title: Structural color changes in permanent enamel of patients with cleft lip and palate: a case-control study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Private Dental Practice, Nordhausen, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Kulas
authors.affiliation: Department of Pediatric Dentistry and Primary Prophylaxis, University Hospital Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Illge
authors.affiliation: Department of Pediatric Dentistry, University Hospitel Wien, Wien, Austria.
authors.forename: Katrin
authors.initials: K
authors.lastname: Bekes
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Halle, Halle (Saale), Germany.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Eckert
authors.affiliation: Department of Orthodontics, University Hospital Halle, Halle (Saale), Germany.
authors.forename: Robert A W
authors.initials: RA
authors.lastname: Fuhrmann
authors.affiliation: Department of Pediatric Dentistry and Primary Prophylaxis, University Hospital Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany. christian.hirsch@medizin.uni-leipzig.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Hirsch
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002971:Cleft Lip; D002972:Cleft Palate; D003116:Color; D003124:Colorimetry / Q000706:statistics & numerical data; D015897:Comorbidity; D003731:Dental Caries / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D003743:Dental Enamel / Q000473:pathology*; D003744:Dental Enamel Hypoplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014075:Tooth Discoloration / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult
keywords: Dental caries susceptibility; Dental enamel; Fluorides; Orthodontic treatment; Tooth color