Quality of Life Associations with Caries Experience and Behavioral Challenges in the Dental Setting Among Children with Orofacial Clefts
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Children with orofacial clefts experience many challenges beyond facial differences including risks for psychosocial and behavioral problems. As a result, evaluation for negative impacts on health-related quality of life (HRQOL) is highly important. Because the cleft condition manifests orally, more research is needed with regard to the dental impact on HRQOL. It is currently unknown how significantly HRQOL correlates with dental status or behavior of these children. The objective of this study was to evaluate HRQOL and surgical history of children with orofacial clefts to see if these measures correlate with caries experience and/or behavior in the dental chair. Patient data was obtained with IRB-approval. The study population included patients with a non-syndromic orofacial cleft diagnosis between the ages of 4 and 10. Parent-reported data was obtained for 79 patients. Self-reported data was obtained for 23 patients. PedsQL Psychosocial Summary scores, PedsQL Total scores, number of surgeries and demographics were collected from the psychology department craniofacial clinic database. Decayed, missing, filled teeth (dmft) scores and Frankl scores during dental exams were collected from dental records. Median time between encounters with the psychology providers and the dental clinic for all patients was 42 days. Spearman?s Rank Correlation test identified significant correlations between parent-reported PedsQL Psychosocial Summary scores and dmft scores (p = 0.006) and PedsQL Total scores and dmft scores (p = 0.022), indicating that for the parent-reported group higher caries experience is significantly correlated with lower HRQOL. Parent-reported PedsQL data were not correlated with Frankl scores. There is also no correlation between dmft or Frankl scores and the number of surgeries in the parent-reported group. For the self-reported group, significance was demonstrated between PedsQL Psychosocial Summary scores and Frankl scores (p = 0.002) and PedsQL Total scores and Frankl scores (p < 0.000), indicating that for the self-reported group lower HRQOL is significantly associated with poorer behavior in the dental chair. Self-reported PedsQL data were not correlated with dmft scores. There is also no correlation between dmft or Frankl scores and the number of surgeries in the self-reported group. This study demonstrates that higher caries experience is associated with significantly lower HRQOL in children with orofacial clefts for the parent-reported group. Also, significantly lower HRQOL in children with orofacial clefts is associated with poorer behavior in the dental chair for the self-reported group. The number of surgeries a child with orofacial clefts has undergone is not associated with caries experience or behavior in the dental chair.