Assessment of Orthodontic Burden of Care in Patients With Unilateral Complete Cleft Lip and Palate

Objective: To identify factors that are commonly felt to impact a team’s ability to ensure patients are orthodontically and dentally prepared for alveolar bone grafting at the appropriate time. Design: Cross-sectional survey. Setting: American Cleft Palate-Craniofacial Association (ACPA)-approved multidisciplinary cleft teams. Participants: Cleft team coordinators. Interventions: Cleft team coordinators were asked to complete the survey. Results: Fifty-three team coordinators from the 167 ACPA-certified cleft teams completed the survey (response rate = 32%). The majority (83.02%) of cleft teams feel having a case manager increases or would increase the rate of timely bone graft preparation. Orthodontic and dental coverage varied greatly between teams with university/hospital employed dentists and volunteer private practice orthodontists representing the most frequent models. The reported percentage of patients seeking regular dental and orthodontic care with providers affiliated with the team did not correlate with the likelihood of timely bone graft preparation ( P = .17; P = .43). Great variability was noted in the manner and frequency of team communication with families during orthodontic bone graft preparation. The presence of a designated case manager on the team was not significantly associated with the percentage of patients who were reported to be orthodontically prepared for bone graft surgery ( P = .25). Conclusion: Within our survey data, there is great variability noted in factors that may potentially impact orthodontic bone graft preparation. The majority of teams felt that a case manager did or would help with this process, however, our study does not support this fact. Significant recall bias concerning the success of bone graft preparation may affect these results.

Section: Discussionmentioning

confidence: 99%

Factors Influencing Timely Preparation of Alveolar Bone Grafting: A Survey of the ACPA

Jodeh

Pringle

Crisp

et al. 2020

“…This was done in order to adjust to the fact that all patients had already been recruited in the study when the pain questionnaires were completed; therefore, acute initial pain would have been mostly referred as a past experience with the additional bias of painkillers intake. Given the high burden of orthodontic care in patients with CLP and in patients affected by CFA (Meazzini et al, 2015; Alberconi et al, 2018), we were especially interested in the “burden of orthodontic pain” felt by these patients.…”

Section: Methodsmentioning

confidence: 99%

“…Some authors reported that patients wearing Invisalign experienced less pain during treatment and took less pain medications compared to patients wearing braces (Miller et al, 2007; Fujiyama et al, 2014; White et al, 2017; Almasoud, 2018), while others found no statistically significant differences in the pain levels (Shalish et al, 2012; Noll et al, 2017). Few articles have taken specifically in consideration the burden of care of orthodontic treatment in cleft patients (Meazzini et al, 2015; Alberconi et al, 2018), and none have considered their burden in terms of pain perceived. Given the multiple choices in orthodontic techniques, the objective of this study was to compare, in a prospective case–control study, the difference in pain perception between treatment with AL and traditional orthodontics in patients affected by cleft and craniofacial anomalies (CFA).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Pain Perception in Patients Affected by Cleft and Cranio Facial Anomalies Treated With Traditional Fixed Appliances or Invisalign

Meazzini¹,

Tortora

Mazzoleni

et al. 2019

Introduction: The objective of this prospective study was to compare the difference in pain perception between treatment with aligners (AL) and fixed appliances (FA) in patients affected by cleft and craniofacial anomalies (CFA). Methods: The sample consisted of 100 syndromic caucasian patients affected by various CFA from 2 different hospitals. Fifty patients treated with AL were matched for sex, age, and CFA with a control sample of 50 patients treated with FA. A modification of the Mc Gill Pain Questionnaire was adapted to our needs. Results: Statistical differences were found. Aligners induced more tightness and tension than FA, while FA induced more pain descriptors and patients reported a higher intake of painkillers. Conclusions: The results of this study documented a higher pain perception with FA than with AL in patients affected by CFA. The higher sensitivity to pain in cleft and craniofacial patients with fixed treatment could be related to their higher prior sensitization, given the past surgeries and orthodontic treatments. Thus, this study might suggest that Invisalign treatment might be a further interesting treatment option for patients with cleft in order to reduce their burden of orthodontic pain.

“…Recently, individual interventions have been assessed for the impact on burden of care. Alberconi et al (2018) assessed the burden of care of orthodontic treatment in patients with unilateral complete cleft lip and palate by considering mean time of treatment, number of appointments, mean number of appliances, mean number of surgical procedures, and mean distance traveled to appointments. Attempts to quantify this burden have also been studied particularly for NAM, including an assessment of factors influencing completion and noncompletion of NAM (Dean et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

What Is the Burden of Care of Nasoalveolar Molding?

Alfonso

Ramly

Kantar

et al. 2020

Objective: This systematic review aims to evaluate nasoalveolar molding (NAM) in the context of burden of care defined as physical, psychosocial, or financial burden on caregivers. Search Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 databases were searched from inception through December 24, 2019, for keywords and subject headings pertaining to cleft lip and/or palate and NAM. Eligibility Criteria: Clinical studies on NAM with reference to physical (access to care, number of visits, distance traveled), psychosocial (caregiver perceptions, family interactions, breast milk feeding), and financial (direct and indirect costs) burden were included. Data Collection and Analysis: Study selection was performed by 2 independent reviewers. Results: The search identified 1107 articles and 114 articles remained for qualitative synthesis. Burden of care domains were discussed but not measured in 43% of articles and only 25% assessed burden of care through a primary outcome. Of these, 20 articles reported on physical, 8 articles on psychosocial, and 12 articles on financial burden. Quality of evidence is limited by study design and risk of bias. Conclusion: Nasoalveolar molding has been indiscriminately associated with burden of care in the literature. Although NAM may not be the ideal treatment option for all patients and families, the physical considerations are limited when accounting for the observed psychosocial advantages. Financial burden appears to be offset, but further research is required. Teams should directly assess the impact of this early intervention on the well-being of caregivers and advance strategies that improve access to care.