Adherence to Orthodontic Treatment in Youth With Cleft Lip and/or Palate

Abstract

Objective: To identify rates of nonadherence to orthodontic treatment among youth with cleft lip and/or palate (CL/P) and to compare demographic and clinical characteristics of patients categorized as adherent or nonadherent. Design: Retrospective chart review. Setting: Orthodontic treatment program affiliated with a US pediatric hospital-based craniofacial team. Participants: Medical charts of 54 patients with CL/P beginning phase I or phase II orthodontics between 2011 and 2014 (54% male; mean age: 11.7 ± 3.2 years) were reviewed. Main Outcome Measure(s): Data abstracted included demographic and clinical characteristics. Patients were classified as nonadherent based upon treatment termination due to nonadherence, treatment courses extending beyond 3 years, and information about missed appointments, poor oral hygiene, and broken appliances. Results: In all, 24% had treatment terminated due to nonadherence and were significantly more likely to have behavioral health diagnoses ( P = .01) or visits ( P = .02) and social work consults ( P = .01) than patients without termination. Thirty-seven percent had treatment courses beyond 3 years; youth with longer courses were significantly more likely to have cleft lip and palate versus cleft palate only or cleft lip ( P = .03). Patients who missed more than 4 appointments were less likely to have behavioral health diagnoses ( P < .01) compared to those with fewer missed appointments. Poor hygiene and broken appliance notations were common. Youth with poor hygiene notations were significantly older ( P < .01) at treatment initiation than those without notations. Conclusions: Nonadherence was associated with diagnosis, age, and history of behavioral health or social work involvement. An understanding of adherence and relationships with clinical and demographic factors can inform clinical care and support intervention development to improve outcomes.