Prosthodontic Services in Cleft Care: Institutional Barriers and Pathways to Equity

ObjectiveDespite the critical role of prosthodontic care in cleft rehabilitation, access remains inconsistent, and the institutional barriers to its integration are uncharacterized. This study evaluates institutional and socioeconomic barriers to prosthodontic care for patients with cleft conditions and identifies strategies to improve service delivery.DesignCross-sectional survey of 35 American Cleft Palate-Craniofacial Association-approved cleft-craniofacial teams across academic medical centers, public institutions, and private practices in the United States and Canada. The survey assessed institutional characteristics, prosthodontic service availability, barriers to care, insurance coverage patterns, and improvement strategies. Descriptive statistics were used to analyze response patterns.ResultsThirty-five institutions participated (68% academic medical centers, 24% public institutions). Most teams (22/31, 71%) lacked dedicated prosthodontic providers. Among 7 teams with on-staff prosthodontists, wait times were 3 months or less in 6 of 7 (86%) and 6 to 9 months in 1 of 7 (14%). The most common institutional barriers were insufficient funding and limited prosthodontist availability (each 10/18, 56%). Insurance denials for lack of prosthodontic coverage were reported by 75% of respondents (3/4 teams). Among 14 respondents (40%) reporting socioeconomic effects on access, financial barriers were most frequently cited (11/14, 79%), followed by transportation (7/14, 50%) and work/family obligations (6/14, 43%). Among teams without an on-staff prosthodontist, 12 of 22 (55%) had access to an external prosthodontist. Proposed solutions included increased insurance coverage (20/23, 87%) and legislative advocacy (17/23, 74%).ConclusionsAccess to prosthodontic care for patients with cleft conditions is limited by workforce shortages, inadequate funding, and insurance denials. Expanded insurance coverage, legislative advocacy, and strategic prosthodontist recruitment are needed to improve access.