Objectives: This study sought to (1) analyze the demographic profile of patients who completed combined orthodontic and surgical treatments at the Kuwait Ministry of Health dental clinics, (2) evaluate the source, type, amount and timing of preoperative patient information, (3) determine posttreatment patient satisfaction and (4) examine whether patient satisfaction is associated with preoperative information. Subjects and Methods: Of the 145 patients who completed combined orthodontic and surgical treatments at least 6 months prior to the initiation of this study, 74 agreed to be interviewed by telephone by means of a structured survey including questions covering the study's objectives. Results: The mean age of participants was 21.1 years; 52 (70.3%) were female and 22 (29.7%) were male. Of these 74 patients, 70 (94%) did not regret their decision to undergo orthognathic surgery and 62 (83.8%) would repeat the same treatment if it was needed. The majority of the respondents reported that the importance of treatment compliance had been explained very well prior to surgery, but that information about the associated functional and social problems was lacking. The orthodontist was the most prominent source of information before treatment began. As the presurgical orthodontic treatment phase progressed, the roles of the surgeon and orthodontist became more evenly distributed. Conclusion: The patients who underwent orthognathic surgery were satisfied and generally well informed. However, information regarding surgical risks and functional discomforts was not adequate. Participants were more likely to be satisfied when they were provided with more information about discomfort and surgical risks.

Background The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. Methods The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. Results The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. Conclusions This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Objective Accurate nationwide epidemiological evidence is vital to study the seasonal, geographic, and ethnic influence on the trends of orofacial cleft prevalence in Kuwait. Design Data obtained from the National Center for Health Information and Ministry of Health Hospital digital records were reviewed retrospectively to identify patients with orofacial clefts (OFC) using the ICD-10 diagnostic codes. The Jonckheere-Terpstra test was used to assess the trend of birth prevalence across the different years. The associations of types of OFC with ethnic and geographic influences were tested with chi-square or Fisher's exact tests, while the strength of that association was tested with multi-nominal logistic regression. Results Birth prevalence in Kuwait ranged from 0.75–2.55 per 1000 live births (0.73- 2.73 among Kuwaitis, 0.60–3.27 among non-Kuwaitis), with no statistically significant change observed during the past 28 years. The risk of unilateral cleft lip and palate was eight times higher during summer compared to Autumn, while the risk of cleft lip and palate remained lower during winter. Jahra (OR-7.76, CI- 1.51–39.80), Farwaneya (OR-6.65, CI- 1.34–33.06), and Hawalli (OR-6.72, CI- 1.26–35.98) governorates had higher odds of bilateral cleft lip when compared to Mubarak Alkabeer. Conclusions The study outcome is an indicator to improve patient care and customize healthcare infrastructure in the Ministry of Health. It also provides insight to develop projections of future needs. Future studies should focus on understanding the factors that might be a potential contributor to the seasonal change observed in the prevalence of OFC.

Objective The purpose is to evaluate outcomes of alveolar bone grafting based on the pre-grafting orthodontic preparation methods. Design Retrospective analysis of individuals with unilateral cleft lip and palate. Subjects and Settings 28 individuals with non-syndromic UCLP from two craniofacial centers, 14 individuals each from XXXX and XXXX. Interventions The alignment group underwent maxillary expansion with incisors alignment while the non-alignment group underwent only maxillary expansion for presurgical orthodontic preparation. Methods Initial and post-surgical CBCT scans were compared to observe changes in angulation of the incisor adjacent to the cleft site, alveolar bony root coverage, and bone graft outcomes. Results In the alignment group, the buccolingual rotation decreased by 32.35 degrees ( p = .0002), the anteroposterior inclination increased by 14.01 degrees ( p = .0004), and the mesiodistal angulation decreased by 17.88 degrees ( p = .0001). Alveolar bony coverage did not change after bone graft in both groups, and no difference was observed between the groups. Chelsea scale showed satisfactory bone graft outcome (category A, C) in 12 cases (85.71%) in the alignment group and 11 cases (78.51%) in the non-alignment group. The volumetric measurement showed the alignment group had better bone fill of 69.85% versus 51.45% in the non-alignment group ( p = .0495). Conclusions Alveolar bony coverage on the tooth adjacent to cleft sites did not change with alveolar bone grafting surgery in either of the alignment and non-alignment group. Presurgical orthodontic alignment does not induce root exposure nor poorer bone grafting outcome.

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