Centre‐level variation in dental treatment and oral health and individual‐ and area‐level predictors of oral health in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: the Cleft Care <scp>UK</scp> study. Part 3

Smallridge, J.; Wills, Andrew K; Mahmoud, Osama; Chong, Amanda H W; Clark, Victoria; Collard, M; Sandy, Jonathan R; Ness, Andy R

doi:10.1111/ocr.12185

Cited by 9 publications

(25 citation statements)

References 34 publications

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“…In this supplement, we have explored centre‐level variability across a range of treatment and outcome measures. Our results, which are reported in full in each respective paper in this supplement, suggest that there was centre‐level variation in several of these treatment indicators and outcomes across the domains of oral health, audiology and speech . Describing and exploring these centre‐level variations is important for several reasons.…”

Section: Discussionmentioning

confidence: 67%

“…We have described a standard hierarchical statistical model to predict centre‐level means and centre‐level variation and highlighted how to interpret the output from these models using the expository examples of facial growth and appearance. We found modest differences between centres in the age at assessment and gender of the children over and above that which may be expected from sampling variation and so we controlled for these differences in the analysis presented in this paper and in the subsequent papers in this supplement . We found no evidence of centre‐level variation in dento‐alveolar relationships and facial appearance.…”

Section: Discussionmentioning

confidence: 75%

“…In this study, we outline the approach we have adopted to describe centre‐level variation and illustrate this by reporting the results for facial growth (dento‐alveolar relationship) and facial appearance. Subsequent papers in this supplement employ the same approach to describe centre‐level variation in audiology, oral health, speech and behavioural outcomes . The final paper summarizes the results of these analyses and discusses implications …”

Section: Introductionmentioning

confidence: 99%

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Centre‐level variation of treatment and outcome in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 1: Methodology and results for dento‐facial outcomes

Wills

Mahmoud

Hall

et al. 2017

Orthod Craniofacial Res

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Structured AbstractObjectivesOutline methods used to describe centre‐level variation in treatment and outcome in children in the Cleft Care UK (CCUK) study. Report centre‐level variation in dento‐facial outcomes.Setting and Sample PopulationTwo hundred and sixty‐eight five‐year‐old British children with non‐syndromic unilateral cleft lip and palate (UCLP).Materials and MethodsBetween January 2011 and December 2012, data were collected on a comprehensive range of outcomes. Child facial appearance and symmetry were assessed using photographic pictures. Dental arch relationships were assessed from standardized dental study models. Hierarchical statistical models were used to predict overall means and the variance partition coefficient (VPC)—a measure of amount of variation in treatment or outcome explained by the centre.ResultsData on dento‐alveolar arch relationships and facial appearance were available on 197 and 252 children, respectively. The median age of the children was 5.5 years, and 68% were boys. Variation was described across 13 centres. There was no evidence of centre‐level variation in good or poor dento‐alveolar arch relationships with a VPC of 4% and 3%, respectively. Similarly, there was no evidence of centre‐level variation in good or poor facial appearance with a VPC of 2% and 5%, respectively.ConclusionsThere was no evidence of centre‐level variation for dento‐facial outcomes although this study only had the power to detect large variation between sites.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Centre‐level variation of treatment and outcome in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 1: Methodology and results for dento‐facial outcomes

Wills

Mahmoud

Hall

et al. 2017

Orthod Craniofacial Res

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“…In this supplement, we report further on a UK‐wide cross‐sectional survey of 5‐year‐old children with unilateral cleft lip and palate conducted between January 2011 and December 2012—Cleft Care UK (CCUK) that we have described previously . We have already shown that some outcomes (such as facial growth, speech and parental report of self‐confidence) have improved following centralization while some outcomes (such as oral health and hearing) have not changed .…”

Section: Introductionmentioning

confidence: 82%

“…We have summarized the centre‐level variation for all treatments and outcomes in Table . We found centre‐level variation for some treatments such as early grommet placement (VPC 18%, P <.001), fitting of hearing aids (VPC 8%, P =.03), fluoride treatment (eg, VPC for fluoride tablets: 57%, P <.001), secondary speech surgery (VPC 15% P <.001) and treatment for cleft speech characteristics (VPC 9% P =.006) . There was also centre‐level variation for some outcomes such as intelligibility of speech (VPC 13%, P =.001) with the centres with the best results having half the number of children with poor intelligibility of speech .…”

Section: Centre‐level Variationmentioning

confidence: 95%

Centre‐level variation in treatment and outcomes and predictors of outcomes in 5‐year‐old children with non‐syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications

Ness

Wills

Mahmoud

et al. 2017

Orthod Craniofacial Res

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Structured AbstractObjectives: To summarize and discuss centre-level variation across a range of treatment and outcome measures and examine individual and ecological determinants of outcome in children in Cleft Care UK (CCUK).Setting and sample population: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK and treated within a centralized service. Materials and Methods:Children had a range of treatment and outcome measures collected at a 5-year audit clinic. These outcomes included dento-alveolar arch relationships from study models, measures of facial appearance from cropped photographs, hearing loss from audiological assessment, speech from speech recordings, self-confidence and strengths and difficulties from parental self-report. Data were collected on educational attainment at age 7 using record linkage. Centre variation was examined using hierarchical regression and associations between variables were examined using logistic or poisson regression.Results: There was centre-level variation for some treatments (early grommet placement, fitting of hearing aids, fluoride treatment, secondary speech surgery and treatment for cleft speech characteristics) and for some outcomes (intelligibility of speech).Hearing loss was associated with a higher risk of poor speech while speech therapy was associated with a lower risk of poor speech. Children had high levels of caries but levels of preventative treatment (fluoride varnish and tablets) were low. Conclusions:Further improvements to and monitoring of the current centralized model of care are required to ensure the best outcomes for all children with cleft lip and palate. K E Y W O R D Scentralization, cleft lip, cleft palate, outcomes, variationThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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A retrospective nationwide study of the dental caries experience of New Zealand children with orofacial cleft

Fowler

Corbett

Lee

et al. 2019

Comm Dent Oral Epid

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ObjectivesTo investigate the dental caries experience of New Zealand children born with orofacial cleft (OFC), to compare this to age‐specific national population‐based data and to investigate any differences by demographic characteristics, cleft type and exposure to community water fluoridation.MethodsNationwide retrospective study of 554 dental records from 478 children born after 1 January 2000 with OFC were assessed at aged 5 (n = 333) and 12 years (n = 221), with 76 children (15.9%) having records at both ages. Community Oral Health Service records were analysed to determine dental caries experience (dmft/DMFT). Logistic regression was used to assess the likelihood of having experienced dental caries (d3mft/D3MFT ≥ 1) and multivariable models for variables including demographic characteristics, cleft type and exposure to community water fluoridation.ResultsA higher (49.6%) caries prevalence (dmft ≥ 1) and mean dmft at 5 years old (2.3; SD 3.6) were found in children with OFC than 5‐year‐olds in the general population (prevalence 40.4% and mean dmft 1.8). The 12‐year‐old (37.6%) caries prevalence (DMFT ≥ 1) and mean DMFT 0.8 (SD 1.4) were similar to population‐based data (caries prevalence 37.3% and mean DMFT 0.9). Children with caries (dmf/DMF ≥ 1) had means of 4.8 (SD 3.8) at age 5 and 2.1 (SD 1.4) at age 12 years. Greater caries experience was associated Pacific and Māori ethnicity, and not receiving community water fluoridation. No differences were detected by sex or cleft type.ConclusionThe dental caries experience for 5‐year‐old children with OFC was poor in relation to population‐based data and similar for 12‐year‐olds. Preventive guidelines for children with OFC from an early age should be a priority, along with the extension of community water fluoridation coverage.

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Centre‐level variation in dental treatment and oral health and individual‐ and area‐level predictors of oral health in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: the Cleft Care UK study. Part 3

Abstract: The association with use of fluoride tablets and varnish probably reflects reverse causality but indicates the need for early preventative interventions in children with UCLP.

Cited by 9 publications

References 34 publications

Centre‐level variation of treatment and outcome in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 1: Methodology and results for dento‐facial outcomes

Centre‐level variation of treatment and outcome in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 1: Methodology and results for dento‐facial outcomes

Centre‐level variation in treatment and outcomes and predictors of outcomes in 5‐year‐old children with non‐syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications

A retrospective nationwide study of the dental caries experience of New Zealand children with orofacial cleft

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