Dental care pathways and parent-reported dental outcomes for 5-year-old children born with a cleft in the UK

  • Sowmya S Simon

Student thesis: Doctoral ThesisDoctor of Dental Surgery (DDS)


Aims: To establish if there are variations within cleft dental care pathways (CDCPs) for 5-year-old children in the United Kingdom (UK), to investigate the impact of COVID-19 on CDCPs, and to investigate whether any observed variations are associated with parent-reported dental caries for 5-year-old children born with cleft.

Methods: The study comprised two main parts. Part 1 involved requesting information on CDCPs from lead dentists for 5-year-old children at all 16 UK cleft centres, including completion of an online survey. Part 2 involved obtaining existing Cleft Collective (a UK longitudinal cohort study of children with cleft) questionnaire data on parent-reported dental caries of 5-year-old children with cleft.

Results: Part 1 – Lead dentists (n=15) from 15/16 UK cleft centres responded. Some variations in CDCPs were observed among cleft centres. Dentists reported on the effect of COVID-19 including impact on dental examinations (73%), affected waiting lists (93%) and changes in the child’s recall frequency (67%). Part 2 – Parents of 5-year-old children with clefts (n=454) completed the Cleft Collective questionnaire. After adjustment for confounders (age, sex, ethnicity, cleft type, socioeconomic status), there were suggestions of associations between the following variables and a decrease in odds of parent-reported dental caries: giving preventative dental advice under age 6 months, consultant-level clinician doing majority of dental treatment, increased recall frequency during COVID-19, utilising primary care for >50% overall cleft dental workload, and provision of fissure sealants/fluoride varnish in primary care. However, there was no statistical evidence of any of these associations.

Conclusions: Despite some suggestion of centre-level variation in UK CDCPs including the impact of COVID-19, no statistical evidence of associations were found with parent-reported dental caries. Given the high caries rate in the cleft population, further exploration of CDCPs is required if improvement in dental health outcomes for children with cleft is to be accomplished.
Date of Award23 Jan 2024
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorPeter V Fowler (Supervisor), Sam D Leary (Supervisor), Yvonne E Wren (Supervisor) & Julie C Williams (Supervisor)


  • cleft lip and palate
  • Dental care
  • children
  • Cleft
  • parent reported outcomes

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