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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 234-238

Impact of endodontic treatment on the quality of life of individuals with cleft lip and palate

1 Endodontic Section, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
2 Pediatric Dentistry Section, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil

Date of Submission30-Aug-2022
Date of Acceptance10-Oct-2022
Date of Web Publication14-Nov-2022

Correspondence Address:
Sávio Brandelero Junior
Rua Silvio Marchione 3-20 CEP 17012-230 Bauru, São Paulo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_131_22

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Background: The root canal treatment can involve of teeth adjacent to the cleft area, either due to caries or for prosthetic purposes. Therefore, endodontic treatment could interfere with quality of life? Aims e Objectives: To assess the impact of endodontic treatment on the quality of life (QoL) and oral health of individuals with cleft lip and/or palate. Material and Methods: Sixty-five individuals meet the criteria, and this is a cross-sectional study. The Oral Health Impact Profile (OHIP-14) questionnaire was applied before endodontic treatment; 30–90 days after treatment. More questions were applied: “Was there any improvement in your QoL after endodontic treatment?” The options were “yes”/”no,” and mention the reason, in case the answer was negative. Results: OHIP-14 revealed weak impact for functional limitation, physical handicap, social impairment, and disabilities. The questionnaire showed medium impact physical pain and psychological discomfort/disability. The answer to question “Was there any improvement in your QoL after endodontic treatment?” was positive for 94% of respondents. Among the respondents, complete unilateral cleft lip and palate was observed in 28 individuals (43.1%), and 31.6% of teeth submitted to endodontic treatment were adjacent to the cleft area. Vital pulp therapy for prosthetic purposes was predominant (36.7%), and 25 out of the 79 endodontically treated teeth were premolars. Conclusion: The endodontic treatment improved the QoL and oral health of 94% of participants, and the OHIP-14 was effective in assessing the influence of medium impact factors.

Keywords: Cleft lip, cleft palate, endodontics, quality of life

How to cite this article:
de Carvalho Santos MM, Junior SB, Cusicanqui Méndez DA, Silva Dalben Gd, Nishiyama CK, Castro Pinto Ld. Impact of endodontic treatment on the quality of life of individuals with cleft lip and palate. J Dent Res Rev 2022;9:234-8

How to cite this URL:
de Carvalho Santos MM, Junior SB, Cusicanqui Méndez DA, Silva Dalben Gd, Nishiyama CK, Castro Pinto Ld. Impact of endodontic treatment on the quality of life of individuals with cleft lip and palate. J Dent Res Rev [serial online] 2022 [cited 2023 Jan 30];9:234-8. Available from: https://www.jdrr.org/text.asp?2022/9/3/234/361134

  Introduction Top

The quality of life (QoL) may be measured in a subjective and preconceived manner and may be related to oral health, either in endodontic treatment, removal of carious tissue, or oral rehabilitation. The QoL is influenced by factors such as the individual's personality and financial resources, which are directly related to the manner through which the individual faces life and its possibilities. All these aspects may be addressed qualitatively using questionnaires with open questions, leaving the individual free to respond how oral health may affect his/her QoL.[1]

The dental clinical examination should not focus on the mouth, but rather on the individual; the oral and general health should not be separated, since the oral health affects the general health, welfare, and QoL.[2] If the oral health is affected, both the general health and QoL may be impaired.

The Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo (HRAC/USP) is well-known for the rehabilitation of individuals with cleft lip and palate and other congenital

craniofacial anomalies. It offers multiprofessional care according to the needs of assisted patients.

Malformations affecting the face of human beings occur in 1–2/1000 births among Caucasoids, and in Brazil, this prevalence is reported as 1:650.[3] These malformations may be diagnosed prenatally since the face and palate are formed early in pregnancy, between the 4th and 8th weeks of intrauterine life, assigning the human aspect to the face.[3]

In Endodontics, the evaluation of treatment is guided by clinical and radiographic findings, and few studies in the literature have reported the QoL and satisfaction in the literature, requiring further studies on this issue.[4] The endodontist has great responsibility and the planning of root canal treatment should be careful, requiring manual skill, tactile sensitivity, and care in the handling of instruments, which are important for good evolution of an effective endodontic treatment.[5],[6] The conservative treatment allows the maintenance of vitality of the dentin-pulp complex, even if the tooth presents contamination due to caries or history of trauma. The endodontic intervention should be radical if the inflammation increases and another endodontic treatment may be necessary. Endodontic re-interventions are performed on root canals previously submitted to endodontic treatment that present recontamination.[7] Vital pulp therapy is the removal of vital, normal, or inflamed pulp. Its main indication is irreversible pulpitis, or when the conservative treatment did not present a response compatible with pulp health and may be performed in a single session.[8] Periapical disease, in turn, initiates after pulp necrosis, when the bacteria and their metabolic products affect the region beyond the tooth apex.[9]

Evaluations of the QoL and satisfaction of individuals provide information on their respective expectations and needs, evidencing possible failures and searching for improvements in the services provided.[10] Questionnaires that evaluate the QoL and specific oral problems are sociodental indicators with wide indications, including political, research, public health, and clinical actions.[11] The application of questionnaires for evaluations of QoL is wide and includes the individual care at the dental clinic, but also evaluates the effectiveness of treatments and functioning of health services, besides suggesting guidelines for oral health policies related to endodontics.[12]

Adulyanon et al. applied a questionnaire to assess the oral impacts in daily activities as physical, psychological, and social activities of a population. In this study, the greatest impact on the patients was caused by toothache and oral discomfort.[13]

The main instruments that evaluate the QoL are important because they measure the perception on the impact of oral diseases on the population welfare. They indicate seven concepts of oral health: pain, functional limitation, psychological deficiency, physical discomfort, psychological incapacity, social incapacity, and deficiency.[1]

The Oral Health Impact Profile (OHIP-14) is a short questionnaire from OHIP-49, composed of 14 questions aiming to evaluate the impact of oral problems on the QoL and how this impact is noticed by individuals by questions about dysfunctions, discomforts, and disabilities caused by oral problems.[14],[15]

The evaluation of the QoL of individuals with cleft palate and submitted to endodontic treatment has not yet been described in the literature, making such analysis relevant for the follow-up of these individuals. Thus, this study investigated the impact of endodontic treatment on the QoL and oral health of individuals with cleft lip and/or palate.

  Subjects and Methods Top

This study was approved by the Institutional Review Board of the HRAC/USP under protocol 407.100/2013. All individuals or caretakers read and signed an informed consent form agreeing to participate in the study.

This prospective study included all individuals submitted to endodontic treatment. The only exclusion criterion was refusal to participate in the study. A single examiner applied a questionnaire containing information from demographic data: name, age, telephone, gender, naturality, and aim of endodontic treatment, as well as the type of cleft lip and/or palate.

To investigate the impact of endodontic treatment on the QoL and the oral impact, the questionnaire OHIP-14–was applied[15] which analyzes the dimensions that impact the QoL, namely functional limitation, physical pain, psychological discomfort, physical incapacity, psychological incapacity, social incapacity, and deficiency. The questions were arranged on a scale of responses divided as follows: 0 = never, 1 = rarely, 2 = sometimes, 3 = often, and 4 = always, which was multiplied by the corresponding weight[14] and the negative impact of oral health conditions on the QoL was considered weak for results from 0 to 9, medium from 10 to 18, and strong from 19 to 28.[14]

The study was performed at two moments: M1– application of the OHIP-14 questionnaire for up to 10 min on the first consultation and treatment onset and M2– by telephone call, 30–90 days after completion of endodontic treatment, in which the participant replied only to the question “was there improvement in your QoL after endodontic treatment?,” with the options to reply yes or no. If the response was “no,” the reason for the negative response was asked and recorded. The OHIP-14 was not applied at this moment.

The results achieved were inserted into Microsoft Excel 2010 worksheets and descriptive methods were applied for the calculation of absolute and percentage values.

  Results Top

A total of 65 individuals were interviewed, being 25 males (38.5%) and 40 females (61.5%). The mean age of individuals participating in the study was 30.26 years, ranging from 12 to 54 years.

Concerning the type of tooth involved, endodontic treatment was more prevalent in premolars, molars, and incisors [Figure 1]. Concerning the endodontically treated teeth in relation to the cleft area, there were 25 teeth (89.3%) at the cleft region and three teeth (10.7%) at noncleft regions, considering 17 maxillary central incisors and 8 maxillary canines, at the cleft region. No maxillary lateral incisors at the cleft area were observed in this study, and the endodontic procedures performed are shown in [Figure 2]. Concerning the type of cleft lip and/or palate of individuals analyzed, complete unilateral cleft lip and palate was the most prevalent, followed by complete bilateral cleft lip and palate [Table 1].
Figure 1: Percentage representation of endodontically treated teeth according to dental group involved

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Figure 2: Number and frequency of endodontic treatments types which individuals were submitted

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Table 1: Frequency in number and percentage of cleft types in individuals undergoing endodontic treatment

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The results of questionnaire OHIP-14, which analyzes the dimensions of impact on the QoL, revealed score 8 for functional limitation, which is considered the weak impact. For the analysis of physical pain, the responses achieved score 15, considered as medium impact. The score observed for psychological discomfort was 11, considered medium impact. Concerning the physical incapacity, the impact was low with score 8, evidencing that, regardless of the type of discomfort experienced by the individual, the impact was not sufficient to interfere with feeding. Psychological incapacity achieved a score of 10, considered medium impact, since the patients mentioned they were ashamed because they were not satisfied with their quality of oral health because they presented some type of scar and speech disorders. Concerning the social incapacity, the score was seven, which is considered weak or low impact. Concerning the questions about deficiencies, a score of six was observed, considered low or weak impact on the QoL [Table 2].
Table 2: Frequency of answers obtained in relation to oral health impact profile index questions

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The responses to the question: “Was there improvement in your QoL after endodontic treatment?” evidenced that, among the 65 individuals, 61 (94%) responded “yes” and four (6%) responded there was no improvement. Among these, one individual mentioned tooth extraction; two individuals reported there was no improvement since they had not yet received a denture and did not have a good chewing capacity; one individual referred constant pain and thus a follow-up session was scheduled to investigate the causes of pain.

In this study, 72 individuals responded to the OHIP-14 questionnaire at M1, yet seven individuals were lost to follow-up and did not respond the questionnaire at M2. Among these, four did not return for the completion of endodontic treatment and three did not reply to telephone call.

  Discussion Top

Considering that HRAC/USP receives individuals from several Brazilian states, this study was difficult due to the frequency of follow-up of participants for treatment completion, especially in cases of pulp necrosis and endodontic retreatment requiring a change of dressing or root canal obturation. This is common in this type of study.[4]

Individuals with complete cleft lip and palate may present a delay of approximately 6 months in the formation of permanent teeth and delayed eruption. In addition, the maxillary incisors may present anomalies of shape, structure, number, and position, which may lead to difficult hygiene and consequently to dental caries, as well as peg-shaped teeth, which often require reshaping.[3] This study addressed the involvement of teeth adjacent to the cleft area in need of endodontic treatment, either due to caries or for prosthetic purposes. In the individuals analyzed, teeth at the cleft area with greater involvement were the maxillary incisors and canines, including 25 teeth (89.3%) at the cleft area and three teeth (10.7%) in noncleft areas.

Pulp necrosis are divided into nonvital pulp therapy Type I, in which there is pulp necrosis without radiographic evidence of periapical lesion; and nonvital pulp therapy Type II, which is pulp necrosis with the presence of radiographically visible periapical lesion.[5] In cases of nonvital pulp therapy followed in this study (24 cases), it was always necessary to perform more than one treatment session, for change of dressing. The greater number of endodontic sessions did not impair the complaint of worsened QoL of the individual (M2).

Retrospective analysis of the QoL of endodontically treated individuals, randomly selected by clinical records, who responded to a questionnaire on the impact of oral health on the QoL (OHIP-17) and performed a test on satisfaction with the treatment performed, it was observed that endodontic treatment interfered with the QoL of patients since it promoted the welfare, with psychological, physical and social changes, and the individuals were satisfied.[16] The OHIP was applied on a Canadian study, which posed questions related to the QoL assessing, on each item, if the initial complaint was better, worse, or unaltered after endodontic treatment. The author concluded that the endodontic treatment improved the QoL of individuals analyzed in 70% and the degree of satisfaction was high.[4]

The OHIP-14 index indicates a weak impact of oral health on the QoL of individuals reporting predominance of physical pain, psychological discomfort, and psychological incapacity, as well as those feeling discomfort during feeding and reporting pain in the mouth,[17],[18] which are similar to data found in this study. It was observed that the dimensions presenting greater impact on the QoL of individuals analyzed had medium impact, which were the physical pain with score 15, followed by psychological discomfort with score 11 and psychological incapacity with score 10. The dimensions with lowest impact on QoL had a weak impact and included functional limitation, physical incapacity, social incapacity, and deficiency. The OHIP-14 relates the QoL and oral health, evaluating how difficult it is to relate with other people in society, work, or daily life activities in the presence of pain, fear, difficulty to rest due to discomfort in the mouth or teeth.[14],[15],[16] In this study, the greatest complaint was related to pain, which presented medium impact in the result of the OHIP-14.

Considering the scarce literature on the QoL related to endodontics in individuals with cleft lip and palate, this study contributes to investigations in this field, demonstrating that since well-conducted endodontic therapy is necessary for the dental rehabilitation (Santos Junior 2019) and performed within strict standards of quality and accuracy in this group of individuals, impact the QoL.

The endodontic treatment improved the oral health of individuals in the study, with the improvement of 94% in the QoL of participants. The OHIP-14 was efficient to evaluate the influence of factors with medium impact, namely physical pain, psychological discomfort, and psychological incapacity, on the QoL of participants.

Ethical clearance

This study was approved by the institutional Ethics Committee of Hospital for Rehabilitation of Craniofacial Anomalies approval under protocol No 407.100/2013.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Dugas NN, Lawrence HP, Teplitsky P, Friedman S. Quality of life and satisfaction outcomes of endodontic treatment. J Endod 2002;28:819-27.  Back to cited text no. 1
Jokovic A, Locker D, Tompson B, Guyatt G. Questionnaire for measuring oral health-related quality of life in eight- to ten-year-old children. Pediatr Dent 2004;26:512-8.  Back to cited text no. 2
Silva Filho OG, Freitas JA. Morphological characterization and embryological origin. In: Cleft lip and palate: an interdisciplinary approach. Livraria Santos Editora: São Paulo; 2007. p. 17-49.  Back to cited text no. 3
Júnior M, Guedes CA, Ottoni J, Costa S. Endodontic therapy in a Family Health Residency: patients' satisfaction and self-perceived quality of life. Brazilian Journal of Dentistry 2009;65:252.  Back to cited text no. 4
Leonardo MR. Endodontics: Root canal treatment, technical and biological principles. São Paulo: Artes Médicas; 2005.  Back to cited text no. 5
Leonardo MR, Leonardo RT. Root canal treatment: Technological advances in minimally invasive and restorative endodontics. São Paulo: Artes Medicas; 2012.  Back to cited text no. 6
Hussne RP, Berbert FL, Nishiyama CK, Câmara AS, Pinheiro CR, Leonardo RT. Investigation of the endodontic needs and planning in patients with cleft lip and or palate submitted to surgical treatment. Perspect Oral Sci 2009;1:19-23.  Back to cited text no. 7
Siqueira JF Jr., Rôças IN, Lopes HP, Alves FR, Oliveira JC, Armada L, et al. Biological principles of endodontic treatment of teeth with vital pulp. Brazilian Journal of Dentistry 2012;68:161.  Back to cited text no. 8
Gomes Filho IS, da Cruz SS, de Macêdo TC, Rasquin LC, Trindade SC, Rebello IM, et al. The influence of periodontal disease on pulp tissue – Clinical and radiographic evaluations.Sitientibus (UEFS). 2006;34:101-14.  Back to cited text no. 9
Nobre ES, Câmara GP, da Silva KP, Nuto SA. Quality evaluation of the dental service rendered by a private university: the users' point of view. Brazilian Journal in Health Promotion2012;18:171-6.  Back to cited text no. 10
Tesch FC, Oliveira BH, Leão A. Measuring the impact of oral health problems on children's quality of life: conceptual and methodological issues. Reports in Public Health 2007;23:2555-64.  Back to cited text no. 11
Fleck MP. The World Health Organization instrument to evaluate quality of life (WHOQOL-100): characteristics and perspectives. Revista Ciência and Saúde Coletiva 2000;5:33-8.  Back to cited text no. 12
Adulyanon S, Vourapukjaru J, Sheiham A. Oral impacts affecting daily performance in a low dental disease Thai population. Community Dent Oral Epidemiol 1996;24:385-9.  Back to cited text no. 13
Slade GD, Nuttall N, Sanders AE, Steele JG, Allen PF, Lahti S. Impacts of oral disorders in the United Kingdom and Australia. Br Dent J 2005;198:489-93.  Back to cited text no. 14
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.  Back to cited text no. 15
Ribeiro IL, Veloso HH, Valença AM, Neto EA, Júnior OB. Evaluation of quality of life and level of user satisfaction of network of specialized care with the endodontic treatment in the municipality of João Pessoa, Paraíba, Brazil, 2009. Dental Journal of Central Brazil 2012;21:557-563.  Back to cited text no. 16
Alvarenga FA, Henriques C, Takatsui F, Montandon AA, Telarolli Júnior R, Monteiro AL, et al. Oral health impact profile in the quality of life of patients over 50 years old of two public institutions of Araraquara city, SP, Brazil. Rev Odontol UNESP. 2011;40:118-24.  Back to cited text no. 17
Silva ME, Villaça ÊL, Magalhães CS, Ferreira EF. Impact of tooth loss in quality of life. Ciência & Saúde Coletiva 2010;15:841-50.  Back to cited text no. 18


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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