Essay on Orofacial Development Problems

Cleft Lip or Palate

Cleft lip and palate are among the congenital craniofacial issues prevalent among infants leading to malformation of the upper lip. It is a critical challenge due to the morbidities among children and the psychological impacts among mothers. The condition results from disrupted teratogenic genes during embryonic development and the cracking of the palate or lips (Zhu et al., 2021). The condition can occur as symptomatic or asymptomatic based on a child’s condition. Approximately 70% of the facial deformities due to these conditions are asymptomatic and manifest as cleft palate and lip or cleft lip and palate.

Based on the stage of prenatal development, cleft lip and palate may result in the 20^th week of pregnancy or some few weeks after birth. Generally, the face and upper lip development occur between the 5^th and 9^th week, where any craniofacial deformities may set in later after the development—the palate forms later after the development of the lips (Zhu et al., 2021). The clefts do not occur together—a child with a left cleft lip cannot develop a right cleft lip. During perinatal care, clinicians can detect the condition in the 20^th-week of pregnancy scan.

Cleft lip and palate have significant implications on children and mothers, such as social stigma, low self-confidence among grown children, challenges in communication associated with language and speech delay, dental problems, and feeding difficulties. According to Grollemund et al. (2020), parents whose children have cleft lip and palate tend to distant themselves to avoid social stigma. Consequently, children grow with minimal parental love, which is essential for behavioral development. The deformations on the mouth impair speech and language development while affecting the feeding behaviors among children.

The available treatment of the condition is surgery. However, the procedure is complex since it is not a standardized surgery—it requires critical experience among physicians. Subsequently, the surgical intervention leaves a permanent scar on infants, a condition that affects parent-infant interactions in the case of early treatment (Grollemund et al., 2020). Late treatment is significant to enhance parents accepting the malformation and plan for the intervention.

Cleft lip and palate have a complex etiology involving the interaction of maternal factors during pregnancy, genetic factors, and environmental factors. The key risk factors are vitamin deficiency, specifically folic acid, during fetal development. Additionally, smoking, drug use, and exposure to specific chemicals increase the incidence of the disease (Grollemund et al., 2020). Exposure to chemicals from drugs, smoking, and inadequate vitamins such as vitamin B6 result in DNA damage due to metabolic activation. Consequently, the impaired genes alter the metabolic pathways and fetal development, leading to cleft lip and palate.

Hypodontia

This is a type of tooth agenesis associated with genetic syndrome or non-syndromic trait resulting in lack of one or more permanent or primary teeth. It is a condition with high prevalence among humans as the most craniofacial malformations among children. The highest population with the condition lacks one or two primary premolars or the two lateral incisors on the upper part of the mouth (Al-Ani et al., 2017). According to Al-Ani et al. (2017), the incidence of hypodontia is higher during permanent than deciduous dentition. It offers a critical challenge due to management complexities.

Based on the prenatal development stage, hypodontia may result during teeth development after four months when infants start developing teeth. By the age of three, children without one or two teeth are considered to have hypodontia. An x-ray to identify the potential of growing teeth renders a correct diagnosis. However, if there are no teeth observed through x-ray, a child is predisposed to hypodontia.

The critical implications include delayed language and speech development, especially for children missing the two lateral incisors (Al-Ani et al., 2017). Additionally, the lack of one or two permanent or primary teeth affects feeding behaviors among children. Psychological impacts include a lack of smiles, especially among children. The pronunciation of specific words is a common problem among individuals with hypodontia, resulting due to a lack of lateral incisors. Consequently, the condition results in social stigma.

Management of hypodontia is challenging due to complications associated with treatment interventions. There is a potential of compromised treatment as the primary outcome of prolonged treatment. The available management interventions include early extraction of a primary tooth to allow adjacent movement and growth of the teeth (Al-Ani et al., 2017). Also, removal of the primary molar spurt adjacent growth of teeth during puberty. However, artificial teeth are alternative due to compromised treatment outcomes.

The etiology of hypodontia comprises environmental and genetic factors. Intrauterine conditions such as thalidomide implicate the etiology of hypodontia. There is a cross association of hypodontia with chemotherapy among pregnant women (Al-Ani et al., 2017). Trauma or infections may result in hypodontia. Genetic predisposition involves paired box 9 gene (PAX9), axis inhibition protein 2 (AXIN2), and muscle segment homeobox 1 (MSX1), which are significant in signaling and mediating signal transduction cascades during tooth development (Al-Ani et al., 2017). Hypodontia may result from the impairment of these genes.

References

Al-Ani, A., Antoun, J., Thomson, W., Merriman, T., & Farella, M. (2017). Hypodontia: An Update on Its Etiology, Classification, and Clinical Management. Biomed Research International, 2017, 1-9. doi.10.1155/2017/9378325

Grollemund, B., Dissaux, C., Gavelle, P., Martínez, C., Mullaert, J., Alfaiate, T., & Guedeney, A. (2020). The impact of having a baby with cleft lip and palate on parents and on parent-baby relationship: the first French prospective multicentre study. BMC Pediatrics, 20(1). doi.10.1186/s12887-020-02118-5

Zhu, Y., Miao, H., Zeng, Q., Li, B., Wang, D., & Yu, X. et al. (2021). Prevalence of cleft lip and/or cleft palate in Guangdong province, China, 2015–2018: A Spatio-temporal descriptive analysis. BMJ Open, 11(8), e046430. doi.10.1136/bmjopen-2020-046430