Evaluation of Patient and Parent Satisfaction After Orthodontic Treatment/Orthognathic Surgery for Cleft Lip and Palate Deformity.

OBJECTIVES: The objectives of this study were to evaluate the satisfaction of patients, parents, and individuals other than health professionals (neighbors or relatives), regarding the quality of care, and to evaluate the patients general care, facial appearance, dental changes, and psychological assessment by social outlook and emotional quotient.
MATERIALS AND METHODS: Sixty patients with cleft lip and palate reporting to a dental institution were divided into two age groups, 0-15 years (G1) and 15-30 years (G2), their parents (P1 and P2) and a group comprising their neighbour's or relatives (T1 and T2) were also divided according to G1 and G2. To evaluate their satisfaction toward the treatment received, three separate questionnaires were given to the three groups and their responses were subjected to statistical analysis.
RESULTS: The results showed that majority of patients (74%) and their parents (60%) were satisfied with the orthodontic treatment they received to align the teeth. But they were not satisfied with the appearance of lip (61.6% and 56.6%), nose (60% and 53.3%), and speech (62%). This study showed that cleft-affected individuals were teased mainly for speech (60%) followed by lip and teeth. Sixty percent of the patients admitted that their self-confidence was quite affected because of cleft and 36.6% expressed that their school/college results have been affected.
CONCLUSION: Majority of cleft lip and palate patients as well as their parents were satisfied with their child's dental appearance; they were unsatisfied with the appearance of nose, lip, smile, and speech.

INTRODUCTION

The incidence of cleft lip and palate is 1.09 in 1000 live births in South India.[1] An individual with a disfigurement may be more prone to developing psychological problems.[2] Patient satisfaction is a key indicator of treatment quality.[3] Studies using structural personality tests have shown that but personality profiles of adolescents with cleft lip and palate have suggested self-concern and self-doubt regarding interpersonal relationships,[4] learning disability, low school achievement, and grade retention.[5]

Furthermore, the prolonged treatment duration required and the multidisciplinary approach needed to treat these patients also aggravate the psychological distress in the patients as well as their parents.[67] The purpose of this study was to determine the psychosocial status of cleft lip and palate patients and their parents and to assess the level of satisfaction with cleft treatment among cleft-affected patients and their parents.

MATERIALS AND METHODS

The sample comprised 60 patients (n = 60) with cleft lip and palate. Patients (G) were divided into two groups. The first group consisted of children aged 0–15 years (G1), whereas the second group consisted of patients aged 15–30 years (G2). The study also included 60 parents (any one) of cleft lip and palate individuals (P) who were also divided according to G1 and G2 as P1 and P2. Sixty individuals other than health professionals such as neighbors or relatives of the patients (T) were also similarly divided into T1 and T2.

The evaluation was based on the responses to a questionnaire, which consisted of questions regarding general care, facial appearance or esthetics, dental appearance, and social and emotional aspects. Three separate questionnaires were given for the patients (G1 and G2), parents (P1 and P2), and the third persons (T1 and T2).

RESULTS

Comparison between G1 and G2

General care

Majority of patients, 80% of G1 and 60% of G2, were satisfied with the treatment they received.

Facial appearance or beauty

Sixty percent of patients from G1 and 40% from G2 were satisfied with their smile [Graph 1]. Of the patients from both the groups, 80% of G1 were satisfied with facial symmetry in comparison to 57% of G2. Equal number of patients in each group (56.7%) were dissatisfied with their appearance of lip. Sixty-three percent of patients from G1 and 53% from G2 were satisfied with their chin, whereas 66.7% of G1 and 53% of G2 were dissatisfied with the appearance of their nose.

Graph 1

Are you satisfied with your/your son/daughter's/patients'—smile?

Dental appearance

Seventy percent of patients from G2 and 60% from G1 were satisfied with the orthodontic treatment they received to align upper incisors, whereas 80% of G2 and 77% of G1 were satisfied with the alignment of their lower incisors.

Functional

Majority of patients, 97% in both the groups, were satisfied with their swallowing. Sixty-three percent of patients from G2 and 60% from G1 were dissatisfied with the speech. Of the 60 patients, 97% of G1 and 90% of G2 were satisfied with their breathing efficiency, whereas 90% of G1 and 87% of G2 were satisfied with their masticatory ability.

Social and emotional

Forty percent of patients from G2 and 33% from G1 felt that their deformity had fairly affected their education, whereas 43% of G1 and 40% of G2 answered that cleft lip/palate had made it a little difficult for them to make friends. 56.7% of G1 and 50% of G2 admitted that they had been teased often because of their defects, whereas 60% in both G2 and G1 reported that they had been teased for their speech problem, 16.7% of G1 and 13% of G2 for lip, 20% in both the groups for teeth, and 3% in both the groups for the scar [Graph 2].

Graph 2

How often have you been teased because of your cleft? Very often/often/rarely/not teased

Comparison between two P1 and P2

Sixty-three percent of parents in each group were satisfied with the treatment received by their son/daughter for cleft lip or palate, whereas 83% of parents of patients in both the groups wanted to be involved in treatment planning discussions.

Sixty percent of parents from P2 and 56.7% from P1 were dissatisfied with their children’s smile, whereas 70% of parents in both the groups were satisfied with their children’s symmetry. When they were asked about how satisfied they were with the appearance of lip, 63% of parents from P2 and 60% from P1 answered that they were dissatisfied, whereas 60% of parents in each group were satisfied with their children’s chin.

Sixty-three percent of parents from P1 and 53% from P2 were satisfied with the orthodontic treatment to align upper incisors, whereas 60% of parents from P2 and 57% from P1 were satisfied with the alignment of lower incisors. In each group, 63% of parents were satisfied with the incisor exposure.

When asked whether they felt that cleft lip/palate had affected their children’s school or college results, 40% of parents of P1 and 33% of P2 responded that they felt that cleft had fairly affected their children’s studies. Of the 60 parents, 50% of P2 and 43% of P1 answered that cleft lip/palate has made very little difficulty to their children to make friends. Sixty percent of parents in each group thought that cleft lip/palate has made their children less confident than their contemporaries. When asked whether they felt that their children were teased often because of their defects, 40% of parents from P1 and 33% from P2 admitted that their children were teased because of cleft; 60% in both the groups felt that their children were teased mainly for speech problem; and 20% in each group answered they felt that their children were teased because of their lips and appearance of teeth. 56.7% of parents of P1 admitted that orthodontic correction of their sons/daughters teeth had a positive influence on their self-confidence, in comparison to 50% of parents of P2.

Comparison between T1 and T2

In both the groups, 56.7% were dissatisfied with the patients’ smile, whereas 70% were satisfied with the facial symmetry. A total of 63% of T1 age group were dissatisfied with the appearance of patients’ lip, in comparison to 56.7% of T2. Equal number of T1 and T2 (40%) were satisfied with the patients’ chin. Fifty-three percent 53% of T1 and 50% of T2 were dissatisfied with the patients’ appearance of nose.

A total of 57% T1 and 53% of T2 were satisfied with the patients’ upper incisor alignment. Fifty-three percent in both groups were satisfied with the patients’ lower incisor alignment. A total of 57% in both groups were satisfied with the patients’ incisor exposure.

DISCUSSION

Human face is a primary means of identification and a rich source of nonverbal information. The more attractive one’s external appearance, the greater the likelihood of receiving positive peer appraisal, which supports a positive internal self-image.[8] Stricker et al.[9] mentioned that physical attractiveness or lack of it affects interpersonal relationships with peers, family, friends, and other people significant to the person being considered. Although satisfaction with treatment outcome in the cleft population is generally high, patients still seem to have concerns about the appearance of features directly related to the cleft.[10] Donabedian[11] stated that patient satisfaction should be the “ultimate validator of the quality care”. Hunt et al.[1213] determined the psychosocial effects of cleft lip and/or palate. They concluded that children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as a part of their routine cleft care. Parents of children with CLP reported various psychosocial problems among their children. Parents considered children who had been teased to have greater psychosocial problems.[1213] Millard and Richman[14] said that children with cleft show relatively good overall adjustment, but some problems appear related to speech and facial appearance.

CONCLUSION

From the findings of the study, we conclude as follows:

Counseling the parents and thereby motivating them and educating them regarding the cleft and the various procedures by which the deformity can be tackled are one of the most important aspects of treatment.

Psychological sessions need to be incorporated in the treatment plan of these cleft lip/palate-affected individuals, and psychological aspects regarding the cleft lip/palate need to be assessed regularly.

Though the majority of cleft lip and palate patients as well as their parents were satisfied with their/their children’s dental appearance, they were unsatisfied with their/their children’s appearance of nose, lip, smile, and speech.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.