Kulas Antje, Illge Christina, Bekes Katrin, Eckert Alexander W, Fuhrmann Robert A W, Hirsch Christian
Private Dental Practice, Nordhausen, Germany.
Department of Pediatric Dentistry and Primary Prophylaxis, University Hospital Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany.
J Orofac Orthop. 2016 Jan;77(1):45-51. doi: 10.1007/s00056-015-0007-z.
White spots are more common in patients with cleft lip and palate (CLP) than in the normal population. Whether these are due to the cleft itself or concomitant circumstances (e.g., surgical procedures, orthodontic treatments, systemic fluoridation, increased caries risk) remains unclear. This case-control study evaluated both their prevalence in CLP patients versus control subjects and associated risk factors.
A total of 73 CLP patients (average age 8.7 years, range 6-18 years, 42 % male) and a control group of 73 age- and gender-matched non-CLP patients were included. Enamel color changes, subsuming mineralization defects (DDE index), mild dental fluorosis (Dean's index), and initial caries (ICDAS score 2), were recorded. Caries index (dmf-t/DMF-T) scores were also recorded to distinguish between high or low caries risk as defined by the Deutsche Arbeitsgemeinschaft für Jugendzahnpflege criteria. Histories of systemic fluoridation, trauma to primary teeth, surgery, and orthodontic treatment were obtained using a questionnaire. Statistical analysis included t test, χ (2) test, and multivariable logistic regression.
Enamel color changes were observed three times more often in the CLP group than in the control group (39.7 vs. 12.3 %; p < 0.001). Significantly more patients in the CLP group had a history of orthodontic treatment (38.4 vs. 15.1 %; p < 0.05). An increased risk for enamel color changes was associated with CLP itself [OR (odds ratio) 3.6; 95 % confidence interval (CI) 1.3-9.9] and table salt plus tablets combined for systemic fluoridation (OR 2.7, 95 % CI 1.1-6.9). No increased risks were identified for increased caries risk, history of primary-tooth trauma, or history of orthodontic treatment.
The higher prevalence of enamel color changes in the CLP group (more than threefold compared to the control group) was not related to previous orthodontic treatments; however, systemic fluoridation (table salt and tablets) constituted a risk factor for the enamel color changes seen in the CLP patients.
唇腭裂（CLP）患者中的白斑比正常人群更为常见。这些白斑是由腭裂本身还是伴随情况（如外科手术、正畸治疗、全身用氟、龋齿风险增加）引起的仍不清楚。本病例对照研究评估了CLP患者与对照受试者中白斑的患病率及其相关危险因素。
共纳入73例CLP患者（平均年龄8.7岁，范围6 - 18岁，42%为男性）和73例年龄及性别匹配的非CLP患者作为对照组。记录釉质颜色变化，包括矿化缺陷（DDE指数）、轻度氟斑牙（Dean指数）和初始龋（ICDAS评分2）。还记录龋指数（dmf - t/DMF - T）得分，以根据德国青少年牙科学会标准区分高龋风险或低龋风险。通过问卷调查获取全身用氟、乳牙外伤、手术和正畸治疗史。统计分析包括t检验、χ²检验和多变量逻辑回归。
CLP组釉质颜色变化的观察频率是对照组的三倍（39.7%对12.3%；p < 0.001）。CLP组有正畸治疗史的患者明显更多（38.4%对15.1%；p < 0.05）。釉质颜色变化风险增加与CLP本身相关[比值比（OR）3.6；95%置信区间（CI）1.3 - 9.9]以及全身用氟的食盐加片剂联合使用（OR 2.7，95% CI 1.1 - 6.9）。未发现龋齿风险增加、乳牙外伤史或正畸治疗史会增加风险。
CLP组中釉质颜色变化的患病率较高（比对照组高三倍多）与先前的正畸治疗无关；然而，全身用氟（食盐和片剂）是CLP患者中所见釉质颜色变化的一个危险因素。
