Dental Experience of Children With Cleft Lip and/or Palate by 12 Months

Cleft lip and/or palate (CLP) affects approximately 1.7 per 1000 live births [1]. Children with CLP face a significantly higher risk of dental anomalies, caries and delayed development, requiring early preventive dental care [1]. These children may have differences in the number, size, shape and timing of tooth eruption, as well as enamel defects [1]. In response, national CLP standards recommend that preventive dental advice be provided by 6 months [2]. Furthermore, a national initiative by BSPD for all children, ‘Dental Check by 1’ (DCBy1), encourages parents and guardians to take their baby to the dentist by age one to enable preventive advice [3]. There are limited published data regarding access to dental care for children and young people (CYP) under cleft services following the COVID-19 pandemic. Pre-pandemic data from the South-West Cleft Service (SWCS) reported that 92% of children were registered with a general dental practitioner (GDP) [4]. This did not, however, appear to translate into adequate preventive care. Since the pandemic, dental access for this population has worsened. A national survey conducted between July 2023 and February 2024 (as yet unpublished) found that nearly one-third of families under SWCS experienced difficulties accessing dental services. In light of this, an audit was undertaken to evaluate whether children with CLP under SWCS received timely preventive care and dental contact in line with national standards. A two-cycle retrospective audit was conducted. Children were identified from cleft birth lists held by SWCS. Families were contacted consecutively from the birth list until the sample size of 30 families was reached. Data were collected via telephone interviews with parents/carers using a standardised proforma. Due to a smaller eligible cohort, attempts were made to contact all families on the birth list over a 4-month period. All contacted families were offered an appointment with the cleft dental team. In both cycles, those reached by telephone were sent a cleft dental pack, which included a dental leaflet and a single-tufted toothbrush. Families not reached were sent a letter and prevention pack by post. Data were analysed using Microsoft Excel (Microsoft Corporation, Washington, US). In cycle 1, 30 families were interviewed; the data are presented in Table 1 and demographics in Table 2. n = 11 7/11 seen dentist (64%) n = 3 2/3 seen dentist (67%) n = 2 0/2 seen dentist (0%) n = 1 1/1 seen dentist (100%) In cycle 2, 25 CLP patients that met the inclusion criteria were identified. Families could not be contacted in 9 cases despite multiple attempts and were excluded; the remaining 16 were included (Table 1). Upon offer of an appointment with the cleft dental team, 9/30 (30%) declined the offer in cycle 1 because Bristol Dental Hospital was too far to travel to. As distance was identified as a potential issue, these data and demographics were also collected in cycle 2 (Table 2). This audit demonstrated dental access issues for CYP with experience of CLP. Difficulties accessing dental care included long waiting times and finding a dental home. Regular dental attendance is associated with less caries experience and a better oral health-related quality of life, so long-term solutions must be found [6]. In cycle 2, dental awareness and the provision of preventative advice improved significantly, largely due to the content of the telephone contact and wider provision of the cleft dental pack. Many parents or carers that were offered an appointment with the cleft dental team were willing to travel to Bristol for this and had concerns they wished to discuss, such as dental development (the path or sequence of eruption, absence of teeth and position), gingival overgrowth and maxillary labial frenum abnormality. This highlighted the importance of early engagement with cleft dental services. The introduction of telephone contact at 6 months increased the percentage of patients seen by a dentist, despite GDP visits falling, through appointments made with the cleft dental team at Bristol Dental Hospital instead. This was not a viable option for all patients. In cycle 2, as locality data were collected, we identified that three families declined the offer of an appointment with the cleft dental team—despite never having been seen by a dentist—due to the distance from Bristol Dental Hospital. Two of these families were from Exeter, an area known to be a dental desert. The main limitation of this audit is the uncertainty regarding whether children received preventive dental advice. Parents/carers might recall a dental visit but may not remember if preventive advice was given or its details. Another limitation is that although all families were sent a dental pack, the number of packs received by families, particularly those who were uncontactable, was not confirmed. Since cycle 2, monthly cleft dental clinics have been introduced at a spoke clinic in Plymouth and there has been an increase in the cleft dental workforce in the South-West. Further work is needed to enhance primary care access for CYP with experience of CLP. Improvements in both audit standards were noticed in cycle 2 after the introduction of telephone contact at 6 months. However, the results indicate that most children with CLP in the South-West miss DCBy1, indicating significant access issues. This demonstrates the need for increased service provision for these high-risk, priority patients. The authors declare no conflicts of interest.