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Functional outcomes in the Cleft Care UK study--Part 3: oral health and audiology
J Smallridge1,2, A J Hall3,4, R Chorbachi5
1South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK.
Insights
Dental caries and hearing outcomes for children with cleft lip and palate did not improve with centralized care. Reduced grommet use and increased hearing aid use were observed, but overall results remained similar to earlier studies.
Area of Science:
- Pediatric dentistry
- Audiology
- Cleft lip and palate care
Background:
- Two UK studies, Clinical Standards Advisory Group (CSAG, 1998) and Cleft Care UK (CCUK, 2013), evaluated children aged 5 with non-syndromic unilateral cleft lip and palate.
- CSAG utilized a dispersed care model with low-volume operators, while CCUK implemented a centralized, high-volume operator system.
Purpose of the Study:
- To compare oral health and hearing outcomes between the CSAG and CCUK cohorts.
- To assess the impact of different care models on pediatric outcomes for cleft lip and palate.
Main Methods:
- Cross-sectional studies involving 5-year-old children born with non-syndromic unilateral cleft lip and palate.
- Oral health assessed via standardized proforma; hearing evaluated using pure tone audiometry, otoscopy, and tympanometry.
- Data collected from medical records and parental reports.
Main Results:
- Oral health outcomes, including mean dmft (2.3) and caries prevalence, showed no significant change between the two studies.
- A 17.6% reduction in grommet insertion was noted in the CCUK cohort compared to CSAG.
- While hearing levels remained unchanged, there was an increase in hearing aid usage for children with hearing loss.
Conclusions:
- Centralized care in the CCUK study did not yield better dental caries or hearing outcomes compared to the dispersed CSAG model.
- Reduced need for grommets and increased hearing aid use suggest potential shifts in management strategies.
- Current service specifications for cleft care require critical review and implementation to improve patient outcomes.
Objectives:
To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies.
Setting And Sample Population:
Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system.
Materials And Methods:
Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report.
Results:
Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids.
Conclusions:
Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented.
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