Identifying the effect of cleft type, deprivation and ethnicity on speech and dental outcomes in UK cleft patients: a multi-centred study

Abstract

Background: Outcome measures are increasingly important in the modern National Health Service. In the care of children born with cleft lip and/or palate there are many different outcomes to consider but only a few reliable, validated outcome measures exist. The dmft (decayed, missing and filled teeth) index and cleft speech characteristics (CSCs) are used regularly by cleft teams throughout the UK to assess outcomes in children with cleft lip and/or palate. We hypothesized that these two outcome measures might be significantly influenced by the demographics of the populations studied independent of the care provided.

Methods: A retrospective review of all patients aged between five and six referred to three regional cleft centres during a twelve month period were included in the study. Speech and dental outcomes were compared with patient ethnicity, cleft type and level of deprivation as determined by the Carstairs score.

Results: The data of 287 patients were used. Speech was significantly affected by cleft type (p < 0.03), whereas dentition was significantly affected by ethnicity (p = 0.002) and deprivation (p = 0.012).

Conclusions: This study demonstrates that the demographics of cleft populations can significantly affect the measures of outcome used to assess the quality of care provided by cleft teams. It has also demonstrated that these demographics are not evenly distributed across the country and that some cleft teams will have a more 'at risk' population than others.

Level of evidence: Risk, level II.

Keywords: Cleft lip and palate; Cleft type; Dentition; Deprivation; Ethnicity; Speech.