Donald Burden

Self-reports of psychosocial functioning among children and young adults with cleft lip and palate.

Objective: A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate. Participants: The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age. Outcome measures: Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview. Results: Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001). Conclusions: Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.

Parent reports of the psychosocial functioning of children with cleft lip and/or palate.

Objectives: (1) to determine the opinion of parents regarding the psychosocial functioning of their child with cleft lip and/or palate (CLP); (2) to identify predictors of psychosocial functioning; and (3) to determine the level of agreement between children with CLP and their parents. Participants: One hundred twenty-nine parents of children with CLP and 96 parents of children without CLP participated in this cross-sectional study. Outcome measures: Parental opinion of the childs self-esteem, anxiety, happiness, and problems caused by facial appearance were assessed using visual analogue scales. Parents completed the Child Behavior Checklist and were interviewed. Results: Children with CLP were more anxious (p < 0.05), less happy with their appearance (p < 0.001), and in general (p < 0.05) had lower self-esteem (p < 0.05) and greater behavioral problems (p < 0.001) compared with non-CLP children. Parents reported that their child with CLP was teased more often (p < 0.001) and was less satisfied with his/her speech (p < 0.01) compared with reports of parents in the control group. A number of factors affected parents’ ratings of their childs psychosocial functioning (presence of CLP, appearance happiness, previous history of CLP, and visibility of scar). Children who had been teased were more anxious (p ≤ 0.01), less happy with their appearance (p < 0.001) and had greater behavioral problems (p < 0.001). Conclusions: Parents of children with CLP reported various psychosocial problems among their children. Parents considered children who had been teased to have greater psychosocial problems.

Dental Arch Widths and Mandibular-Maxillary Base Widths in Class II Malocclusions Between Early Mixed and Permanent Dentitions

The aim of the study was to analyze the transverse morphology and development of the dental arches and skeletal mandibular-maxillary bases in untreated Class II malocclusions. Using the records of the Belfast Growth Study, a Class II division 1 group (II/1) and a Class II division 2 group (II/2) were compared with a Class I group and a control group with good occlusion. On posteroanterior cephalograms, maxillary skeletal base width and bigonial and biantegonial widths were determined at two-year intervals between seven and 15 years. Maxillary and mandibular intermolar widths were measured on the associated study casts. As a result, maxillary skeletal base widths were smallest in the Class II/1 subjects. No statistically significant differences were found among the groups for the skeletal mandibular widths. With respect to the development of the dental arches, maxillary intermolar widths were smaller in the Class II/1 group than in the Class I and the good-occlusion groups. These group differences were present for the total period of observation, ie, seven to 15 years, and statistically significant at most ages. When the relative difference between the maxillary and the mandibular intermolar widths was examined, the Class II/1 cases were found to have the largest average difference (about -2.5 mm for boys and -1.5 mm for girls), indicating a relatively narrow maxillary arch. Less pronounced molar differences were found in the Class II/2 group. In the Class II/1 subjects the deviations in molar differences observed at 15 years of age were established already at 7 years of age and maintained during 7 and 15 years of age.

Palatally ectopic canines: Closed eruption versus open eruption

This paper reviews the available evidence supporting 2 commonly used methods of surgically exposing palatally ectopic canines. The closed eruption method (a bonded attachment is placed at operation and the palatal flap is sutured back intact) is compared with the open eruption method (a window of palatal mucosa is excised and the canine allowed to erupt naturally). The choice of surgical technique is reviewed in terms of the long-term periodontal implications, the rate of repeat surgery, and treatment time.

The incidence of bacteremia after orthodontic banding.

This investigation assessed the incidence of bacteremia after orthodontic banding. Thirty adult volunteers with good oral health, who were not at risk from bacterial endocarditis, were included in this study. An orthodontic band was placed on a first molar of each subject. Venous blood samples were taken before, and 1 to 2 minutes after the molar band was fitted. Microbiologic tests performed on the blood samples revealed a comparatively low incidence of bacteremia (10%) after orthodontic banding.

The effect of etch duration on the microstructure of molar enamel: An in vitro study

This in vitro study evaluated the influence of varying etch time on the microstructure of molar buccal enamel. The buccal surfaces of four groups of extracted first molar teeth were etched for 15, 30, 45, and 60 seconds. The etch patterns obtained were photographed with a scanning electron microscope and rated with a 3-grade scale. The 15-second etch time failed to produce any optimal etch patterns. The best etch patterns were found in molars etched for 60 seconds.

A Comparison of Craniofacial Form in Northern Irish Children With Unilateral Cleft Lip and Palate Treated With Different Primary Surgical Techniques

Objective The quality of outcomes in patients with unilateral cleft lip and palate (UCLP) was compared between two senior plastic surgeons. One surgeon carried out a one-stage Wardill-Kilner palate repair. The other surgeon employed a vomer flap hard palate repair followed by a von Langenbeck soft palate closure (Oslo protocol). Design Retrospective analysis. Patients Thirty-four children (mean age 9.7 years) born with complete skeletal UCLP in Northern Ireland from 1983 to 1991 who received primary repair surgery from one of the two surgeons. Main Outcome Measures Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. Results Twenty-nine of the 34 subjects had good or satisfactory arch relationships. Comparison between the surgeons revealed that the Wardill-Kilner group had a greater proportion of Goslon grades of greater than 3, indicating poor arch relationships. However, this difference failed to reach statistical significance. There were no significant cephalometric differences between patients treated by the two surgeons. Conclusions Although the difference was not statistically significant, the highest proportion of patients likely to require orthognathic surgery was found in those treated using the Wardill-Kilner technique.

Equity and orthodontic treatment: A study amongadolescents in Northern Ireland

This epidemiological study investigated the reasons why children in Northern Ireland who need orthodontic treatment do not receive treatment even when it is provided free by the state. A total of 1584 15- and 16-year-olds were examined in 23 high schools with the Index of Orthodontic Treatment Need. The characteristics of the adolescents who had received orthodontic treatment were compared with those who had a definite need for treatment and yet did not receive treatment or advice. One in 10 of the adolescents examined had an unmet need for orthodontic treatment. Logistic regression analysis was used to assess the influence of 11 variables including socioeconomic status, religion, and standard of dental health on the uptake of orthodontic care. This analysis revealed that the only significant predictors of whether an adolescent received orthodontic treatment was the dental attendance pattern of the adolescent, the adolescents dental health, and the dental attendance pattern of the adolescents mother. Those adolescents who had good dental health, who regularly attended a dentist, and whose mother regularly attended a dentist were more likely to receive orthodontic treatment.

Psychological Status of Patients Referred for Orthognathic Correction of Skeletal II and III Discrepancies

OBJECTIVE To establish the extent of psychological problems among patients who require orthognathic treatment. MATERIALS AND METHODS Five aspects of psychological functioning were assessed for 162 patients who required orthognathic treatment and compared with 157 control subjects. RESULTS Analysis of variance did not detect any significant difference in the five psychological scores recorded for the skeletal II, skeletal III, and control groups. The proportion of subjects with one or more psychological measure beyond the normal range was 27% for skeletal II subjects, 25% for skeletal III subjects, and 26% for control subjects. One skeletal II subject (1.5%), three skeletal III subjects (3%), and five control subjects (3%) required referral for psychological counseling. CONCLUSIONS The orthognathic patients did not differ significantly from the control subjects in their psychological status.

A Retrospective Comparison of Craniofacial Form in Northern Irish Children with Unilateral Cleft Lip and Palate

OBJECTIVE This study evaluated the craniofacial form of a sample of Northern Irish children with unilateral cleft lip and palate (UCLP). The quality of the outcomes achieved was compared with the outcomes reported for the six centers involved in the European multicenter study (Mars et al., 1992; Mølsted et al, 1992). DESIGN Retrospective analysis. PATIENTS All children born with complete skeletal UCLP in Northern Ireland during the years 1983 to 1987. MAIN OUTCOME MEASURES Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. RESULTS The sample comprised 25 children with complete skeletal UCLP who had cephalometric radiographs and study casts recorded at a mean age of 9.4 years (range, 8 to 11 years). Cephalometric analysis revealed no important skeletal differences between the Northern Irish UCLP children and the published results from the six Eurocleft centers. The soft tissue profile of the Northern Irish UCLP children was significantly more convex than the soft tissue profile recorded for center D in the Eurocleft study. The Goslon ranking system revealed that 18 (72%) of the Northern Irish UCLP children had good or satisfactory dental arch relationships. CONCLUSIONS No clinically important differences were detected between the mean cephalometric skeletal parameters of the Northern Irish UCLP children and those published for the six cleft centers involved in the Eurocleft study. On average, the Northern Irish UCLP children were found to differ significantly from Euroclefts center D in their soft tissue facial contour and sagittal lip profile. The quality of the dental arch relationships of the Northern Irish sample was between the best and the less good Eurocleft centers.