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OBJECTIVE: To evaluate the oral features in individuals with oral-facial-digital syndrome type 1 (OFD 1), previously diagnosed by the Genetic Sector of the Hospital of Rehabilitation of Craniofacial Anomalies of the University of Sao Paulo (HRAC-USP). DESIGN: Twelve patients with OFD 1 were examined clinically and radiographically; their medical files were also evaluated. RESULTS: Associated oral malformations were observed in all patients (100%). The most frequent findings were tongue hamartomas, multiple buccal frena, asymmetric lips, asymmetric tongue, and bilateral maxillary gingival swelling. Interestingly, atrophy of the maxillary midline frenum was also observed in all the individuals examined. CONCLUSIONS: Several extra and intraoral alterations were observed in patients with OFD 1. The authors suggest the inclusion of atrophy of the maxillary midline frenum as a commonly found characteristic of OFD 1. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the prevalence and type of enamel hypoplasia in deciduous canines of patients with complete unilateral and bilateral cleft lip and palate, as well as its distribution according to gender, dental arch, and side of cleft. DESIGN: Cross sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Sao Paulo, Brazil. MATERIAL AND METHODS: Three-hundred twelve Caucasian children (193 boys, 119 girls), aged 3 to 10 years, presenting complete unilateral and bilateral cleft lip and palate were included in this study. A single examiner carried out clinical examination under natural light with a dental probe and dental mirror and, after drying of the tooth, by means of a simplified hypoplasia index. RESULTS: A prevalence of 43.8% was observed for unilateral and 39% for bilateral clefts. Both groups revealed similar distributions regarding the maxillary and mandibular dental arches and gender. Similar distribution was also observed on the cleft and noncleft sides for the unilateral cleft group. The most frequent type and severity was obvious hypoplasia, followed by minimal hypoplasia, both roughly round. CONCLUSION: The results suggest that the cleft does not influence the occurrence of hypoplasia in deciduous canines. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the prevalence of enamel alterations affecting the deciduous and permanent central maxillary incisors of children with complete unilateral cleft lip and palate and to verify their characteristics. DESIGN: Cross-sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies-University of Sao Paulo, Bauru, Sao Paulo, Brazil. PATIENTS: A sample of 90 patients attending the Hospital for Rehabilitation of Craniofacial Anomalies, presenting with complete cleft lip and palate, of both genders, ages 2 to 11 years old. METHODOLOGY: The buccal surfaces of the maxillary central incisors of patients were analyzed for observation of the presence of enamel defects, their type, number, and location. The prevalence of defects was compared between deciduous and permanent teeth and between the incisors at the cleft and noncleft sides. RESULTS: There was a higher frequency of defects among incisors on the cleft side for both deciduous and permanent dentitions compared with the noncleft side (p < .05); the permanent central incisor was more frequently affected than the deciduous. Evaluation of the types of defects for both incisors in both dentitions demonstrated a homogeneous distribution, except for a lower proportion of yellow opacity in the permanent dentition on the cleft side. In general, the most affected area in all dentitions was the incisal third. CONCLUSION: The prevalence of enamel alterations affecting incisors adjacent to the cleft was higher than for incisors on the noncleft side. This difference also was present in the permanent dentition. [ABSTRACT FROM AUTHOR]

Orofacial clefts (OC) represent some of the most common congenital malformations and affect multiple structures in the craniofacial region. There are a wide range of morphological OC types within the spectrum of both non-syndromic OC (NSOC) and syndromic OC, including cleft lip (CL), cleft lip and palate, (CLP), and cleft palate (CP). Here, we describe the most frequent dental anomalies seen in the permanent dentition of individuals with NSOC, comparing them between the three main cleft types (CL, CLP, and CP). We present these findings from the perspective of prevalence relating to each anomaly, as well as the clinical characteristics and potential impact on the rehabilitation process. The investigation of dental anomalies associated with NSOC is important, helping to expand the phenotypic characterization of NSOC, improve the initial diagnostics, and establish appropriate rehabilitation and counseling., (© 2022 Wiley Periodicals LLC.)

Introduction  Cortisol is a hormone involved in the response to stress. Attention is a function that can change due to exposure to stress. Objectives  To verify the correlation between the level of salivary cortisol and sustained auditory attention in children with cleft lip and palate, as well as to compare the results of the variables analyzed between female and male patients. Methods  In total, 103 children aged 6 to 11 years, were divided into 2 groups: those with cleft lip and palate (experimental group, EG; n  = 69) and the control group (CG; n  = 34). The Sustained Auditory Attention Ability Test (SAAAT) and salivary cortisol levels, measured by an enzyme immunoassay kit (Salimetrics, Stage College, PA, US), were calculated and compared regarding the two groups. The statistical tests used were the Mann-Whitney test and the Spearman correlation. Results  The median level of salivary cortisol was of 0.03615 µl/dL and 0.18000 µl/dL respectively for the EG and CG, with a significant difference between the groups ( p  = 0.000). Absence of statistical significance (total error score = 0.656; vigilance decrement = 0.051) was observed the for SAAAT among the EG (median total error score = 12.00; 25th percentile [25%] = 7.00; 75th percentile [75%] = 21.00; and vigilance decrement = 1.00; 25% = 0.00; 75% = 2.50) and the CG (median total error score = 12.00; 25% = 6.00; 75% = 24.00; and vigilance decrement = 0.00; 25% = -1.00; 75% = 2.00). Conclusion  All children had median levels of salivary cortisol and scores for sustained auditory attention within normal parameters. A significant correlation between the level of salivary cortisol and the ability to sustain auditory attention was observed in children without cleft lip and palate. There were no differences regarding the SAAAT and salivary cortisol between female and male patients., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: Frontonasal dysplasia is a rare developmental defect of the midface, and little is known about the dental involvement in individuals with this condition. This study investigated tooth abnormalities and occlusal disorders in individuals with frontonasal dysplasia., Design: Cross-sectional., Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil., Interventions: Clinical oral examination, analysis of patient records, and panoramic radiographs., Participants: A total of 20 individuals with frontonasal dysplasia aged 7 to 17 years., Main Outcome Measures: Prevalence of the several tooth abnormalities and occlusal disorders analyzed., Results: A total of 19 individuals presented at least one tooth abnormality, with highly variable findings. In radiographs, 20% of individuals (all presenting oral clefts) presented agenesis of lateral incisors and second premolars. No supernumerary teeth were observed; 65% of individuals exhibited occlusal alterations, especially anterior open bite in the two individuals with median cleft lip., Conclusions: Variable clinical and radiographic alterations were observed, probably due to the large variety of phenotypic characteristics. No specific dental alteration could be related with frontonasal dysplasia.

Objectives: To assess the impact of promoting self-care in nursing workload and associate it to the variables: age, gender, socioeconomic status, education, marital status and number of children of caregivers., Methods: Prospective study with 31 children and their caregivers. Participants were assessed at two moments, 1st and 2nd hospitalization, the nursing workload was measured by the Nursing Activities Score (NAS)., Results: The mean NAS in the 1st hospitalization was 60.9% and in the 2nd hospitalization was 41.6%, that is, 14.6 and 9.9 hours of nursing, respectively. The nursing workload on the first day of hospitalization was higher compared to the last day, both for the 1st (p<0.001) and for the 2nd hospitalization (p<0.001), and higher in the first (p<0.001) and in the last day (p=0.025) in the 1st hospitalization. Comparing the 1st hospitalization to the 2nd hospitalization, the first was higher (p<0.001), and NAS items related to the training of self-care was influenced (p<0.001)., Conclusion: The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation., Objetivos: Verificar o impacto da promoção do autocuidado na carga de trabalho de enfermagem e associá-la às variáveis: idade, gênero, classificação socioeconômica, escolaridade, estado civil e número de filhos dos cuidadores., Método: Estudo prospectivo, onde participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos, 1ª e 2ª internação, quanto à carga de trabalho de enfermagem mensurada por meio do Nursing Activities Score (NAS)., Resultados: A média NAS na 1ª internação foi de 60,9%, e na 2ª internação foi de 41,6%, ou seja, 14,6 e 9,9 horas de enfermagem, respectivamente. A carga de trabalho de enfermagem no primeiro dia de internação foi maior quando comparada ao último dia, tanto na 1ª (p<0,001) como na 2ª internação (p<0,001), e maior no primeiro (p<0,001) e último dia (p=0,025) na 1ª internação. Ainda, na 1ª internação, foi maior quando comparada à 2ª internação (p<0,001), e os itens NAS referentes à capacitação do autocuidado a influenciaram (p<0,001)., Conclusão: A carga de trabalho de enfermagem referente à promoção do autocuidado correspondeu a 14,6 horas e foi superior ao determinado pela legislação existente.

The aim of this study was to measure and compare the dimensions of the dental arches on three-dimensional digital study models in children with and without cleft lip and palate before the primary surgery. The sample consisted of 223 digital models of children aged 3-9 months, divided into 5 groups: without craniofacial deformities, unilateral and bilateral incomplete cleft lip and alveolus, unilateral and bilateral complete cleft lip and alveolus, unilateral cleft lip and palate, and bilateral cleft lip and palate. Dental casts of the maxillary dental arches of the children were used. The dental casts underwent a process of scanning through 3D scanner and the measurements used for the correlation among groups were made on the scanned images. Statistical analysis was performed by t test and ANOVA followed by Tukey test. The results showed that the intercanine distance and anterior cleft width was wider in children with unilateral cleft lip and palate. The intertuberosity distances and posterior cleft width was wider in children with bilateral cleft lip and palate among the groups. Children with cleft lip and palate before the primary surgery had wider maxillary arch dimensions than the children without cleft lip and palate.

Objective: To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty., Method: Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes., Results: Concerning cheiloplasty, the doubts were related to feeding (36%), hygiene and healing (24% each), pain and infection (8% each). With regard to palatoplasty, the doubts were related to feeding (48%), hygiene (24%), pain (16%), bleeding (8%) and infection (4%)., Conclusion: The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound.

Objective: To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors., Design: Retrospective analysis of patient records and evaluation of preoperative initial photographs., Setting: Tertiary craniofacial center., Participants: Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007., Interventions: The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate., Main Outcome Measures: Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated., Results: Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association (P ≤ .05) between the fistulas and initial cleft width (P = .0003), intraoperative problems (P = .0037), and postoperative problems (P = .00002)., Conclusions: The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.

We report the case of a 9-year-old girl who presented with a complaint of a malodorous bloody discharge from the left naris. The patient had previously undergone a complete repair of left-sided cleft lip and palate. Clinical examination revealed hyperplasia of the nasal mucosa on the left side. X-ray examination of the nasal cavity demonstrated a radiopaque structure that resembled a tooth and a radiopaque mass similar to an odontoma that was adherent to the root of the suspected tooth. With the patient under general anesthesia, the structure was removed. On gross inspection, the structure was identified as a tooth with a rhinolith attached to the surface of its root. Microscopic examination revealed normal dentin and pulp tissue. A nonspecific inflammatory infiltrate was observed around the rhinolith, and areas of regular and irregular mineralization were seen. Some mineralized areas exhibited melanin-like brownish pigmentation. Areas of mucus with deposits of mineral salts were also observed. Rare cases of an intranasal tooth associated with a rhinolith have been described in the literature. We believe that this case represents only the second published report of an intranasal tooth associated with a rhinolith in a patient with cleft lip and palate.

Objective: To determine the timing and sequence of eruption of primary teeth in children with complete bilateral cleft lip and palate., Material and Methods: This cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo, Bauru, SP, Brazil, with a sample of 395 children (128 girls and 267 boys) aged 0 to 48 months, with complete bilateral cleft lip and palate., Results: Children with complete bilateral clefts presented a higher mean age of eruption of all primary teeth for both arches and both genders, compared to children without clefts. This difference was statistically significant for all teeth, except for the maxillary first molar. Mean age of eruption of most teeth was lower for girls compared to boys. The greatest delay was found for the maxillary lateral incisor, which was the eighth tooth of children with clefts of both genders. Analyzing by gender, the maxillary lateral incisor was the eighth tooth to erupt in girls and the last in boys., Conclusion: The results suggest an interference of the cleft on the timing and sequence of eruption of primary teeth.

Objective: To evaluate the presence of enamel alterations in deciduous maxillary central incisors of infants with unilateral cleft lip and alveolar ridge, with or without cleft palate, and to compare the occurrence and location of these alterations between the central incisor adjacent to the cleft and the contralateral incisor., Design: Intraoral clinical examination was performed after tooth cleaning and drying by a single examiner with the aid of a dental mirror, dental probe, and artificial light, with the child positioned on a dental chair. The defects were recorded in a standardized manner according to the criteria of the Modified Developmental Defects of Enamel Index., Setting: Hospital for Rehabilitation of Craniofacial Anomalies (HRAC) at Bauru, São Paulo, Brazil., Patients: One hundred one infants were evaluated. All were white, of both genders, aged 12 to 36 months and had at least two thirds of the crowns of maxillary incisors erupted., Results: Demarcated opacity was the most common defect at both cleft and noncleft sides, followed by diffuse opacity. The occurrence of hypoplasia at the cleft side was 11.8%. Most defects affected less than one third of the crown., Conclusion: The occurrence of enamel defects in deciduous maxillary central incisors of patients with unilateral cleft lip was 42.6%, mainly affecting the cleft side as to both number and severity.

Introduction: The Apert syndrome is a rare disorder of autosomal dominant inheritance caused by mutations in the FGFR2 gene at locus 10q26; patients with this syndrome present severe syndactyly, exophthalmia, ocular hypertelorism and hypoplastic midface with Class III malocclusion, besides systemic alterations. Most investigations available on the Apert syndrome address the genetic aspect or surgical management, with little emphasis on the oral aspects., Objective: To investigate the oral findings, including dental anomalies, ectopic eruption of the maxillary permanent first molars and soft tissue alterations, in subjects with Apert syndrome., Materials and Methods: Clinical and radiographic examination of nine patients with Apert syndrome, aged 6 to 15 years, not previously submitted to orthodontic or orthognathic treatment., Results: Dental anomalies were present in all patients, with one to eight anomalies per individual. The most frequent anomalies were tooth agenesis, mainly affecting maxillary canines, and enamel opacities (44.4% for both). Ectopic eruption of maxillary first molars was found in 33.3% of patients; lateral palatal swellings were observed in 88.8% of patients., Conclusions: The occurrence of typical lateral palatal swellings agrees with the literature. The high prevalence of dental anomalies and ectopic eruption may suggest a possible etiologic relationship with the syndrome.

Objective: To examine the prevalence of dental anomalies in the deciduous and permanent teeth, ectopic eruption of permanent first molars, and associated oral malformations in individuals with Treacher Collins syndrome., Study Design: Clinical and radiographic examination of 15 patients with Treacher Collins syndrome, from the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo, not submitted to orthodontic or orthognathic treatment., Results: Dental anomalies were present in 60% of the sample, with 1-8 anomalies per individual. Hypoplastic dental anomalies were the most common, followed by heterotopic and hyperplastic dental alterations. The most frequent anomalies were tooth agenesis (33.3%), mainly affecting the mandibular second premolars, and enamel opacities (20% of patients). Ectopic eruption of the maxillary first molars was found in 13.3% of subjects. Associated oral malformations, primarily isolated cleft palate, followed by complete cleft lip and palate and macrostomia, were observed in 66.7% of patients., Conclusions: Presence of cleft palate associated with the syndrome is in agreement with the literature. The high prevalence of dental anomalies suggests a possible etiologic relationship, not described in the literature so far, between such alterations and the Treacher Collins syndrome. Further investigations on larger samples are required to confirm these results.

Objective: To gain more information on the oral health status of subjects with syndromic craniosynostosis., Design: A cross-sectional study., Materials and Methods: The present study took place at the Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo (HRAC-USP). The sample was 19 patients with syndromic craniosynostosis (10 Apert, 5 Crouzon, 2 Pfeiffer and 2 Saethre-Chotzen), aged 5 to 15 years. An assessment of plaque, caries and gingival indices, and evaluation of the efficacy of toothbrushing was carried out. The measurements included PHP index, dmft and DMFT indices, gingival index, comparison of PHP before and after non-supervised toothbrushing and between individuals with and without severe syndactyly., Results: The patients displayed high plaque index and poor efficacy of toothbrushing, regardless of the presence of severe syndactyly; despite the plaque accumulation, the gingival index was not proportionally high. There was predominance of the D component for the DMFT index, which combined with the need for restorative treatment in 42.1% of the patients indicates poor access to dental care by these patients., Conclusions: The results show the need for a dental follow-up programme for these patients. Carers should be informed of the importance in aiding these patients during accomplishment of oral hygiene at home.

Objective: To evaluate the prevalence and type of enamel hypoplasia in deciduous canines of patients with complete unilateral and bilateral cleft lip and palate, as well as its distribution according to gender, dental arch, and side of cleft., Design: Cross sectional., Setting: Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil., Material and Methods: Three-hundred twelve Caucasian children (193 boys, 119 girls), aged 3 to 10 years, presenting complete unilateral and bilateral cleft lip and palate were included in this study. A single examiner carried out clinical examination under natural light with a dental probe and dental mirror and, after drying of the tooth, by means of a simplified hypoplasia index., Results: A prevalence of 43.8% was observed for unilateral and 39% for bilateral clefts. Both groups revealed similar distributions regarding the maxillary and mandibular dental arches and gender. Similar distribution was also observed on the cleft and noncleft sides for the unilateral cleft group. The most frequent type and severity was obvious hypoplasia, followed by minimal hypoplasia, both roughly round., Conclusion: The results suggest that the cleft does not influence the occurrence of hypoplasia in deciduous canines.

Objective: This study aimed to evaluate a possible delay in root development of the permanent lateral incisor on the cleft side compared with its contralateral tooth in patients with incomplete and complete unilateral cleft lip., Design: Retrospective., Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil., Patients: A sample of 95 panoramic radiographs of patients with incomplete and complete unilateral cleft was obtained from the files of HRAC/USP. The patients were both boys and girls of various races, aged 5 to 11 years, and did not have any syndrome or associated congenital malformation. The sample was divided into three groups according to the severity of the cleft lip., Main Outcome Measure: Radiographs were analyzed to compare root development stage of the lateral incisor on the cleft side with the noncleft side according to the classification of Nolla., Results: The mean delay in root development of the permanent lateral incisor on the cleft side ranged from 0.5 to 1.6 scores for all three groups investigated., Conclusions: Root development of the permanent lateral incisor on the cleft side was delayed compared with the noncleft side.

Objective: To evaluate the prevalence of enamel alterations affecting the deciduous and permanent central maxillary incisors of children with complete unilateral cleft lip and palate and to verify their characteristics., Design: Cross-sectional., Setting: Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo, Bauru, São Paulo, Brazil., Patients: A sample of 90 patients attending the Hospital for Rehabilitation of Craniofacial Anomalies, presenting with complete cleft lip and palate, of both genders, ages 2 to 11 years old., Methodology: The buccal surfaces of the maxillary central incisors of patients were analyzed for observation of the presence of enamel defects, their type, number, and location. The prevalence of defects was compared between deciduous and permanent teeth and between the incisors at the cleft and noncleft sides., Results: There was a higher frequency of defects among incisors on the cleft side for both deciduous and permanent dentitions compared with the noncleft side (p < .05); the permanent central incisor was more frequently affected than the deciduous. Evaluation of the types of defects for both incisors in both dentitions demonstrated a homogeneous distribution, except for a lower proportion of yellow opacity in the permanent dentition on the cleft side. In general, the most affected area in all dentitions was the incisal third., Conclusion: The prevalence of enamel alterations affecting incisors adjacent to the cleft was higher than for incisors on the noncleft side. This difference also was present in the permanent dentition.

Purpose: The purpose of the present study was to assess the acceptance of 4 techniques employed for child behavior management during dental treatment., Methods: Four hundred caretakers of 4- to 10-year-old children with cleft lip and/or palate presented for dental treatment at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil. They were interviewed after explanation and presentation of photographs illustrating the sequence of the following techniques: tellshow-do; voice control; physical restraint; and hand-over-mouth., Results: The levels of acceptance of the techniques were 98%, 96%, 81%, and 85%, respectively. A large acceptance was observed for all techniques investigated. The caretakers' fear that the techniques might make the child afraid of the dentist was commonly mentioned as nonacceptance for all techniques., Conclusions: It was concluded that it is important for pediatric dentistry professionals to inform parents about each technique's objectives before application to avoid possible misunderstandings and to foster a trusting relationship between the child, the parents, and the dentist.

The main object of this study is to analyze the prevalence of oral trauma in subjects with complete bilateral clefts, with anterior projection of the premaxilla. A total of 106 children aging 6 months to 9 years were analyzed. The caretakers answered a specific questionnaire, in order to report the presence or absence of trauma to the soft and/or hard tissues of the child's mouth. Whenever there was a history of trauma, the patients were submitted to clinical examination. The prevalence of oral trauma was 53%, being 91% of soft tissue lesions, 8.9% of avulsion, 7% of luxation and 1.8% of intrusion. For the males, the prevalence was 56% and for the females it was 47%, with no statistical significance. Regarding the following aspects:period of time spent with the parents and at school, and presence or absence of siblings, no statistical difference could be found. Among the traumatized individuals, 80% aged less than 3 years by the moment of the trauma, 89% suffered the trauma at home, 75% presented lesions in the soft tissue at the premaxilla, 16% in the maxillary incisors, and 8.9% presented lesions in both structures. It was noticed that 45% of the permanent incisors that succeeded the traumatized deciduous teeth presented alterations, being 48% of structure and 52% of structure and position. The prevalence of trauma in this sample was superior to that observed in the literature, without any positive associations between the evaluated aspects. These results suggest that the projection of the premaxilla brings about a higher risk of oral trauma around this area.

The present study aimed at evaluating the prevalence of tooth ankylosis in deciduous molars of Caucasian children with cleft lip and/or palate aged 5 to 12 years, of both genders. A total of 330 patients seen at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo for routine treatment were clinically evaluated. The prevalence of ankylosis was analyzed in relation to gender, age range (5-7, 8-10, 11-12 years), type of cleft, affected tooth and arch. The total group showed a prevalence of 18%, with no statistical difference between genders and among types of cleft; ankylosis was more often in the mandibular arch, lower first molars and among children in the age ranges 8-10 and 11-12 years. The results agreed with those observed in the related literature for patients without clefts, pointing out the absence of influence of the cleft on the prevalence of ankylosis. This reinforces the importance of early diagnosis of this anomaly and of the treatment of choice, which are similar in patients with or without clefts.

Objective: To evaluate the prevalence of palatal and alveolar cysts in babies with cleft lip and/or palate., Design: Cross-sectional., Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP), Bauru, São Paulo, Brazil., Participants: Two hundred ninety-one Caucasian babies divided into four groups according to the type of cleft: cleft lip with or without cleft alveolus (70), complete unilateral cleft lip and palate (112), complete bilateral cleft lip and palate (56), and cleft palate (53)., Results: A low prevalence of palatal and alveolar cysts was observed among patients with the four different types of clefts, with no statistically significant difference between genders. The maxilla and the anterior area of the mouth were more affected than the mandible and the posterior area., Conclusions: The low prevalence of palatal and alveolar cysts in the four groups of babies with clefts included in this study may have been due to the high mean age of the sample.

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 435 children aged 0 to 48 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.

Objective: To compare periodontal conditions in children with and without cleft., Design: Clinical examinations and microbiological analysis of 57 selected children, including 30 with unilateral complete cleft lip and palate (experimental group) and 27 without clefts (control group)., Setting: Hospital of Rehabilitation of Craniofacial Anomalies (HRCA) in Bauru, Sao Paulo, Brazil., Patients, Participants: All children examined were healthy and between the ages of 5 and 6 years., Results: The mean plaque index (PI) in the experimental group was higher (1.82 +/- 0.3) than in the control group (1.63 +/- 0.38), although this difference was not statistically significant. The mean gingival index (GI) in the experimental group (1.82 +/- 0.38) was found to be significantly higher (p <.05) than that of the control group (0.79 +/- 0.33). The cleft area in the experimental group, with a mean PI of 2.04 +/- 0.58 and mean GI of 1.11 +/- 0.26, compared with the posterior area, with a mean PI of 1.74 +/- 0.37 and mean GI of 1.04 +/- 0.26, showed a statistically significant difference only in the PI. Most of the children in both experimental and control groups presented a moderate PI degree (73.33% and 81.48%, respectively) and a high prevalence of mild gingivitis (53.33% and 70.37%, respectively). Analysis of the organisms showed that Prevotella nigrescens was detected in 16.67% of the experimental group and 11.11% of the control, whereas Porphyromonas gingivalis and Treponema denticola were not detected., Conclusion: Children with clefts showed greater gingival inflammation, despite the same amount of plaque and prevalence of microorganisms.

Objective: To investigate the pattern of breast-feeding and sugar intake among babies with cleft lip and palate., Participants: Caretakers of 200 babies with cleft lip and palate enrolled at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil., Results: A low prevalence of breast-feeding was found. The most reported reason was the sucking inability of the baby. Complete cleft lip and palate was the primary cause affecting sucking. The first contact with sugar occurred mainly through the baby bottle with milk during the first month of life. For nutritional supplement, the children were given sugar and fruit juices in the bottle., Conclusions: It was observed that dietary habits in babies with cleft lip and palate are more risky. This highlights the role played by early education and constant oral hygiene follow-up for prevention in these patients.

Objective: The objective of this retrospective study was to verify whether the root development of the permanent lateral incisor on the cleft side was delayed, compared with its contralateral tooth in subjects with complete unilateral cleft lip and palate., Setting: Craniofacial Anomalies Rehabilitation Hospital (HRAC)-University of São Paulo-Bauru, Brazil., Patients: A sample of 98 panoramic radiographs of HRAC patients with complete unilateral cleft lip and palate was selected, regardless of sex and race., Main Outcome Measure: Panoramic radiographs were analyzed and the root development stage of the cleft-side permanent lateral incisor was compared with its contralateral tooth., Results: Overall, the permanent cleft-side lateral incisor was significantly delayed in root development in relation to the non-left side contralateral tooth (p <.05). However, no significant differences were observed between boys and girls., Conclusions: Root development of the permanent cleft-side lateral incisor was delayed, compared with its contralateral tooth. The cleft itself may play an important role in this delay because the results from boys and girls were very similar.

Cleft lip and palate are relatively common congenital malformations, which may require specialist paedodontic treatment. In this article, the case of a 9-year-old boy with bilateral complete cleft lip and palate is presented. He attended the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC) for routine examination, during which the presence of pre-canine supernumeraries bilaterally in the cleft area was seen. The extraction of these dental elements was justified by extensive carious lesions and because they represented a potential problem during secondary palatoplasty. The precautions needed in tooth extraction in patients with cleft lip and palate are described, together with illustrations of the clinical procedure.

Objective: Natal/neonatal teeth are very common in children with complete unilateral and bilateral cleft lip and palate. The extraction of these teeth is the usual treatment in the Hospital for Rehabilitation of Craniofacial Anomalies. The objective of this study was to verify whether these teeth could be of the normal complement or whether they were supernumerary., Design: The primary dentition of children with cleft lip and palate with and without natal/neonatal teeth was compared at the Hospital for Rehabilitation of Craniofacial Anomalies., Subjects: The sample consisted of 55 children with complete unilateral and bilateral cleft lip and palate with natal/neonatal teeth and 54 without., Results: No positive association between these groups and missing lateral incisor or supernumerary or complete dentition was found., Conclusion: The extraction of the natal/neonatal teeth did not alter the final complement of primary teeth, and these teeth could be the lateral incisor or supernumerary.

Objective: The objective of this study was to determine the prevalence of ectopic eruption of intranasal teeth., Design: This was a retrospective study, where records of children with repaired cleft lip and palate were analyzed., Setting: The study was conducted at a large craniofacial center, the Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru, São Paulo, Brazil., Subjects: The sample consisted of 815 records from patients with bilateral cleft lip and palate (BCLP) and 1,495 records from patients with unilateral cleft lip and palate (UCLP). The age of the subjects was 5 to 10 years old and the groups included both males and females., Results: The results showed that 0.61% of the children with BCLP and 0.40% of those with UCLP had an intranasal tooth. The prevalence of an intranasal tooth for the whole group was 0.48%, and it appeared to be more common in females.

Many dentists refuse to offer dental assistance to cleft lip and palate patients because they lack understanding about this malformation and do not want to make a professional mistake with the anesthesia. The aim of this work is to guide clinical practitioners, who want to work with these patients about the anatomical features of the cleft lip and palate area and the implications in the anesthetic procedures.

In the daily routine of the Hospital for Research and Rehabilitation of Cleft Lip and Palate, a high frequency of natal/neonatal teeth was observed. Therefore, this retrospective study was conducted to determine the prevalence of this anomaly in 692 patients with complete unilateral and 327 bilateral cleft lip and palate, who were less than 3 months old, without prior surgery, and registered at the Hospital from 1989 to 1994. A higher prevalence of such teeth was found in the complete bilateral cleft group (10.6%), than in the complete unilateral cleft group (2.02%). Both, however, were higher than that reported for noncleft groups. There were also different characteristics in the appearance of these teeth in cleft patients from those previously related in the literature for normal patients. The conclusion was that these differences constitute another particularity of the cleft lip and palate patient.