Faculty Bibliography

Abstract Introduction: Nasoalveolar molding (NAM) is a treatment option available for early cleft care. Despite the growing debate about NAM's efficacy, questions remain regarding its prevalence and demographic characteristics of families undergoing this technique prior to traditional cleft surgery. Objectives: To determine the number of teams currently offering NAM, and to identify salient clinical and sociodemographic variables in infants and families who choose NAM compared with those who choose traditional cleft care across three well-established cleft centers. Results: 89% of US cleft teams contacted using phone surveys reveal that NAM is available at 39% of these centers. Chart reviews and phone correspondence with caregivers indicate that the average distance to the cleft center was 65.5 miles and caregiver age averaged 30.9 (SD=5.7) years. 85% of families who chose NAM received total or partial insurance coverage. No difference in caregiver education, income, or distance to the clinic between treatment groups was found. On average, infants receiving NAM and cleft surgery had larger clefts and had more clinic visits than infants receiving traditional cleft surgery. Infants who were first-born and those who did not have other siblings were more likely to receive NAM than infants who were residing with other siblings. Conclusions: Currently over one-third of US cleft centers offer NAM. While the cleft size was larger in the NAM group, no treatment group differences in education, income, and distance to the clinic were found. KEY WORDS: Nasoalveolar molding, access to care, demographic variables, cleft care, social support, birth order, insurance.

Oral health-related quality of life (OHRQoL) is a multidimensional construct that measures well-being associated with the teeth, mouth, and face. This cross-sectional study examined OHRQoL, demographic data, and clinical indicators in 839 treatment-seeking youths with cleft from 6 geographically diverse cleft treatment centers. Individuals without health insurance and representing ethnic minorities had lower OHRQoL scores on the Child Oral Health Impact Profile and a higher rate of surgical recommendations. These findings imply a risk factor for reduced OHRQoL and unmet needs among vulnerable youths with clefts. (Am J Public Health. Published online ahead of print March 15, 2012: e1-e3. doi:10.2105/AJPH.2012.300654).

Objectives: This study assessed the reliability and validity of the Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) from the validated 34-item COHIP. Methods: Participants included 205 pediatric, 107 orthodontic, and 863 patients with craniofacial anomalies (CFAs). Item level evaluations included examining content overlap, distributional properties, and use of the response set. Confirmatory factor analysis identified potential items for deletion. Scale reliability was assessed with Cronbach's alpha. Discriminant validity of the COHIP-SF 19 was evaluated as follows: among pediatric participants, scores were compared with varying amounts of decayed and filled surfaces (DFS) and presence of caries on permanent teeth; for orthodontic patients, scores were correlated with anterior tooth spacing/crowding; and for those with CFA, scores were compared with clinicians' ratings of extent of defect (EOD) for nose and lip and/or speech hypernasality. Convergent validity was assessed by examining the partial Spearman correlation between the COHIP scores and a standard Global Health self-rating. Comparisons between the COHIP and the COHIP-SF 19 were completed across samples. Results: The reduced questionnaire consists of 19 items: Oral Health (five items), Functional Well-Being (four items), and a combined subscale named Socio-Emotional Well-Being (10 items). Internal reliability is >/=0.82 for the three samples. Results demonstrate that the COHIP-SF 19 discriminates within and across treatment groups by EOD and within a community-based pediatric sample. The measure is associated with the Global Health rating (P < 0.05), thereby indicating convergent validity. Conclusions: Reliability and validity testing demonstrate that the COHIP-SF 19 is a psychometrically sound instrument to measure oral health-related quality of life across school-aged pediatric populations.

Despite its relatively recent emergence over the past few decades, oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research. OHRQoL is a multidimensional construct that includes a subjective evaluation of the individual's oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self. It has wide-reaching applications in survey and clinical research. OHRQoL is an integral part of general health and well-being. In fact, it is recognized by the World Health Organization (WHO) as an important segment of the Global Oral Health Program (2003). This paper identifies the what, why, and how of OHRQoL and presents an oral health theoretical model. The relevance of OHRQoL for dental practitioners and patients in community-based dental practices is presented. Implications for health policy and related oral health disparities are also discussed. A supplemental Appendix contains a Medline and ProQuest literature search regarding OHRQoL research from 1990-2010 by discipline and research design (e.g., descriptive, longitudinal, clinical trial, etc.). The search identified 300 articles with a notable surge in OHRQoL research in pediatrics and orthodontics in recent years.