ABSTRACT Cleft lip and palate (CL/P) represent the most common craniofacial birth defects worldwide, affecting approximately 1 in 700 live births with significant geographic and ethnic variations. From a preventive medicine perspective, addressing CL/P requires a multifaceted approach encompassing primary, secondary, and tertiary prevention strategies. Primary prevention focuses on preconception and prenatal interventions, including folic acid supplementation, avoidance of teratogenic exposures, and genetic counseling. Secondary prevention involves early prenatal diagnosis through advanced imaging techniques and preparation for immediate postnatal care. Tertiary prevention emphasizes comprehensive management protocols to prevent complications and optimize long-term outcomes. This narrative review synthesizes current evidence on preventive strategies across the continuum of care for CL/P, examining epidemiological patterns, risk factors amenable to modification, the role of periconceptional nutrition, environmental exposures, and public health interventions. Evidence demonstrates that periconceptional folic acid supplementation reduces CL/P risk by approximately 25%–50%, while maternal smoking and alcohol consumption significantly increase risk. Multidisciplinary team approaches, early feeding interventions, and systematic protocols for preventing otitis media and speech disorders constitute essential components of tertiary prevention. Population-based screening programs and health education initiatives show promise in reducing CL/P burden. Despite advances, significant gaps remain in implementing evidence-based preventive strategies, particularly in low-resource settings. Future directions include enhanced genetic screening, targeted interventions for high-risk populations, and strengthened integration of preventive services within existing healthcare systems to reduce both incidence and long-term morbidity associated with CL/P.
ABSTRACT Cleft lip and palate (CLP) is the most prevalent congenital malformation, affecting facial development and altering tooth positioning, which increases the susceptibility to dental caries. When involving the alveolar ridge, CLP presents bone alterations that are radiographically visible, making the differential diagnosis between CLP-related defects and periapical lesions a clinical challenge, since the bone defect resulting from CLP may resemble periapical bone rarefaction of endodontic origin. This article aims, through the presentation of two clinical cases, to report differential diagnostic situations between these conditions, emphasizing the importance of distinguishing CLP-related bone defects from periapical pathology to avoid overtreatment. By thorough clinical examinations and a conservative approach, it was possible to preserve the pulp vitality of some of the involved teeth, performing endodontic treatment only on the tooth in which pulp necrosis was confirmed by pulp sensitivity and vitality tests. The study highlights the importance of accurate diagnosis in individuals with this condition.
ABSTRACT Timely surgical repair of cleft lip and palate is critical for achieving optimal functional outcomes and improving psychosocial well-being; however, delayed intervention remains prevalent in resource-limited regions of India. To address these challenges, the Rashtriya Bal Swasthya Karyakram and initiatives by Smile Train have focused on early detection, improved access to care, and increased community awareness. This retrospective analysis evaluates the long-term impact of these programs on the age distribution of primary cleft surgeries in Uttar Pradesh. Data from the Smile Train database at a high-volume plastic surgery center in Lucknow were reviewed, including 13,153 patients treated between 2007 and 2025, of whom 11,032 primary cases under these initiatives were analyzed. Over the study period, a total of 11,032 primary cleft lip and palate repairs were performed, with the highest surgical volume recorded during 2021–2025 (3952; 35.8%). The proportion of primary lip repairs performed within the recommended age of 3–6 months increased from 2.5% in 2007–2010 to 12.9% (895/6,935) in 2021–2025, while timely primary palate repairs (9–12 months) rose from 3.1% to 16.8% (205/1221). Age distribution trends demonstrated a clear shift toward earlier intervention, with a substantial increase in surgeries performed before 5 years of age and a corresponding decline in delayed presentations. These findings indicate that the combined efforts of RBSK and Smile Train’s rural outreach programs have significantly improved timely access to cleft care, enabling earlier surgical intervention and enhancing awareness in Uttar Pradesh.
ABSTRACT Background: The study aimed to develop and validate a yardstick for assessing the treatment outcome among nonsyndromic patients with repaired complete bilateral cleft lip and palate (BCLP) using dental casts. Materials and Methods: This cross-sectional study included 30-pairs of study models of 30-BCLP patients (mean age: 14.61 ± 3.14 years) that reflected the full range of complexity of malocclusion. A Great Ormond Street, London and Oslo (Goslon)-like yardstick named the Postgraduate Institute BCLP (PGI-BCLP) yardstick was developed and applied to categorize the severity of malocclusion and hierarchical complexity of treatment required, ranging from Group 1 (no treatment required) to Group 5 (very complex treatment). The categories were made jointly by three orthodontists (I, II, and III), each having extensive experience in cleft orthodontic management. Scoring was done independently by the three orthodontists at two timepoints. The inter- and intraexaminer reliability of the PGI-BCLP yardstick was determined by kappa statistics and validated by clinical outcome assessment using the Jaccard similarity index after the completion of orthodontic treatment. Results: Distribution of scores included 6 patients in Group 2, 16 patients in Group 3, and 8 patients in the category of 4 or 5 with none in Group 1. Comparison of the first and second assessment scores revealed kappa coefficients of 0.91, 0.86, and 0.88 for examiners I, II, and III, respectively. Jaccard similarity index for younger (85%) and older (100%) patients showed excellent clinical predictability of treatment outcome after the completion of treatment. Conclusions: The PGI-BCLP yardstick showed an excellent intra- and interexaminer reliability with excellent clinical accuracy of prediction of treatment outcome.
Children with repaired cleft lip and palate (RCLP) often exhibit compensatory articulation necessitating intensive and consistent speech therapy. However, these children have difficulty accessing speech services due to the unavailability of speech-language pathologists in their localities and the affordability of travelling expenses and time. Telepractice has emerged as a feasible alternative mode of service delivery which reduces travel expenses and time for families. The study aimed to investigate the effectiveness of articulation therapy for stop consonants through telemode in Kannada-speaking children with RCLP between the age range of 4 and 10 years. A time series research design was employed to compare the production of stop consonants across pretherapy, posttherapy, and follow-up phases. Ten children with RCLP underwent 30 sessions of articulation therapy through telemode via Zoom platform. The stop consonants were selected from the Kannada Diagnostic Photo Articulation Test for periodic assessment. The outcome measure such as cleft type errors (CTEs), percentage of consonants correct revised (PCC R) and proportion of whole word correctness (PWC) were analyzed across pretherapy, posttherapy, and follow up phases. The results reported an overall reduction in CTE across pretherapy, posttherapy, and follow-up. Friedman analysis was performed to analyze outcome measures CTE, PCC-R, and PWC across three time points. The findings indicated a significant reduction in glottal stop between pretherapy and follow-up ( P = 0.030). Additionally, there was a significant increase in PCC-R scores from pretherapy to posttherapy ( P = 0.016) and pretherapy to follow-up ( P = 0.000), indicating improved consonant proficiency. PWC scores also showed a significant improvement between pretherapy and follow-up ( P = 0.000). These outcome measures enhanced the articulatory placement and oral airflow. Articulation therapy delivered via telemode is effective in minimizing compensatory articulation in children with RCLP.
