The Clinical Standards Advisory Group (CSAG) Cleft Lip and Palate Study

Area of Science:

• Pediatric Dentistry
• Orthodontics
• Craniofacial Anomalies

Background:

• Unilateral cleft lip and palate (UCLP) requires specialized, multidisciplinary care.
• Previous assessments suggest variability in care quality for UCLP patients.
• A national study was conducted to evaluate current care standards and outcomes.

Purpose of the Study:

• To assess the quality of care and clinical outcomes for children with UCLP in the UK.
• To evaluate the effectiveness of existing treatment protocols and identify areas for improvement.
• To examine the training and involvement of consultant orthodontists in UCLP care.

Main Methods:

• A national study examining two cohorts: 5-year-olds and 12-year-olds with UCLP.
• Data collection from 57 UK cleft teams, including assessment of neonatal appliances and dental arch relationships using the Goslon and Five-Year-Old Indices.
• Evaluation of skeletal relationships, bone graft success, and prevalence of dental caries.

Main Results:

• 37-39% of children had 'poor' or 'very poor' dental arch relationships.
• 70% of 12-year-olds exhibited a Skeletal III relationship; 42% of bone grafts were deficient or failed.
• 40% of 5-year-olds and 20% of 12-year-olds required treatment for active caries.

Conclusions:

• Current standards of care for UCLP have not significantly improved over the last decade.
• The study highlights significant deficiencies in dental arch relationships, bone grafting, and caries management.
• Recommendations include a centralized care model potentially involving fewer orthodontists to improve outcomes for UCLP patients.