Efficacy of orthodontic and orthognathic treatment for oral and maxillofacial deformities.

BACKGROUND: This study aims to assess the efficacy and safety of orthodontic and orthognathic treatment (OOT) for patients with oral and maxillofacial deformities (OMDF) systematically. METHODS: This study will comprehensively search Cochrane Library, PubMed, EMBASE, Scopus, Web of Science, PsycINFO, Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from their inceptions to the July 1, 2019. Grey literature will be explored via searching dissertations, Google scholar and conference abstracts. Two team members will independently perform all citations, data extraction, and methodological quality. We will also utilize RevMan 5.3 Software for statistical analysis. RESULTS: This study will provide high quality evidence of OOT for OMDF. The primary outcomes consist of number of patients cured; proportion of patients healed; and time to complete healing within trial period. Secondary outcomes include quality of life (often assessed as any relevant scales, such as 36-Item Short Form Survey), costs, and complications. CONCLUSION: This study will provide evidence for judging whether OOT is effective treatment for OMDF. SYSTEMATIC REVIEW REGISTRATION: CRD42019144610.

A model for interprofessional health care: lessons learned from craniofacial teams.

Seventy-six years ago, Herbert K. Cooper, DDS, DSc, LHD, FACD, created the first interprofessional health care team in response to the frequency of craniofacial anomalies and related speech and hearing deficits in Lancaster, Pa. His experiences and those from subsequent "medical-dental-nursing-pharmacy allied health professions" craniofacial teams inform and provide "best practices" for the future of interprofessional education. This paper revisits the genesis of craniofacial teams and highlights successes, challenges and cost benefits applicable today.

International confederation for cleft lip and palate and related craniofacial anomalies task force report: holistic outcomes.

Objective : This paper describes the process and outcomes of the 2013 American Cleft Palate-Craniofacial Association task force on Holistic Outcomes. The goals and membership of the task force are presented. Methods : Using internet communication, the group introduced themselves, shared ideas and information related to holistic assessment and implementation of using a validated holistic measure, the Child Oral Health Impact Profile (COHIP) at participating international sites. Results : Data from the sites were analyzed using descriptive statistics. Administration of the COHIP was successful. It varied from self-completion as well as verbal presentation due to language differences and a function of the short time period to complete collection. Additionally qualitative comments were reported by the task force site directors. Conclusions : Future directions for holistic assessment and communication among task force members and sites were discussed at the Congress and are presented in this report.

Changing face of cleft care: specialized centers in developing countries.

The organization and management of specialized cleft lip and palate centers in developing countries are challenging because of the lack of financial resources devoted to the national health care system. The treatment of cleft lip and palate is of low priority for health care and budgets; however, gradual progress is possible. As an example of how care might be improved in the developing world, we suggest guidelines to strengthen the local cleft lip and palate centers in Brazil based on the ideal geographic distribution of cleft centers around the country, to achieve the following objectives: first, avoid patient's migration; second, facilitate patient's adherence; third, focus on a global and continuous multidisciplinary treatment; and fourth, avoid indiscriminate opening of nonprepared cleft lip and palate centers in our country. This ideal scenario would put the cleft lip and palate health attention on the right path in Brazil.

Characteristics of dental clinics in US children's hospitals.

PURPOSE: This study's purpose was to describe the workforce, patient, and service characteristics of dental clinics affiliated with US children's hospitals belonging to the National Association of Children's Hospital and Related Institutions (NACHRI). METHODS: A 2-stage survey mechanism using ad hoc questionnaires sought responses from hospital administrators and dental clinic administrators. Questionnaires asked about: (1) clinic purpose; (2) workforce; (3) patient population; (4) dental services provided; (5) community professional relations; and (5) relationships with medical services. RESULTS: Of the 222 NACHRI-affiliated hospitals, 87 reported comprehensive dental clinics (CDCs) and 64 (74%) of CDCs provided data. Provision of tertiary medical services was significantly related to presence of a CDC. Most CDCs were clustered east of the Mississippi River. Size, workload, and patient characteristics were variable across CDCs. Most were not profitable. Medical diagnosis was the primary criterion for eligibility, with all but 1 clinic treating special needs children. Most clinics (74%) had dental residencies. Over 75% reported providing dental care prior to major medical care (cardiac, oncology, transplantation), but follow-up care was variable. CONCLUSIONS: Many children's hospitals reported comprehensive dental clinics, but the characteristics were highly variable, suggesting this element of the pediatric oral health care safety net may be fragile.

Willingness to participate in complementary and alternative medicine clinical trials among patients with craniofacial disorders.

OBJECTIVES: The Oregon Center for Complementary and Alternative Medicine (OCCAM) conducted focus groups with participants to determine willingness to join a complementary and alternative medicine (CAM) research study, and to aid in the design of three clinical randomized controlled trials (RCTs) of CAM and craniofacial disorders. SETTING/LOCATION: Center for Health Research, Kaiser Permanente, in Portland, Oregon. SUBJECTS: Kaiser Permanente health plan members meeting RCT inclusion criteria. DESIGN: Twelve (12) focus groups were conducted with a total of 85 participants. Six (6) of the focus groups were with members who self-identified as users of CAM therapies. Focus groups explored participants' experiences of CAM for temporomandibular disorder (TMD) and periodontal disease, and their reactions to proposed aspects of the trials. Trained facilitators led the focus groups, which lasted approximately 2 hours and were audiotaped for future transcription. Researchers then coded the transcripts to identify responses to specific questions and to capture emergent themes. RESULTS: Acupuncture, chiropractic, and massage were most frequently accessed and reported as helpful by participants. Participants who had not used CAM treatments for their condition expressed interest and openness to experiencing CAM treatments through a research study. In general, participants expressed willingness to be randomly assigned to (rather than choose) a CAM treatment arm. Travel to practitioners' offices and frequent (> 1 per week) visits were acceptable to most participants, if there was flexibility in appointment scheduling. CONCLUSIONS: Findings indicate considerable willingness to engage in CAM trials, even among individuals who have not used CAM. Participants' willingness to engage in CAM studies was influenced by the nature of their condition, their prior experiences with conventional and CAM treatments, and the possibility of experiencing CAM "for free" through participation in the trial. Their acceptance also was tempered by concerns about particular modalities and the possibility of having to give up aspects of their current health routine. Researchers engaging in CAM studies should take these factors into consideration as they design studies.

The enigma of lambdoid positional molding.

One hundred and twenty-one consecutive patients presenting to the Children's National Medical Center with lambdoid positional molding (LPM) were reviewed. Clinical features included unilateral occipital flattening and alopecia and forward displacement of the ipsilateral ear, forehead, and maxilla. Head tilt and tightness of the ipsilateral sternocleidomastoid muscle were common. An unexplained preponderance of LPM was found in males (74%) and on the right side (72%), both findings statistically significant (p < 0.001). Importantly, a variety of other abnormalities were seen with LPM: torticollis (41%), large head circumference (40), excess extra-axial cerebrospinal fluid (35), developmental delay (19), and other CNS abnormalities (20%). Systemic problems affecting the mobility were also common. Only 3 patients had craniosynostosis, and only 2 with LPM required surgery for severe cosmetic deformities. An apparent increase in the incidence of LPM was attributed to current recommendations to keep infants supine to decrease the risk of sudden infant death syndrome, overutilization of infant carriers similar to cradleboards of earlier cultures, and neonatal medical problems resulting in relative immobility. No evidence was found to support the concept that LPM causes compressive brain pathology; thus, surgical treatment is not required for such fears. Further, the sequelae of underlying CNS and systemic problems associated with LPM would not be corrected by opening unfused sutures, but could even be misinterpreted as complications of surgery.