth and general pathologic conditions. J Dent Child. ;:. Haring FN. Dental development in cleft and noncleft subjects. Angle Orthod. ;: 0. Hayes RL, Mantel N. Procedures for computing the mean ages of eruption of human teeth. J Dent Res. ;:. Infante PF, Owen GM. Relation of chronology of deciduous tooth emergence to height, weight and head circumference in children. Arch Oral Biol. ; :. Kramer GJ, Hoeksma JB, Prahl-Andersen B. Emergence of the deciduous incisors in CLP children. Eur J Orthod. ;: 0. Kramer GJ, Hoeksma JB, Prahl-Andersen B. Emergence of the deciduous canines and molars in CLP children. Eur J Orthod. ;:. Lavelle CL. A note on the variation in the timing of deciduous tooth eruption. J Dent. ;: 0. Lysell L, Magnusson B, Thilander B. Eruption of the deciduous teeth as regards time and order. Int Dent J. ;:.

5 Duque et al., TOOTH ERUPTION IN CLEFT PATIENT Lysell L, Magnusson B, Thilander B. Relations between the times of eruption of primary and permanent teeth: a longitudinal study. Acta Odont Scand. ;:. Loevy HT, Aduss H. maturation in cleft lip, cleft palate or both. Cleft Palate J. ;:. Magnüsson TE. Emergence of primary teeth and onset of dental stages in Icelandic children. Community Dent Oral Epidemiol. ;:. Peterka M, Peterková R, Likovsky Z. Timing of exchange of the maxillary deciduous and permanent teeth in boys with three types of orofacial clefts. Cleft Palate Craniofac J. ;:. Peterka M, Tvrdek M, Müllerova Z. eruption in patients with cleft lip and palate. Acta Chir Plast. ;:. Pöyry M. Prenatal factors and tooth eruption in children with oral clefts. J Dent Child. ;:. Pöyry M. Development correlations in tooth formation timing in children with lip and palate. Proc Finn Dent Soc. ;:0. Pöyry M, Ranta R. Emergence of deciduous teeth in children with oral clefts. Proc Finn Dent Soc. ;:. Pöyry M, Ranta R. Formation of anterior maxillary teeth in 0--year-old children with cleft lip and palate and prenatal risk factors for delayed development. J Craniofac Genet Dev Biol. ;:. Ranta R. A review of tooth formation in children with cleft lip/palate. Am J Orthod Dentofacial Orthop. ;0:. Seow WK. Effects of preterm birth on oral growth and development. Aust Dent J. ;:. Suzuki A, Watanabe M, Nakano M, Takahama Y. Maxillary lateral incisors of subjects with cleft lip and/or palate: II. Cleft Palate Craniofac J. ;: 0. Vono AZ, Vono BG, Freitas JAS, Lopes ES. Estudo da cronologia de erupção dos dentes decíduos em crianças leucodermas, brasileiras de Bauru, Estado de São Paulo. Estomatol Cult. ;:.