Are there any solutions for improving the cleft area hygiene in patients with cleft lip and palate? A systematic review.

Children with cleft lip and palate (CLP) present high incidence of oral health problems, namely those associated with the accumulation of dental plaque. The objective of this systematic review was to verify if there is any solution to improve the hygiene of the cleft area.A structured systematic review was performed based on articles published in several electronic databases: PubMed, Web of Science, Cochrane Library and Scopus in the last 20 years. The MeSH terms used were cleft lip, palate, harelip, oral hygiene and toothbrush.From 270 potentially relevant articles, 39 articles were selected, corresponding to a total of 3226 CLP patients and 914 matched controls. The selected studies exhibited great heterogeneity regarding the type of the study, study population (average range 0 -49 years old; sampling sizes 15-400 CLP patients), evaluation periods, reported variables and oral hygiene routines. Consensual outcomes were the presence of high plaque indexes, high prevalence of dental caries and worse oral hygiene patterns in CLP patients. Additionally, poor education in oral health and low motivation to integrate regular hygiene routines in the daily family life were also evident.There is a clear need to improve the oral hygiene care of CLP children, but few studies were focused on specific preventive approaches. Development of devices especially designed to the hygiene of the cleft area and implementation of standardized prevention and control programmes targeting education, motivation and compliance would contribute to improve oral health in CLP children.