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Evidence found and GRADE certainty

122 questions · 185 findings · 7 reviews · Oral and maxillofacial surgery

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No studies found 0 · 0%GRADE not reported 175 · 94.6%Very low 0 · 0%Low 10 · 5.4%Moderate 0 · 0%High 0 · 0%

Cleft lip and/or palate (CL/P) vs No cleft lip and/or palate (non-CL/P)

Streptococcus mutans count · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)

No difference in mean Streptococcus mutans presence was reported; GRADE was not reported.

1 finding from 1 review

Extraction of the mandibular permanent first molar vs Not applicable (single-group prevalence)

Rotation of the mandibular first premolar · Children and adolescents after extraction of a mandibular permanent first molar (before eruption of the second molar)

After mandibular first molar extraction, the first premolar was rotated in about 38% of cases (2 studies; very imprecise; not GRADE-rated).

1 finding from 1 review

Second molar at Demirjian stage A-D at extraction vs Second molar at Demirjian stage F-H at extraction

Spontaneous space closure · Children and adolescents with maxillary permanent first molar extraction

In the maxilla, M2 Demirjian stages A-D were not associated with a statistically significant difference in space closure odds.

1 finding from 1 review

Non-syndromic cleft lip and palate (CLP) status and its oral microbiota (exposure/grouping) vs Children and adolescents aged 0-18 years without CLP (controls)

Periodontal conditions (gingival inflammation, bleeding on probing, probing depth, clinical attachment loss) · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)

Narrative synthesis of 6 studies suggests children/adolescents with CLP have poorer periodontal status (higher gingival and plaque indices, deeper probing, more bleeding and attachment loss) and harbor periodontopathogens; no pooled estimate and the evidence is ungraded.

1 finding from 1 review

Cleft lip and/or palate (CL/P) vs No cleft lip and/or palate (non-CL/P)

Early childhood caries experience (mean dmft) · Children in the primary dentition with non-syndromic cleft lip and/or palate (CL/P) and comparable children without CL/P

In the combined primary and mixed dentition, there was no evidence of a difference in caries experience between children with and without CL/P (SMD 0.09, 95% CI -0.59-0.76; 5 studies; ungraded).

4 findings from 1 review
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Cleft lip and/or palate (CL/P) vs No cleft lip and/or palate (non-CL/P)

Care index (CI = f/[d+m+f]) in the primary dentition · Children in the primary dentition with non-syndromic cleft lip and/or palate (CL/P) and comparable children without CL/P

The care index tended to be higher in children without CL/P (2 of 3 studies), suggesting more extraction-based caries management in children with CL/P; not pooled (narrative; ungraded).

1 finding from 1 review
  • Caries in children with and without orofacial clefting: A systematic review and meta-analysis. 2022 All outcomes
    Children with CL/P and comparable non-CL/P children across 12 countries (India, Brazil, China, Sweden, UK, USA, Germany, Greece, Ireland, Netherlands, Jordan, Thailand); studies published 1989-2021
    Two out of three studies for which the CI could be calculated (Nagappan 2019; Veiga 2016) showed a higher CI for non-CL/P children demonstrating a higher proportion of extraction-based treatment in CL/P children…
    3 studies
    GRADE not reported

Isolated cleft palate (CP) or other specific cleft type vs Cleft lip and palate (CLP) or other cleft type

Caries experience by cleft type · Children in the primary dentition with cleft lip and/or palate (CL/P)

Whether cleft type is associated with caries experience could not be determined; the planned CP-versus-CL/P subgroup analysis was not possible owing to sparse isolated-CP data (5 studies described narratively; ungraded).

1 finding from 1 review
  • Caries in children with and without orofacial clefting: A systematic review and meta-analysis. 2022 All outcomes
    Children with CL/P and comparable non-CL/P children across 12 countries (India, Brazil, China, Sweden, UK, USA, Germany, Greece, Ireland, Netherlands, Jordan, Thailand); studies published 1989-2021
    Five studies investigated caries experience by cleft type (Howe 2017; Kirchberg 2014; Mutarai 2008; Sunderji 2017; Zhu 2010). A subgroup analysis comparing CP and CL/P as different entities was not possible due to the…
    5 studies
    GRADE not reported

Cleft lip and/or palate (CL/P) vs No cleft lip and/or palate (non-CL/P)

Restorative index (RI = f/[d+f]) in the primary dentition · Children in the primary dentition with non-syndromic cleft lip and/or palate (CL/P) and comparable children without CL/P

The restorative index tended to be lower in children with CL/P (3 of 5 studies), indicating a lower proportion of restoratively managed carious teeth; not pooled (narrative; ungraded).

1 finding from 1 review
  • Caries in children with and without orofacial clefting: A systematic review and meta-analysis. 2022 All outcomes
    Children with CL/P and comparable non-CL/P children across 12 countries (India, Brazil, China, Sweden, UK, USA, Germany, Greece, Ireland, Netherlands, Jordan, Thailand); studies published 1989-2021
    Of the five studies for which the RI could be calculated, three of them (Dahllof 1989; Nagappan 2019; Veiga 2016) showed a lower RI for children with CL/P compared to children with no CL/P demonstrating a lower…
    5 studies
    GRADE not reported

Bilateral extraction of compromised mandibular first permanent molars vs Age- and gender-matched non-extraction controls

Lower incisor inclination (lingual tipping and retrusion) · Children (approximately 11 years or older) with compromised mandibular first permanent molars

Bilateral lower first permanent molar extraction was associated with lingual tipping and retrusion of the lower incisors in one case-control study; ungraded.

1 finding from 1 review

Extraction of a maxillary first permanent molar vs Extraction of a mandibular first permanent molar

Spontaneous space closure · Children aged 5 to 15 years undergoing first permanent molar extraction

Spontaneous post-extraction space closure did not differ significantly between the maxilla and mandible (pooled OR 2.06, 95% CI 0.46 to 9.28; 3 studies; I2 = 72%); ungraded.

1 finding from 1 review

Bilateral extraction of compromised mandibular first permanent molars vs Age- and gender-matched non-extraction controls

Skeletal development (occlusal plane rotation, facial height) · Children (approximately 11 years or older) with compromised mandibular first permanent molars

Bilateral lower first permanent molar extraction was associated with counter-clockwise rotation of the occlusal plane and a mild decrease in lower anterior face height in one case-control study; ungraded.

1 finding from 1 review

Early extraction of a compromised first permanent molar vs Contralateral non-extraction side (same patient)

Development and eruption of the second permanent molar · Children aged 5 to 15 years with a compromised first permanent molar

Root closure and eruption of the second permanent molar appeared accelerated on the extraction side in a single case-control study; ungraded and not statistically tested.

1 finding from 1 review

Early extraction of a compromised mandibular first permanent molar vs Contralateral non-extraction side (same patient)

Development and eruption of the third molar · Children aged 5 to 15 years with a compromised first permanent molar

Development and eruption of the third molar appeared accelerated after early first permanent molar extraction in two studies (e.g., eruption OR 2.86, 95% CI 1.37 to 5.96); ungraded.

1 finding from 1 review