Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate : comparison of dental arch relationships and dental indices at 5, 8, and 10 years

Background and trial design The Scandcleft intercentre study evaluates the outcomes of four surgical protocols (common method Arm A, and methods B, C, and D) for treatment of children with unilateral cleft lip and palate (UCLP) in a set of three randomized trials of primary surgery (Trials 1, 2, and 3). Objectives To evaluate and compare dental arch relationships of 5-, 8-, and 10-year-old children with UCLP after four different protocols of primary surgery and to compare three dental indices. The results are secondary outcomes of the overall trial. Methods Study models taken at the ages of 5 (n = 418), 8 (n = 411), and 10 years (n = 410) were analysed by a blinded panel of orthodontists using the Eurocran index, the 5-year-olds' (5YO) index, and the GOSLON Yardstick. Student's t-test, Pearson's correlation, chi-square test, and kappa statistics were used in statistical analyses. Results The reliability of the dental indices varied between moderate and very good, and those of the Eurocran palatal index varied between fair and very good. Significant correlations existed between the dental indices at all ages. No differences were found in the mean 5-, 8-, and 10-year index scores or their distributions within surgical trials. Comparisons between trials detected significantly better mean index scores in Trial 2 Arm C (at all ages) and in Trial 1 Arm B (at 5 and 10 years of age) than in Trial 3 Arm D. The mean Eurocran dental index scores of the total material at 5, 8, and 10 years of age were 2.50, 2.60, and 2.26, and those of the 5YO index and GOSLON Yardstick were 2.77, 2.90, and 2.54, respectively. At age 10 years, 75.8% of the patients had had orthodontic treatment. Conclusions The results of these three trials do not provide evidence that one surgical method is superior to the others. The reliabilities of the dental indices were acceptable, and significant correlations existed between the indices at all ages. The reliability of the Eurocran palatal index was questionable.Peer reviewe

Scandcleft randomised trials of primary surgery for unilateral cleft lip and Palate: 9. Parental report of social and emotional experiences related to their 5-year-old child’s cleft diagnosis

© 2017 Acta Chirurgica Scandinavica Society. Background and aim: Parents of children with a cleft lip and palate may be emotionally affected by the child’s diagnosis. Their experiences and perceptions are important when evaluating the complexity of satisfactory treatment outcomes. The objective was to examine parents’ social and emotional experiences related to their child’s cleft diagnosis, and their perceptions of the child’s adjustment to living with a visible difference. Design: International multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods: A cohort of 448 children born with a non-syndromic UCLP were included. A total of 356 parents completed the Scandcleft Parent Questionnaire. Results: The majority of parents experienced practical and emotional support from family, friends, and health professionals. Nevertheless, parents had to cope with other people’s reactions to the cleft, experiences that were described as ranging from hurtful to neutral and/or positive. According to parents, 39% of the children had experienced cleft-related comments and/or teasing. More than half of the parents reported specific worries related to their child’s future. Conclusion: While the majority of the parents experienced positive support and coped well with the child’s diagnosis, some parents were at risk for psychological and emotional challenges that should be identified by the cleft team. To optimise outcomes and the child’s adjustment, these parents should be offered psychological support when necessary. Trial registration: ISRCTN29932826

Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls

Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls, 2015, BMC Oral Health, Abstract Background: Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. Methods: The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the child's oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low". Results: Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p < 0.05) and displayed less good oral hygiene (p < 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67 % but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95 % CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. Conclusion: Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention

Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls

Background: Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. Methods: The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the childs oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low". Results: Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p less than 0.05) and displayed less good oral hygiene (p less than 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67 % but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95 % CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. Conclusion: Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.Funding Agencies|FORSS - Medical Research Council of Southeast Sweden, Futurum, - Academy of Health and Care Jonkoping County Council; Swedish Dental Association; Swedish Society of Paediatric Dentistry</p

Comparing caries risk profiles between 5-and 10-year-old children with cleft lip and/or palate and non-cleft controls

Background: Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. Methods: The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the childs oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low". Results: Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p less than 0.05) and displayed less good oral hygiene (p less than 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67 % but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95 % CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. Conclusion: Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.Funding Agencies|FORSS - Medical Research Council of Southeast Sweden, Futurum, - Academy of Health and Care Jonkoping County Council; Swedish Dental Association; Swedish Society of Paediatric Dentistry</p

Reliability and Validity of Swedish version of the Oral Health Impact Profile

The aim of this study was to translate the Oral Health Impact Profile (OHIP) into Swedish and evaluate the reliability and validity of the Swedish version (OHIP-S). The OHIP is a 49-item, self-administered questionnaire divided into seven different subscales. The original version in English was translated into Swedish, accompanied by back-translation into English, after which the Swedish version was revised. A total of 145 consecutive patients participated and answered a questionnaire. The patients comprised five clinically separate groups: temporomandibular dysfunction (TMD) (n=30), Primary Sjögren’s Syndrome (SS) (n=30), burning sensation and pain in the oral mucosa (Oral mucosal pain, OMP) (n=28), skeletal malocclusion (Malocclusion) (n=27), and healthy dental recall patients (Controls) (n=30). The TMD group and the Control group participated in a test-retest procedure. The internal reliability of each subscale was calculated with Cronbach’s alpha and found to be high and to range from 0.83-0.91. The stability (test-retest) of the instrument, calculated using the intraclass correlation coefficient, ranged from 0.87-0.98. The construct validity of OHIP-S was compared with subscales of the Symptom Check List (SCL-90) (rho 0.65) and the Jaw Function Limitation Scale (JFLS) (rho 0.76) and analyzed with Spearman’s correlation coefficient. Convergent validity was evaluated by comparing OHIP with self-reported health using Spearman’s correlation coefficient and was found to be acceptable (rho 0,61). In the evaluation of the discriminative ability of the instrument, significant differences were found in the total OHIP-S score between the controls and the four other groups (P < 0.001). We conclude that the reliability and validity of OHIP-S is excellent. The instrument can be recommended for assessing the impact of oral health on masticatory ability and psychosocial function

Controlling the Uncontrollable : Patient Safety and Medication Management From the Perspective of Registered Nurses in Municipal Home Health Care

Most adverse events in health care are related to medication management and they are almost always preventable. Increased knowledge of patient safety related to medication management in home health care is an urgent issue to provide safe care for all patients regardless of where the health care takes place. This study explored patient safety within medication management in municipal home health care. Vignettes were used as stimulus during qualitative interviews with registered nurses. Three main themes with related subthemes were identified as challenges to patient safety within medication management in home health care: (1) challenges to information transfer, (2) challenges related to delegation, and (3) challenges of advanced medical treatments in the home. The issue of transfer of information permeated our findings. Coordinating medications, delegating tasks, along with more advanced care require clear communication between care providers to be compatible with patient safety within medication management in home health care.Funding Agencies|County Council of Ostergotland; Linkoping University; strategic research fund for Health Care and Welfare [2016186-14]; AFA Insurance [1702266]</p

Supplemental Material, DS1_CPCJ_10.1177_1055665618767425 - Salivary Cortisol Rhythms in Children With Cleft Lip and/or Palate: A Case–Control Study

<p>Supplemental Material, DS1_CPCJ_10.1177_1055665618767425 for Salivary Cortisol Rhythms in Children With Cleft Lip and/or Palate: A Case–Control Study by Anna Lena Sundell, Agneta Marcusson and Carl-Johan Törnhage in The Cleft Palate-Craniofacial Journal</p

Validation of reported dentoalveolar relationships in the Swedish Quality Registry for Cleft Lip and Palate

Objectives: The present study validated data that had been reported to the Swedish Quality Registry for Cleft Lip and Palate (CLP) under new requirements from 2016, when use of the 5-year-old (5YO) and the Modified Huddart and Bodenham (MHB) indices for rating occlusion in children born with unilateral CLP (UCLP) was introduced. Materials and methods: The sample included blinded study casts (n = 97) and photos (n = 4) of 5-year-old children who had been born with UCLP in 2009−2011 and were enrolled at one of six cleft centres in Sweden. Fourteen orthodontists from the centres assessed the patients (n = 101) using the 5YO and the MHB indices. Median 5YO and MHB scores of the 14 assessments were compared with original registry data (n = 61). Each centre devised code keys to protect the identities of their patients in the registry. Results: Interrater agreement among the 14 orthodontists was good for the 5YO index (quadratic-weighted kappa: 0.72−0.92) and the MHB index (intraclass correlation coefficient: 0.991−0.994). Comparisons of median 5YOs for each identifiable child with their registry data (n = 61) found total agreement for 70.5 per cent. Comparisons between median MHBs and registry data showed very good or good agreement in 93.4 per cent of the cases. Limitations: Two teams lost their code keys, which reduced the sample to 61 patients. Conclusions: The dentoalveolar outcome data in the CLP registry was trustworthy. There was good agreement among the Swedish cleft teams assessing the 5YO and MHB indices in children born with UCLP at age 5 years