Orofacial functions and quality of life in children with unilateral cleft lip and palate

Orofacial dysfunction in cleft lip and palate patients using the nordic orofacial test-screening

INTRODUCTION

The Nordic Orofacial Test-Screening (NOT-S) protocol serves as a widely recognized tool for assessing orofacial dysfunction comprehensively. This study aimed to compare orofacial dysfunction between unilateral (UCLP) and bilateral (BCLP) cleft lip and palate patients using the NOT-S.

MATERIALS AND METHODS

This descriptive cross-sectional study enrolled 104 patients, comprising 72 with unilateral cleft lip and palate (UCLP) and 32 with bilateral cleft lip and palate (BCLP) referred to the cleft lip and palate clinic of Mashhad Dental School. Orofacial dysfunction was assessed using the Nordic Orofacial Test-Screening (NOT-S), which includes a structured interview and clinical examinations encompassing 6 domains each. Statistical analysis utilized Mann-Whitney, Fisher's exact, and Chi-square tests, with significance set at P < 0.05.

RESULTS

No significant differences were found in structured interview (P = 0.45), clinical examination (P = 0.45), or total NOT-S score (P = 0.11) between the two types of cleft lip and palate.

CONCLUSION

Based on NOT-S assessment, patients with unilateral (UCLP) and bilateral (BCLP) cleft lip and palate exhibited comparable orofacial dysfunctions. In the structured interview, the most prevalent issues were identified in the domain of chewing and swallowing for both cleft types. In clinical examination, unilateral cleft lip and palate patients commonly experienced facial problems at rest, while bilateral cleft lip and palate patients frequently encountered challenges with speaking. However, these differences were not statistically significant.

Evaluation and recommendations of the oral health, oral function, and orofacial aesthetics-related measures of the ICHOM Standard Set for Cleft Lip and Palate

This study was performed to evaluate the efficacy of outcome measures for the orofacial domain included in the International Consortium for Health Outcomes Measurement Standard Set for Cleft Lip and Palate (ICHOM-SCS). In this multicentre study involving two cleft centres, suggestions to optimize the type and timing of outcome measures were made based on data and clinical experience. Patient-reported outcome measures (PROMs) (CLEFT-Q Jaw, Teeth, Eating/Drinking; Child Oral Health Impact Profile-Oral Symptoms Scale (COHIP-OSS)) and clinical outcome measures (caries experience and dental occlusion) data were collected retrospectively for age 5, 8, 10, 12, 19, and 22 years. The data were categorized by cleft type and analysed within and between age groups using Spearman correlation, the distribution of responses per item, a two-sample test for equality of proportions, and effect plots. Most correlations between PROMs and clinical outcome measures were weak (r < 0.5), suggesting PROMs and clinical outcome measures complement each other. The COHIP-OSS and CLEFT-Q Eating/Drinking barely detected problems in any patient category and are no longer recommended. A suitable alternative appears complex to find; outcomes of this study and the recent literature doubt an added value. Similar problems were found in the CLEFT-Q Jaw at time-point 12 years. Therefore, time-points 15 and 17 years are currently suggested.

Oral habits, sociopsychological orthodontic needs, and sociodemographic factors perceived by caregivers impact oral health-related quality of life in children with and without autism?

BACKGROUND

Caregivers play a crucial role in assessing the oral health-related quality of life (OHRQoL) of young individuals with autism spectrum disorder (ASD).

AIM

This study assessed the impact of sociodemographic and oral conditions on OHRQoL and family dynamics in young individuals with and without autism, as perceived by guardians.

DESIGN

This comparative cross-sectional study included young individuals aged 6 to 14 years and their guardians. Data were collected at a specialized institution and dental schools. Guardians completed the Parental-Caregiver Perceptions Questionnaire (P-CPQ), Family Impact Scale (FIS), and sociodemographic and oral habits questionnaires. The sociopsychological need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The sample included 144 youths and caregivers. The ASD group had higher P-CPQ and FIS scores. Factors associated with poorer perceived OHRQoL included higher youth age, lower caregiver education, higher IOTN scores, teeth clenching (RR = 1.20; 95% CI: 1.01-1.41), and lip sucking. Lower parental education (RR = 1.75; 95% CI: 1.10-2.80) and higher IOTN scores from the caregiver's perspective impacted family dynamics.

CONCLUSION

Caregivers of young individuals with ASD perceived a lower OHRQoL, and families in this group were more affected by sociodemographic and oral conditions.

Oral health-related quality of life in patients aged 8 to 19 years with cleft lip and palate: a systematic review and meta-analysis

BACKGROUND

Cleft lip and palate (CLP) is the most common facial birth defect worldwide and causes morphological, aesthetic, and functional problems with psychosocial implications for an individual's life and well-being. The present systematic review and meta-analysis assessed whether the treatment of CLP impacts the oral health-related quality of life (OHRQoL) in children and adolescents in comparison to healthy controls.

METHODS

We searched MEDLINE/PubMed, EMBASE, and PsycINFO databases using terms related to CLP, and included articles until August 2023. Observational comparison studies that assessed OHRQoL in non-syndromic CLP patients aged 8-19 years with validated scales designed to such aim or scales capable to identify aspects related to oral health compared to healthy controls were included. We used the ROBINS-I tool for risk of bias assessment. A meta-analysis of continuous variables was performed using inverse variance for pooling estimates, Standardized Mean Difference (SMD) as a summary measure, with random effects model. Heterogeneity was estimated by the I2 statistics. Sensitivity analyses included subgrouping based on the scale, risk of bias and scale domains. Meta-regression was performed under a mixed-effects model considering the variables type of scale, scale domains and risk of bias.

RESULTS

Fourteen studies were included comprising 1,185 patients with CLP and 1,558 healthy controls. The direction of the effect of OHRQoL favoured the healthy group (-0.92; 95% CI:-1,55;-0,10) and I2 = 95%. After removing three studies, I2 dropped to 80%. Meta-regression showed no influence on risk of bias (p = 0.2240) but influence of scale type (p = 0.0375) and scale domains (p < 0.001). The subgroup analysis indicated that the CPQ and COHIP scales presented very discrepant SMD values, despite pointing to the same effect direction. In contrast, the OHIP scale showed a non-significant difference between cases and controls, with estimates much lower than the other two scales. Results also suggest that OHRQoL associated with oral functionality and social well-being is more influential on outcomes than emotional well-being.

CONCLUSION

The global OHRQoL is slightly worst in the CLP patients than control group. The difference between OHRQoL was mainly detected through OHIP. The most affected domains are functional, emotional and social.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022336956.

Effect of self-perceived oral habits on orofacial dysfunction and oral health-related quality of life among a group of Egyptian children: a cohort study

PURPOSE

This study aims to investigate the relationship between OHRQoL and orofacial dysfunction in children practicing oral habits.

METHODS

Thirty Egyptian Children, aged from five to seven years, practicing oral habits (habit practicing/exposed group), were examined for orofacial dysfunction using Nordic Orofacial Test-Screen (NOT-S). Their parents were asked to fill 8-item Parental-Caregiver Perception Questionnaire (P-CPQ), translated to Arabic, as an assessment tool for their children's OHRQoL. The scores of the habit practicing group were compared to those obtained from another 30 children with matched criteria not practicing oral habits (habit free/ control group).

RESULTS

Children in the exposure group showed higher total NOT-S score (median 3, range 1-5) and higher P-CPQ (median 6, range 1-16) than the control group (median 0.5, range 0-2) and (median 4, range 1-8), with a statistical significance (p = 0.00, p = 0.014), respectively. A statistically significant moderate positive correlation was found between OHRQoL and orofacial dysfunction in the habit practicing group, (R = 0.384, p = 0.036). The exposure group was found to be 7.4 and 1.5 times the control group in developing orofacial dysfunction, and having inferior OHRQoL, respectively.

CONCLUSION

An existing association between the degree of orofacial dysfunction and OHRQoL in children practicing oral habit(s) is suggested.

TRIAL REGISTRATION NUMBER

NCT04575792, date of registration: 26/9/2020, first posted (approved): 5/10/2020.

Orofacial dysfunction, nonnutritive sucking habits, and dental caries influence malocclusion in children aged 8-10 years

INTRODUCTION

Malocclusion is one of the most prevalent oral health problems and can affect self-esteem, social relations, and oral health-related quality of life. The present study aimed to evaluate associations between malocclusion and orofacial dysfunction, nonnutritive sucking habits, cavitated carious lesions, and anxiety in Brazilian children.

METHODS

An analytical cross-sectional study was conducted with a representative sample of 739 children aged 8-10 years. Parents or guardians provided sociodemographic data and information on the nonnutritive sucking habits of the children. The children answered the Revised Children's Manifest Anxiety Scale. Four trained examiners examined the children for the diagnosis of malocclusion (dental aesthetic index), dental caries (International Caries Detection and Assessment System), and orofacial dysfunction (Nordic Orofacial Test-Screening). The control variables were selected using a directed acyclic graph. Descriptive statistics were performed, followed by unadjusted and adjusted robust logistic regression analysis (P <0.05).

RESULTS

The following variables remained associated with the occurrence of malocclusion in the final model: nonnutritive sucking habits (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.25-4.08), orofacial dysfunction (OR, 1.56; 95% CI, 1.13-2.17), and cavitated carious lesion (OR, 1.39; 95% CI, 1.03-1.89).

CONCLUSIONS

Nonnutritive sucking habits, orofacial dysfunction, and cavitated carious lesions were associated with the presence of malocclusion in children aged 8-10 years.

Adaptation of the Quality of Life Adolescent Cleft Questionnaire for Spanish children and adolescents with cleft lip and/or palate

BACKGROUND

The Quality of Life Adolescent Cleft Questionnaire is a measure of quality of life in cleft lip/palate (CL/P) and includes items on pre-treatment and post-treatment status. Items, however, were originally organized in a factor structure that prevents a formal pre-treatment to post-treatment comparison. Additionally, the questionnaire was tested in older patients.

AIM

We aimed to explore a factor structure that allows a comparison of pre- to post-treatment status in children and adolescents with CL/P.

DESIGN

The sample comprised 60 children and adolescents with CL/P. The scale was divided into two groups of items (24 comparing pre-treatment and post-treatment status and 26 measuring current quality of life). Two different exploratory and confirmatory analyses were conducted (one for each group of items). Sources of criterion validity were investigated with measures of self-esteem and self-efficacy.

RESULTS

The results supported a 6-factor structure for the pre-treatment and post-treatment items. In the second group of items, 9 items were removed due to inadequate functioning and a final 4-factor solution was obtained. The criterion validity of factors was good.

CONCLUSION

The proposed factor solution might be more useful to detect the perceived satisfaction in different areas and can be used in younger patients.

A Comparative Study of Oral Health-Related Quality of Life among Cleft Lip and Palate Patients and Their Families during Orthodontic Treatment

(1) Background: It has been recognized that CLP condition may affect oral health-related quality of life (OHRQoL) due to dental anomalies and abnormal craniofacial development. Aim: To assess whether orthodontic treatment affected the levels of OHRQoL in CLP patients and their families. (2) Methods: 226 individuals (111 with cleft and 115 control) and their parents were invited to complete the Oral Health Impact Profile-14 (OHIP-14) and Family Impact Scale (FIS), respectively. The Mann–Whitney test was used for quantitative variables and the Fisher’s exact test for categorical variables. The Spearman Rank Correlation Coefficient was used to correlate the results of the OHIP and FIS questionnaires. (3) Results: No significant difference was found between groups in OHIP-14 but FIS score revealed a significant difference between the two groups evaluated (p < 0.001). Only the social limitation in OHIP score revealed a significant difference (p = 0.001). Regarding FIS score, the most affected dimensions were family activities (p < 0.001), parental emotions (p = 0.001), and family conflict (p = 0.011). (4) Conclusion: Undergoing orthodontic treatment had a similar impact on the overall quality of life in CLP patients and non-cleft patients. Parents of cleft children had a poorer OHRQoL compared to what was perceived by their children and parents of non-cleft children.

Farsi version of the CLEFT-Q: translation, cultural adaptation process and reliability

Background

The purpose of this study was the translation and cultural adaptation of the CLEFT-Q to Farsi and evaluating the reliability of it.

Methods

The English version of the CLEFT-Q was translated to Farsi following the guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). To calculate the reliability, 50 participants filled out the Farsi version of the questionnaire twice at 2-week intervals.

Results

The difficulties during the translation and cultural adaptation process were as follows: 7.56% of items from the independent forward translations, 62.18% of items from the comparison between two forward translations, and 21% of items from the comparison between post-back translation and the original version. The internal consistency and stability of the Farsi version of the CLEFT-Q were 0.979 and 0.997, which both were categorized as excellent.

Conclusion

The Farsi version of the CLEFT-Q is a valid and reliable tool currently available for Farsi-speaking families around the world.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01957-7.

Impact of oral diseases on oral health-related quality of life: A systematic review of studies conducted in Latin America and the Caribbean

Background

We performed a systematic review of studies conducted in Latin America and the Caribbean (LAC) to assess the impact of oral diseases on oral health-related quality of life (OHRQoL).

Materials and methods

Searches were performed of the following PubMed, EMBASE, CINAHL, Scopus, and LILACS databases. Randomized clinical trials, quasi-experimental studies, cohort studies, case and control studies, and cross-sectional studies which included at least 100 participants evaluating the impact of oral diseases on OHRQoL were included. PROSPERO registry number: CRD42020156098.

Results

After exclusion of duplicates, 3310 articles were identified, 40 of which were included in this review. 90% of the studies were conducted in Brazil. The most commonly used OHRQoL measuring instruments were CPQ 11–14 (n = 9), ECOHIS (n-8) and B-ECOHIS (n = 8). The study designs included 32 cross-sectional, 2 cohort and 6 case and control studies. Most of the studies were conducted in children (n = 25) and adolescents (n = 9). Most studies identified an impact on OHRQoL in children, adolescents and adults with oral diseases. Moreover, greater oral disease severity had a greater impact on OHRQoL.

Conclusions

Most studies in LAC report a negative impact of diseases on OHRQoL. More longitudinal studies are required to confirm the results of these studies.

Relationships of Dental Caries and Malocclusion with Oral Health-Related Quality of Life in Lithuanian Adolescents Aged 15 to 18 Years: A Cross-Sectional Study

There is a lack of evidence of the moderating effects of caries lesions and malocclusions on oral health-related quality of life (OHRQoL) among older adolescents. This study aimed to evaluate the relationship of dental caries and malocclusion with OHRQoL among Lithuanian adolescents aged 15 to 18 years. A survey in a representative sample of adolescents included a clinical examination to assess dental health status using the DMFT (Decayed, Missing, and Filled Permanent Teeth) index, and malocclusion using the Index of Complexity, Outcome, and Need (ICON). The Child Perceptions Questionnaire (CPQ) was used to evaluate respondents’ OHRQoL. Negative binomial regression was fitted to associate the clinical variables with the CPQ scores. A total of 600 adolescents were examined. The overall mean DMFT score was 2.7. A need for orthodontic treatment was detected among 27.7% of adolescents. Subjects with caries lesions (DMFT > 3) had higher CPQ scores in the domains of functional limitations and social wellbeing (relative risks were 1.35 (95% confidence interval: 1.09–1.67) and 1.30 (1.03–1.64), respectively), while subjects with a need for orthodontic treatment (ICON > 43) had higher CPQ scores in the domains of emotional wellbeing and social wellbeing (relative risks were 1.81 (1.40–2.22), and 1.69 (1.34–2.14), respectively). It was concluded that both dental caries and malocclusion have negative relationships with OHRQoL in adolescents above 15 years, but their effects occur differently in each OHRQoL domain.