Evaluation of quality of life in patients with cleft lip and/or palate requiring restorative treatment – a longitudinal assessment of patient needs and outcomes

Abstract

There is some evidence in the literature to indicate that the presence of CL/P can negatively affect the QoL. The systematic review in the first chapter indicated that the presence of orofacial cleft did seem to negatively affect the QoL for adults with CL/P, primarily in terms of psychological implications and self-esteem. However, the literature is less clear about whether the completion of dental restorative treatments can improve OHRQoL. Thus the aims of the studies included evaluating OHRQoL using the OHIP-49 among adults with CL/P who had completed dental treatments. Additionally, dental anxiety was assessed using the MDAS to determine whether any correlation existed between levels of OHRQoL and dental anxiety. The studies were divided into two arms, with the first one being a cross-sectional study in which a sample of 70 adult participants (35 with CL/P and 35 without, with the latter acting as a control group) was asked to complete two questionnaires, the OHIP-49 and the MDAS, along with an addition of a single general question. Participants in this study had all completed dental treatment at the University Dental Hospital of Manchester. The second study was a prospective cohort study in which a sample of 25 volunteers with CL/P completed the same questionnaires as in the first study prior to treatment; these respondents were then followed up until they had completed their dental treatments, when they were then asked to complete these questionnaires again. Adults with CL/P showed statistically significantly lower OHRQoL scores with respect to the physical disability (p=0.017) and social disability (p=0.046) domains than the control group. Males with CL/P recorded lower OHRQoL scores in the handicap domain (p=0.026) than females, while participants with cleft lip and palate had lower OHRQoL scores than participants with cleft lip only in terms of the functional limitation (p=0.003) and physical pain (p=0.046) domains. Additionally, the results showed that increasing age was correlated with lower OHRQoL in the functional limitation domain (p=0.025). The first general question was also found to be positively and statistically significantly correlated with almost every domain of the OHIP-49, with the exception of physical pain. No extreme dental anxiety was recorded in the CL/P group and there was no significant difference between groups in this domain. Completion of dental treatments improved scores 21 in all seven domains of OHIP-49; however, this improvement was only statistically significant for the domains of functional limitation (p=0.043) and physical pain (p=0.034), and the overall OHIP-49 scores (p=0.00011) and overall MDAS scores (p=0.041). Additionally, there was no significant correlation between OHIP-49 and MDAS levels. Completion of dental treatments thus seems to be helpful in terms of improving OHRQoL and reducing dental anxiety; however, due to the limitations of these studies, further multi-centre studies are recommended with larger sample sizes to confirm the results and to make the generalisability of these findings wider, preferably to cover the UK as a whole.