Craniosynostosis: orofacial and oral health perspectives with masticatory insights

Abstract

Background: Craniosynostosis (CS), premature fusion of one or more cranial sutures, leads to abnormal skull development, impacting both facial esthetics and oral function. This study aimed to evaluate the specific orofacial and oral health characteristics, including masticatory performance, in Thai patients with CS.

Methods: A comparative study was conducted with Thai CS patients aged 6-17 years and a control group of healthy individuals with similar age distribution. Assessments included craniofacial morphology, oral health status, and masticatory performance. Intergroup comparisons utilized appropriate statistical tests.

Results: The study included 24 CS patients with a mean age of 10.11 ± 2.98 years and 30 controls. CS patients exhibited a significantly higher prevalence of various oral conditions compared to controls: cleft palate (20.8%), anterior open bite (41.7%), anterior crossbite (54.2%), posterior crossbite (50%), combined anterior-posterior crossbite (45.8%), dental crowding in both maxilla and mandible (50% and 45.8% respectively), congenitally missing teeth (50%), supernumerary teeth (12.5%), and eruption failure (54.2%). Furthermore, CS patients exhibited significantly higher caries prevalence and susceptibility, alongside poorer oral hygiene, compared to controls. Regarding jaw relationships, CS patients exhibited a significantly higher proportion of Angle's Class III malocclusion (50%) compared to the control group, where Class I malocclusion was predominant (50%). Masticatory performance, assessed using the two-color gum mixing ability test, showed significantly higher hue variance in CS patients (0.12 ± 0.07) compared to the control group, indicating reduced chewing performance.

Conclusion: This study underscores the significant orofacial and oral health challenges faced by children with CS, including a high prevalence of malocclusions, dental anomalies, elevated caries experience, and compromised masticatory function. These findings emphasize the importance of tailored interventions and comprehensive oral healthcare strategies to address the unique needs of this population and improve their overall quality of life.

Keywords: Cleft palate; Cranial suture; Dental caries; Malocclusion; Openbite; Oral hygiene; Tooth eruption.

Fig. 1

Intraoral features and radiographic images of craniosynostosis (CS) patients. A A 10-year-old boy diagnosed with Apert syndrome (CS-3) showed cleft palate. B A 7-year-old girl with Apert syndrome (CS-2) manifested anterior openbite due to underdeveloped maxilla. C A 10-year-old boy with Crouzon syndrome (CS-16) demonstrated anterior crossbite. D A 6-year-old boy with multiple sutures CS (CS-21) exhibited posterior crossbite. E A 12-year-old boy with Apert syndrome (CS-18) had maxillary dental crowding. F A 15-year-old girl with Apert syndrome (CS-5) manifested mandibular dental crowding. G Panoramic film of A 9-year-old girl with Apert syndrome (CS-2) exhibited congenital missing lower lateral incisor teeth (arrows). H Panoramic film of a 15-year-old girl with Apert syndrome (CS-5) showed failure of tooth eruption (arrow). I Lateral cephalogram of a 10-year-old girl with Crouzon syndrome (CS-17) demonstrated Class III maxillomandibular relationship

Fig. 2

Oral health status of CS patients. A A 15-year-old girl diagnosed with Apert syndrome (CS-5) exhibited poor oral hygiene status. B A 13-year-old boy with Crouzon syndrome (CS-20) had fair oral hygiene status. C A 6-year-old boy with multiple sutures CS (CS-21) showed high dental caries prevalence. D A 10-year-old boy with Apert syndrome (CS-3) had high dental caries prevalence

Fig. 3

The masticatory performance of CS patients using the ViewGum© software. The software presented two scanned images of a piece of chewing gum that had undergone 20 chewing cycles, providing views of both sides of the flattened gum. The images were annotated and depicted with distinct yellow dots, while red dots were employed to indicate the background. Subsequently, the software delineated the gum area and displayed a compact thumbnail image below the primary visuals to visually represent this segmented region. CT, control