Study Examines Youth with Cleft Lip/Palate and Nonadherence Rates to Orthodontic Treatment

ACPAACPA News, Journal

  • Orthodontic treatment central to overall treatment of CL/P
  • Older CL/P patients more likely to not comply with orthodontic treatment regimen
  • History of behavioral health issues may be a factor in nonadherence

CHAPEL HILL, N.C. / Feb. 18, 2020 – Type of cleft diagnosis, patient’s age, and behavioral health were among the issues that could affect adherence to orthodontic treatment among young people with cleft lip/palate (CL/P), according to a recent a study, “Adherence to Orthodontic Treatment in Youth With Cleft Lip and/or Palate”. The researchers’ results were published in the February 2020 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“This study is particularly unique because the authors evaluated orthodontic treatment outcomes from a multidisciplinary approach. Specifically, Crerand and colleagues examined the relationship of adherence in treatment to clinical and demographic factors. Not only does this study demonstrate the complex nature of understanding treatment outcomes, it further underscores the value of collaborative team care. Insights from this study emphasize the value of our time as clinical providers gathered around a conference table discussing the complexities of each patient we serve. And this collaborative approach has proven time and time again to be the best approach to cleft care. Studies, such as this, provide such evidence,” said Jamie L. Perry, PhD, CCC-SLP, editor of The Cleft Palate-Craniofacial Journal.

“Few studies have evaluated any aspect of adherence to orthodontic treatment in youth with CL/P, despite known cleft-related oral health and psychosocial risks,” said Canice E. Crerand, PhD, lead researcher. “In our research, we sought to address these gaps by examining rates of nonadherence to orthodontic treatment among youth with CL/P and comparing demographic and clinical characteristics of these patients categorized as adherent versus nonadherent.”

CL/P can cause a range of complex functional and aesthetic problems for young patients which can affect their physical and psychosocial function and quality of life. Orthodontic treatment is central to the treatment of CL/P since clefts typically disrupt tooth development, jaw growth, and dental occlusion and alignment. Missing and poorly aligned teeth can also contribute to appearance concerns and self-consciousness about smiling and interacting with others.

Orthodontic treatment occurs most commonly during adolescence and can take several years to complete. Patients are expected to participate in their treatment by maintaining good oral hygiene, attending frequent orthodontic appointments, and avoiding food and beverages that might damage orthodontic appliances.

Practicing good oral hygiene and adherence to the treatment regimen are critical to successful orthodontic treatment. However, children with CL/P have an increased risk of caries and clinical observations suggest that they tend to exhibit poor overall adherence to orthodontic treatment.

Crerand and her team of researchers focused their analysis on new CL/P patients at a U.S.-based pediatric hospital with an interdisciplinary craniofacial team that were referred for orthodontic treatment over a four-year period (2011 through 2014). Demographic and clinical data were collected with a focus on whether patients kept orthodontic appointments, oral hygiene notations, number of broken appliances, and whether orthodontic treatment was suspended or terminated.

Although there were few demographic or clinical differences between patients who had treatment terminated due to nonadherence, those who terminated treatment were significantly more likely to have behavioral health diagnoses and documented social work and behavioral health consultation. In addition, those with poor hygiene notations were significantly older at the start of treatment, compared to those with no hygiene notations.

“Overall, we found that a better understanding of the relationships between adherence to orthodontic treatment and clinical and demographic factors can inform clinical care practices and guide intervention development to improve outcomes in patients with CL/P,” Crerand noted. “Further research is needed to evaluate rates of adherence problems among youth with CL/P who are undergoing orthodontic treatment and the associations between adherence and clinical and demographic characteristics.”

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit