Orofacial clefts
Pinki Sonkar received free life-changing cleft repair surgery in 2007, thanks to the Smile Train charity
Six-year-old Pinki before surgery
Pinki a few weeks after surgery – the scar is healing nicely
access to that care is limited. India’s expertise and profile in research in both genetics and environmental factors is developing rapidly, but is not matched by the efficiency of its administrative and governance systems. The 2008 Academy Award-winning
short documentary Smile Pinki illustrated the kind of problem that exists with chil- dren born with CLP in parts of rural India. Pinki Sonkar was ostracised in her local community and was not allowed to attend school because of her facial disfigurement. Her parents were initially unaware of the
possibility that her cleft could be repaired and in any case were unable to afford such surgery. The charity Smile Train, however, offered the surgery free of charge and, even though she was five-years-old when her cleft was repaired, this op has transformed her life. Accompanied by her surgeon Dr Subodh Singh She was invited to London to toss the coin for the 20ı3 Wimbledon Final (see page ı3). The Sri Ramachandra Hospital and
Medical Research Centre in Chennai and St John’s Hospital in Bangalore are examples of centres of excellence in both treatment and research, with a high throughput of patients and, therefore, they are regarded as exemplary research collaborators.
Unique research While maternal tobacco smoking is consistently associated with OFC (Little et al, 2004), this practice is not widespread on the Indian subcontinent. The exact
mechanism of the effect of smoking on the developing embryo to cause a cleft remains unknown, but one hypothesis is hypoxia (Johnstone and Bronsky, ı995), and it was suggested that the principal mechanism may be through carbon monoxide (CO) production. Solid carbon fuel-burning stoves are
commonly used for cooking in parts of India, but to date, no study has ever been carried out on the association between maternal exposure to environmental smoke and risk of oral clefts. This proposal aims to look for the first time at domestic environmental smoke – that is, smoky environment due to cooking and heating in the homes of Indian people. What is unique about this particular
proposal is the fact that the Chennai group has developed a reliable system for the monitoring of indoor smoke exposure that includes CO assessment, and this project is attempting to extrapolate evidence of an environmental exposure – for example,
maternal smoking (which is consistently associated with clefts in the west) – to a problem in the developing world.
Aims and objectives This application would simultaneously address three component parts that bring our complementary multi-disciplinary expertise from the three participating countries to bear. These are:
(a) nutritional assessment using locally validated food frequency questionnaires (FFQ) (b) environmental exposure assessment using locally developed biomarkers and unique monitoring of the domestic environment (c) maternal metabolism assessment with particular interest in maternal diabetes and folic acid/vitamin Bı2/homocysteine metabolism.
Continued » Scottish Dental magazine 21
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