247 Odonto : Dental Journal. Volume 9. Number 2.

December 2022

Early childhood caries prevalence among children with cleft lip and palate at
padjadjaran university dental hospital
Julia Thrisna Silvyani*, Asty Samiaty Setiawan**, Fidya Meditia Putri**
*Program Sarjana Fakultas Kedokteran Gigi, Universitas Padjadjaran
**Departemen Ilmu Kesehatan Gigi Masyarakat, Fakultas Kedokteran Gigi, Universitas Padjadjaran

Correspondence: asty.setiawan@unpad.ac.id

Received 29 June 2022; 1st revision 19 October 2022; 2nd revision 30 November 2022; Accepted 14
Desember 2022; Published online 28 December 2022

Keywords:
ABSTRACT
Background: Cleft lip and/or palate (CL/P) is a congenital abnormality that can
Prevalence; ECC; cleft lip;
be a risk factor for Early Childhood Caries (ECC). ECC is caries that occur in
cleft palate; oral cleft
children aged 0-71 months. Poor oral hygiene often found in CL/P patients due
to anatomic defects, treatment devices, and surgical scars that can facilitate
the colonization of Streptococcus mutans and Lactobacilli as caries-causing
bacteria. This study aims to determine the prevalence of ECC in children with
CL/P aged 2-6 years at Padjadjaran Univeristy Dental Hospital from 2018 -
June of 2021.
Method: The study used a descriptive observational method with a cross-
sectional approach. The data used is secondary data which is CL/P patients
aged 2-6 years medical records at Padjadjaran University Dental Hospital from
2018 until June 2021. The sample obtained using total sampling is 102.
Result: The prevalence of ECC in children with CL/P was 46.08%. Unilateral
complete palatognatoschizis was the most found CL/P cases (49.02%),
including patients with ECC (21.57%). Male is the most common gender in this
study (62.75%) also the gender with the most ECC (28.43%). Most children
aged 13-24 months (66,67%), while 25-60 months (22,55%) had the highest
ECC cases. Most of the CL/P patients came from West Java (95.10%),
including patients with ECC (43.14%)
Conclusion: Children with CLP have a high risk of caries, regardless in this
study, the prevalence was not that high. Although, there are still a hefty amount
of children who experience ECC. Oral hygiene must be a concern of parents
from an early age to prevent ECC.

Copyright ©2022 National Research and Innovation Agency. This is an open access article under the CC BY-SA license
(https://creativecommons.org/licenses/by-sa/4.0/)

doi: http://dx.doi.org/10.30659/odj.9.2.247-257
2460-4119 / 2354-5992 ©2022 National Research and Innovation Agency
This is an open access article under the CC BY-SA license (https://creativecommons.org/licenses/by-sa/4.0/)
Odonto : Dental Journal accredited as Sinta 2 Journal (https://sinta.kemdikbud.go.id/journals/profile/3200)
How to Cite: Silvyani et al. Early childhood caries prevalence among children with cleft lip and palate at padjadjaran
university dental hospital. Odonto: Dental Journal, v.9, n.2, p.247-257, December 2022
 Silvyani/ Setiawan/ Putri 248

INTRODUCTION Britton et al.,(2010)14 14search in West

The worldwide incidence of cleft lip and/or Scotandia by comparing caries prevalence in
palate (CL/P) is about 1/700 live births every year.1 children aged 6 months – 6 years with CL/P
American and Asian populations are with national data of the same age. 14The

approximately 1 in 500, European 1 in 1000, and result was showed that a higher prevalence of
African 1 in 2500.2 CL/P can be caused by a caries found in children with CL/P (62,8%)
genetic disorder such as chromosome more than the national data (42,3%) in the 4,5-
abnormalities or genetic mutation for syndromic, 6-year-old group.14
whereas non-syndromic can be caused by CL/P and ECC affect a child’s quality of
environmental factors such as maternal smoking life.15,16 Pain, difficulty in eating and drinking,
and alcohol use during pregnancy.3 Orofacial cleft and decreased self-esteem of children
defect occupies the second position out of the because of their appearance felt by them.17 It
eight most common types of congenital shows how important it is to prevent caries in
abnormalities in Indonesia with a percentage of children with CL/P which is a risk factor for
20% of 956 cases.4 CL/P proportion of children ECC.9 Many many studies have been carried
aged 24-59 months is 0,12%. 5 out on the prevalence of caries in Indonesia or
Oral hygiene in CL/P patients is frequently another country, but the research that
found in a poor condition due to use of the intraoral specifically discusses the prevalence of caries
appliances during treatment.6 The application of in children with CL/P has never been done in
orthodontic appliances, obturators, and other Indonesia. This is the basis for conducting
appliances can help children during breastfeeding research with the aim of knowing the
and speaking.7 However, Streptococcus mutans prevalence of ECC in children with CL/P at
and Lactobacilli as bacteria that initiate caries were Padjadjaran University Dental Hospital in
facilitated to colonize.8 Worth et al.,(2007)9 show that 2018-2021. The result can be used as the
an individual with an orofacial cleft has a higher risk of basis for prevention that can improve the
caries. child's quality of life.
American Academy of Paediatric Dentistry
defines ECC as “the presence of one or more METHOD
decayed (non-cavitated or cavitated lesions), This study was a descriptive
missing (because of caries), or filled tooth surfaces observational cross-sectional. Population of
in any primary tooth in a child aged 71 months or this study is CL/P patients aged 2-6 years old at
younger”.10 ECC could be the major problem in Padjadjaran University Dental Hospital.24,25
children’s dental and oral health.11 Prevalence of Recently, the study used a total sampling
ECC in Asian countries such as China in the 2- method. So, all of the population were a
year-old group (26,6%), United Arab Emirates sample.24 The sample studied consisted of 102
(83%), and Vietnam (91,9%).12,13 Riskesdas (Riset children found at Padjadjaran University Dental
Kesehatan Dasar) which is done by the Ministry of Hospital. The data were secondary data
Health of the Republic of Indonesia in 2018 shows conducted on the medic records of the CL/P
that caries prevalence in the 3-4-year-old group patient from 2018 to June 2021. The difficulty in
(81,5%) and the 5-9-year-old group (92,6%).5 this study was that the dentist did not fill in all

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 Early childhood caries prevalence among children with cleft lip and palate at padjadjaran university
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the odontogram in the patient's medical record after province of origin that is shown in a table.
checking the medical records one by one. This can Classification of cleft types based on ICD-10.19
happen due to dentists prioritizing good and fast This study was sent to the Research Ethics
service because of the large number of patients.18 Committee of Padjadjaran University for
The following criteria were included in this approval with (1009/UN6.KEP/EC/2021).
study: CL/P patients aged 2-6 years old were
registered on medical records from January 2018 to RESULT
June 2021 with a filled odontogram. The primary The size of the sample that was
teeth boxes should be filled with one or more caries suitable for inclusion criteria was 102. The
signs. Patients with a medical record that isn’t filled distribution of sample characteristics is shown
or can’t be read were excluded. in Table
Data were classified by year of observation,
classification of CL/P, age group (months), and their

Table 1. The distribution of sample characteristics

2018 2019 2020 2021 Total

Characteristics
n % n % n % n % n %
Gender
Males 2 1,96 8 7,84 20 19,61 8 7,84 38 37,25
Females 2 1,96 12 11,76 22 21,57 28 27,45 64 62,75
Age Group (months)
24-30 1 0,98 13 12,75 32 31,37 22 21,57 68 66,67
31-37 2 1,96 7 6,86 10 9,80 12 11,76 31 30,39
38-44 1 0,98 0 0 0 0,00 2 1,96 3 2,94
Age Average (months) ± (DS) 30,29 ± 8,57
Origin (province)
West Java 4 3,92 18 17,65 39 38,24 36 35,29 97 95,10
Central Java 0 0 2 1,96 0 0 0 0 2 1,96
East Java 0 0 0 0 1 0,98 0 0 1 0,98
DKI Jakarta 0 0 0 0 1 0,98 0 0 1 0,98
Banten 0 0 0 0 1 0,98 0 0 1 0,98
Parent’s Occupation
Housewife 1 0,98 4 3,92 19 18,63 13 12,75 37 36,27
Civil’s Employee 0 0 1 0,98 5 4,90 8 7,84 14 13,73
Entrepreneur 1 0,98 4 3,92 5 4,90 2 1,96 12 11,76
Labor 0 0 4 3,92 5 4,90 4 3,92 13 12,75
Seller 0 0 0 0 0 0 2 1,96 2 1,96
Teacher 1 0,98 0 0 1 0,98 0 0 2 1,96
Driver 0 0 0 0 1 0,98 1 0,98 2 1,96
Farmer 0 0 2 1,96 0 0 0 0 2 1,96
Nurse 0 0 0 0 1 0,98 1 0,98 2 1,96
- 1 0,98 5 4,90 5 4,90 5 4,90 16 15,69
Total 4 3,92 20 19,6 42 41,18 36 35,29 102 100,00

Table 1 shows all of the samples was 102. (62,75%) patients. Age group 13-24 months
Males were the most common gender with 64 (66,67%) was the most frequent. The number of

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 Silvyani/ Setiawan/ Putri 250

samples decreases as the patient ages. The (43,14%), and simultaneously free caries
average age group of this study is 30,29 ± 8,57. Age (51,96%). The highest number of ECC cases can
grouping as shown in Table 1 uses.20 be found in 2021 (19,61%), whereas 2020 was
West Java is the origin of the most frequent the year with the lowest number of cases
patient (95,10%). All of the patients. Patients (23,53%).
domiciled on Java island. Sample frequently found Table 3 demonstrates the distribution of
in 2020 (41,18%), whereas in 2018 least of all CL/P patients with ECC regarding cleft type and
(3,92%). age of the patient in 2018 – 2021. Mostly, cleft type
The distribution of sample characteristics in this study was palatognatoschizis unilateral
with ECC cases per year can be seen in Table 2. complete (49,02%). It is frequently found with caries
Males are the most common (28,43%) and the (21,57%) in every age group, yet frequently free of
least (34,31%) of all gender who experience caries (27,45%). The age group of 13-20 months
caries. The age group of 25-60 months of this with palatognatoschizis unilateral cleft type is the
study was the most frequently found with caries highest group with ECC cases (11,76%).
(22,55%), whilst 13-24 months was the age Classification of CL/P cases with the second
group mostly free of caries. (46,08%). highest number of ECC patients also came from

Table 2 reveals West Java was the origin palatognatoschizis cases, but with bilateral

for the most patient who experience caries complete palatognatoschizis classification.
(6,86%). Gnatoshizis wasn’t found in this study.

Table 2. Distribution of ECC cases per year, gender, age group, and origin of CLP patient in 2018-202

2018 2019 2020 2021 Total

Characteristics ECC No ECC No ECC No ECC No ECC No

n % n % n % n % n % n % n % n % n % n %

Gender
1,9 1,9 10,7 17,6 19,6
Female 2 0 0 2 6 5,88 9 8,82 11 5 4,90 3 2,94 18
6 6 8 5 20 1
1,9 2,9 12,7 14,7 12,7 28,4 34,3
Male 2 0 0 3 9 8,82 9 8,82 13 15 13 29 35
6 4 5 1 5 3 1
Age group
(months)
0,9 1,9 10,7 21,5 13,7 20,5 46,0
13-24 1 0 0 2 11 10 9,80 22 8 7,84 14 21 47
8 6 8 7 3 9 8
2,9 22,5
25-60 2 2 0 0 3 4 3,92 8 7,84 2 0 10 9,80 2 1,96 23 8 7,84
4 5
61-71 1 1 0 0 0 0 0 0 0 0,00 0 0 2 1,96 0 0 3 2,94 0 0

Province
3,9 3,9 13,7 15,6 22,5 19,6 15,6 43,1 51,9
West Java 4 0 0 4 14 16 23 20 16 44 53
2 2 3 9 5 1 9 4 6
0,9
Central Java 0 0 0 0 1 1 0,98 0 0 0 0 0 0 0 0 1 0,98 1 0,98
8
East Java 0 0 0 0 0 0 0 0 1 0,98 0 0 0 0 0 0 1 0,98 0 0

DKI Jakarta 0 0 0 0 0 0 0 0 1 0,98 0 0 0 0 0 0 1 0,98 0 0

Banten 0 0 0 0 0 0 0 0 0 0 1 0,98 0 0 0 0 0 0,00 1 0,98

46,0 53,9
47 55
3,9 4,9 14,7 17,6 23,5 19,6 15,6 8 2
Total 4 0 0 5 15 18 24 20 16
2 0 1 5 3 1 9
102 (100,00)

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Table 3. Distribution of ECC cases per age and CL/P classification in 2018-2021

13-24 25-60 61-71 Jumlah

Total
Cleft Type ECC No ECC No ECC No ECC No
n % n % n % n % n % n % n % n % n %
C 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
U
I 1 0,98 1 0,98 0 0,00 0 0,00 0 0,00 0,00 1 0,98 1 0,98 2 1,96
L
C 0 0,00 1 0,98 3 2,94 0 0,00 1 2,13 0 0,00 4 3,92 1 0,98 5 4,90
B
I 0 0,00 0 0,00 0 0,00 0 0,00 1 2,13 0 0,00 1 0,98 0 0,00 1 0,98
C 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
U
I 0 0,00 1 0,98 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 1 0,98 1 0,98
Lg
C 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
B
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
C 0 0,00 1 0,98 1 2,13 0 0,00 0 0,00 0 0,00 1 0,98 1 0,98 2 1,96
U
I 1 0,98 3 2,94 1 0,98 1 0,98 0 0,00 0 0,00 2 1,96 4 3,92 6 5,88
P
C 0 0,00 2 1,96 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 2 1,96 2 1,96
B
I 1 0,98 3 2,94 2 4,26 1 0,98 0 0,00 0 0,00 3 2,94 4 3,92 7 6,86
C 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
U
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
G
C 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
B
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
C 12 11,76 25 24,51 10 9,80 3 2,94 0 0,00 0 0,00 22 21,57 28 27,45 50 49,02
U
I 0 0,00 2 1,96 0 0,00 1 0,98 0 0,00 0 0,00 0 0,00 3 2,94 3 2,94
Pg
C 6 5,88 7 6,86 1 2,13 1 0,98 0 0,00 0 0,00 7 6,86 8 7,84 15 14,71
B
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
C 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
U
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
Lp
C 0 0,00 0 0,00 1 2,13 0 0,00 0 0,00 0 0,00 1 0,98 0 0,00 1 0,98
B
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
C 0 0,00 1 0,98 3 2,94 1 0,98 1 0,98 0 0,00 4 3,92 2 1,96 6 5,88
U
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00
Lgp
C 0 0,00 0 0,00 1 2,13 0 0,00 0 0,00 0 0,00 1 0,98 0 0,00 1 0,98
B
I 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00 0 0,00

Total 68 (66,67) 31 (30,39) 3 (2,94) 47 46,08 55 53,92 102 (100,00)

*L: Labioschizis; Lg: Labiognatoschizis; G: Gnatoschizis; P: Palatoschizis; Pg: Palatognatoschizis; Lp: Labiopalatoschizis; Lgp:
Labiognatopalatoschizis; U: Unilateral; B:Bilateral; C:Complete I:Incomplete

DISCUSSION
ECC is caries found in one or more teeth Foundation for Cleft Lip and Palate Sufferers
with or without cavities in children aged 71 (YPPCBL).
months or younger. Caries seen in this study The dental hospital of Unpad cooperates
were based on observation in medical records with YPPCBL in treating registered cleft lip and
and odontogram records.. This study did not palate patients. Patients were immediately
perform a through ECC examination. referred to the dental hospital of Unpad for
Table 1 showed that most of the samples treatment, either to perform surgery, manufacture
came from the age group of 13-24 months tools to support normal functions, or monitor
(66.67%). The dominance of this age group is dental and oral health. The treatment of cleft lip
caused by the fact that newly born with cleft lip and palate patients is generally carried out
and palate are almost entirely registered at the sequentially and continuously from the age of 3

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 Silvyani/ Setiawan/ Putri 252

months depending on the classification of cleft lip Caries is a multifactorial disease.31

and palate.21 The age distribution of the sample Bacteria that cause caries require an optimal site
in this study is in line with previous research for colonization.12 The alteration of the substrate
conducted at YPPCBL, Bandung that cleft lip and from deposits of food in the oral cavity will be
palate patients enrolled in 2018-2019 dominated changed to acid by a bacterium over time it can
by the age of 0-24 months.22 become caries. 32 More and more teeth erupt with
Table 2 showed that 46.08% of children age. 32 The surface of the teeth in the oral cavity
in this study had ECC. 23The highest incidence of increases, so it can increase the chances of
ECC is in the age group of 25-60 months being a place for bacteria to colonize.33
(22.55%) of all age groups. Table 2 also shows Various things can affect the occurrence
that 21 (30.88%) of 68 children in the 13-24 of ECC in patients with cleft lip and palate
month age group experienced implicit ECC. patients. The main focus of cleft lip and palate
However, this incident should have avoided by patients is caries, not dental and oral health.
age, time of occurrence, and regular visits to the However, their main focus is the various medical
dentist as a regular treatment for cleft lip and procedures needed to correct anatomical defects
palate.24 This is not expected to occur in this age in their child.34Another cause of caries in cleft lip
group because the younger the child is, the fewer and palate patients is the habit of parents giving
the number of teeth that have erupted compared snacks to them. Their parents often give high-
to the older age, although according to Peterka et sugar snacks after going through the cleft lip and
25
al. (1993) there is a delay in the eruption of the palate treatment procedure.35 Wrong feeding
primary lateral incisors because the eruption site timing can also affect the occurrence of ECC in
is around the cleft.25,26 The place for caries- children, as shown by research conducted in
causing bacteria to colonize and the time Southern Thailand.36 This condition happens
available for the caries process to occur is also because parents do not have the heart to refuse
less.27 an abnormal child's request.36 Bottle feeding to
The data in Table 2 showed that the put children to sleep at night also influences the
number of cleft lip and palate patients found in occurrence of ECC.8 Research by Ann et al.,
other age groups is not as much as the 13-24 (2012)37 showed that 99% of parents knew the
month age group, but the percentage of cleft lip types of food that caused tooth decay, but 64%
and palate patients who experience ECC of parents did not know that milk could cause
increases with age. The percentage of ECC in the tooth decay. Forty-five percent of parents even
youngest age group was 30.88%, then 74.19% in add sugar to the milk. This indicates that the
the 25-60 month age group, and 100.00% in the parents in the study were not aware of the hidden
oldest age group of 61-71 months. This is in sugar content in these foods that could cause
accordance with previous research that the caries.
higher the age, the more caries found, but the The use of an acrylic-based intraoral
inequality in the number of patients in each age device also increases the risk of cleft lip and
group in this study must also be considered.28–30 palate patients experiencing ECC.38

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dental hospital

Streptococcus mutans increases in number with male embryos have a higher tendency to interact
age and the time of using the device.8 Previous with the surrounding environment.46
studies have shown that Streptococcus mutans Table 2 showed that cleft lip and palate
and Lactobacilli are more common as caries- male patients experienced more ECC (28.43%)
causing bacteria in children with cleft lip and than female patients (17.65%). These results are
palate patients than in normal children.27 The consistent with other studies.23,47 The fact shows
high number of caries-causing bacteria is caused that men have more physical activity than women
by malocclusion and enamel defects in the form so there can be an increase in the need for
of reduced enamel matrix production which can food.47 The type of food consumed affects the
cause enamel hypoplasia.39,40 These enamel occurrence of ECC, one of which is food with high
defects accelerate the caries process by the sugar content, but it is possible that this result
accumulation of plaque.40 Malocclusion in cleft lip may be influenced by the number of men who are
and palate patients also makes it difficult for far more numerous in this study.48 It can also be
children to clean the oral cavity.41 Children's caused by psychological differences between
interest in maintaining oral health is also reduced boys and girls related to differences in the genetic
because of the difficulty in cleaning the oral cavity conditions of the two sexes. therefore, men tend
where there are anatomical defects and it is not not to pay too much attention to themselves,
uncommon for children to feel afraid.42,43 Plaque including regarding oral health.49
formation in the anterior region is more than in West Java was the highest origin of the
the posterior region due to the influence of CL/P patients (95,10%) Futhermore, the highest
salivary flow rate and intraoral movement due to origin with ECC cases (43,14%) as shown as Table

decreased elasticity of the lips after surgery on 1 followed by Central Java (0,98%), East Java

the cleft and palate.27 The anterior portion of the (0,98%), and DKI Jakarta (0,98%). Padjadjaran

dental arch is more than the posterior segment University Dental Hospital was located in Bandung,
West Java which is closer to the domicile of most of
due to the influence of salivary flow rate and
the CL/P patients. None of the samples are
intraoral movement due to decreased lip
27
domiciled outside Java.
elasticity after cleft and palate surgery. The
Distance is one of the predisposing
condition of cleft lip and palate patients which is
factors for a person to seek treatment because
a risk factor for ECC is also supported by the
the distance of a health facility can be an
results of previous studies.14
obstacle.50 The type of service available at a
Male (67.25%) is the most common sex
health facility also affects a person in seeking
found based on Table 1. Previous literature does
treatment.51 Severity of the disease also affects
not show whether there is a gender predilection
individuals to seek treatment at the health facility
for the incidence of cleft lip and palate patients,
compared to self-medication.50
but several studies have revealed that more
Handayani et al.,(2003)52showed that
males experience cleft lip and palate than
Indonesians are more careful if their baby gets
females.22,28,44 Noorollahian et al.,(2015)45 . The
sick and tend to take it to a medical professional.
difference in results can be caused by genes in

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 Silvyani/ Setiawan/ Putri 254

Almost all samples in the study were registered palatognatoschizis cases (27.45%) dominated in
with YPPCBL, which is a foundation that helps this study. This result can be the reason that this
cleft lip and palate patients in getting treatment at classification is also the classification of the
a low cost or even free of charge.53 The incidence of ECC (14.71%). Unilateral cleft cases
affordable cost is also a consideration for with more caries incidence were also found in the
someone who is less able to seek treatment at a previous literature.58 Cleft palate involvement
health facility rather than taking care of it with the highest caries incidence is in accordance
themselves.51 with the studies of Nagappan et al.,41 Kirchberg
The data obtained in this study indicate et al.,28 Paul & Brandt59, and Johnsen & Dixon35,
that majority of the patient's parents are although all types of the cleft are risk factors for
housewives, then private employees, caries. Cleft palate may result in poorer oral
entrepreneurs, and laborers. A study conducted hygiene than clefts in other areas.8 The
in Depok compared the prevalence of dental attachment of plaque to the teeth is strengthened
caries in children aged 3-5 years with working by fluid from the nose which flows vigorously into
and non-working mothers. This study results the oral cavity.60 Food impaction causes the food
revealed that the prevalence of dental caries in to move through the nose which is then vomited
children was higher in mothers who did not up back into the oral cavity.8 The food is present
work.54 Working mothers have less time for their in the oral cavity for a long time, thereby
children, but earn an income that can help increasing the risk of caries. Other literature
increase knowledge, including dental and oral showed that there is no significant difference in
health.55 The income can also meet the needs of the incidence of caries in children with cleft lip
prevention and treatment in health.54.56 and palate with all classifications examined.45
The results difference also because of Based on previous studies, the
the social environment.57 Working mothers will classification of cleft unilateral cases had a lower
have a wider social environment.54 The social prevalence of dental caries when compared to
environment can help in exchanging information, cleft lip and palate cases with combined clefts.61
one of which is about children's health, while Several studies have shown the opposite, that
mothers who do not work tend to have a narrower there is no significant difference between the
social environment and influence the mother's incidence of ECC and cleft lip and palate
knowledge of the child's dental and oral health.57 classification.60,62 The number of sample
Research by Sjamsudin et al.,(2017)44 characteristics in this study was not evenly
based on data collected from 2011-2015 showed distributed in each group, therefore further
that the highest incidence of cases in West Java research is needed to analyze the characteristics
is cleft lip and palate, followed by cleft lip and cleft of cleft lip and palate patients. Research that
43
palate. Another study stated that most patients discusses the behavior of maintaining dental
at YPPCBL Bandung, West Java for the period health in cleft lip and palate patients that is
January 2018 – December 2019 were cleft lip and associated with the incidence of ECC also needs
palate patients.22 Complete unilateral to be investigated further in the next study.

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dental hospital

CONCLUSION 10. American Academy of Pediatric Dentistry.

Policy on Early Childhood Caries (ECC):
Children with cleft lip and palate have a Classifications, Consequences, and
high risk of caries, regardless in this study, the Preventive Strategies, AAPD Reference
Manual. 2011;34:12–13.
prevalence was not that high. Most of the ages 11. World Health Organisation. WHO expert
found were less than or equal to 24 months might consultation on public health intervention
against early childhood caries: report of a
be the reason because one of the factors for meeting, Bangkok, Thailand, 26-28 January
caries is time. Although, there are still a hefty 2016. REPORT OF A MEETING – Bangkok,
Thailand, 26–28 January 2016. 2016;15–20.
amount of children at that age who experience 12. Anil S, Anand PS. Early childhood caries:
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