The Clinical Standards Advisory Group (CSAG) Cleft Lip and Palate Study
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Published on: September 19, 2015
J Sandy1, A Williams, S Mildinhall
1Division of Child Dental Health, University of Bristol Dental School, Bristol, U.K.
Insights
Care for children with unilateral cleft lip and palate (UCLP) shows disappointing outcomes. A national study found poor dental arch relationships and high rates of bone graft failure, indicating a need for improved standards in cleft care.
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.
Abstract:
A national study of care and outcomes in children born with a unilateral cleft lip and palate (UCLP) was performed over a 15-month period. Two cohorts of children ('5-year-olds' and '12-year-olds') were examined. There were 57 active cleft teams in the U.K. with 105 consultant orthodontists involved in the care of these children. Only 36 teams could provide basic data such as patients names. Of the patients, 47-51 per cent had neonatal appliances. The dental arch relationships were measured with the Goslon Index and a Five-Year-Old Index, 37-39 per cent of both age groups were either 'poor' or 'very poor'. Seventy per cent of the 12-year-old patients had a Skeletal III relation and 42 per cent of bone grafts were seriously deficient or failed. Dental treatment for active caries was needed by 40 per cent of 5-year-olds and 20 per cent of 12-year-olds. In addition, the training of recently appointed consultant orthodontists involved in the care of these children was scrutinized. As a whole, the results were disappointing with standards of care not significantly raised in the last decade. Recommendations have been made to the Department of Health and the implications for the orthodontic profession are explored. Overall, it seems that fewer orthodontists will need to be involved in a centralized care model for these children.
