Knowledge assessment on cleft lip and palate among recently graduated dentists: a cross-sectional study

BMC Oral Health Agha et al. BMC Oral Health (2023) 23:689 https://doi.org/10.1186/s12903-023-03388-y Open Access RESEARCH Knowledge assessment on cleft lip and palate among recently graduated dentists: a crosssectional study Bahn Agha1* , Narmin Mohammed Saeed Helal2, Thaer Jaber Al-Khafaji3, Ghada Abdullah Farie2, Osama Basri4 and Padhraig S. Fleming5 Abstract Background The complex presentation, associated co-morbidities and multi-disciplinary requirements dictate the requirement for in-depth knowledge in order to effectively manage patients with cleft lip and palate (CLP). We aimed to develop a validated questionnaire for cleft lip and palate knowledge assessment and to evaluate the knowledge of cleft lip and palate among a group of recently-graduated dentists. Materials and methods A multiple-site, cross-sectional questionnaire-based study was conducted. The study population included recently graduated dentists involved in a dental internship program. A bespoke questionnaire was developed and validated, with internal consistency assessed using Cronbach’s alpha and factor analysis performed. A 47-item prototype was distilled into a 15-item questionnaire. This was distributed to the participants with a response rate of 67% obtained. Results The overall proportion of correct responses among dental interns was moderate (73%). The best results were found in relation to CLP treatment including the effect of unfavorable surgical outcomes on speech (89.5%) and the impact of CLP on the occlusion (87.6%). The lowest rate of correct responses (26.7%) was identified in relation to the association between CLP and smoking. Conclusion A validated CLP questionnaire was developed, permitting evaluation of the knowledge of cleft lip and palate and its management among recently graduated dentists. There is limited appreciation among dental interns of the risk factors for CLP as well as post-surgical complications. Given that general dentists are often the gatekeepers for the management of patients with cleft lip and palate, it is important that the findings of this survey are used to inform the curriculum and teaching of cleft lip and palate. Keywords Nonsyndromic clefting, Congenital defects, Dental internship, Questionnaire, Curriculum *Correspondence: Bahn Agha 1 Department of Pedodontics, Orthodontics and Preventive Dentistry, College of Dentistry, Mustansiriyah University, Baghdad, Iraq 2 Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia 3 Pedodontics, Orthodontics and Preventive Dentistry Department, College of Dentistry, University of Babylon, Babylon, Iraq 4 Department of Dentistry, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia 5 Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Agha et al. BMC Oral Health (2023) 23:689 Background Cleft lip and palate (CLP) is one of the most prominent hereditary diseases affecting newborns. Clefts occur in the early stages of human embryonic development and are categorized as “non-syndromic” if the malformation appears to be an isolated defect or “syndromic” if the malformation is a part of a larger disorder in a known pathologic pattern. The former represents approximately 70% of facial congenital malformations [1]. The etiology of CLP is thought to be multifactorial, resulting from a combination of genetic and environmental factors [2]. Advanced maternal age, smoking, alcohol consumption, and deficiency in folic acid and B6 and B12 vitamins during pregnancy are associated with an increased risk of CLP [3, 4]. A number of genes and molecular pathways have been linked to the etiology of clefting. An understanding of the molecular mechanisms of cleft formation is therefore important in supporting decision-making and counselling [5]. The prevalence of CLP varies according to race, geographic location, environmental exposure, and social and economic conditions with the highest prevalence found among Asians and Native Americans (1/500), while the lowest prevalence observed among Africans (1/2500). Caucasians have an intermediate prevalence of 1 in 1,000 [2, 4]. With respect to gender, the prevalence of CLP is approximately double that of females [6, 7]. In addition, blood-related couples are at significantly greater risk of having children with congenital defects and genetic disorders [8]. Based on a recent meta-analysis, the global prevalence of cleft palate (CP), cleft lip (CL), and CLP in every 1000 live births was 0.33, 0.3, and 0.45, respectively [9]. A multidisciplinary team strategy is essential to handle patients born with cleft lip and palate conditions [10]. Although every patient’s path is different, many patients with the same cleft phenotype go through similar pathways, including maxillofacial, auditory, speech and language, psychology, pediatric, restorative, and orthodontic clinics. However, dentistry remains essential to several aspects of cleft treatment [11]. In view of the disparate nature of the condition and associated co-morbidity, the adequate provision of dental services to patients with CLP can be challenging [10]. These challenges are exemplified by a failure to identify improved dental outcomes in the recent Cleft Care UK study relative to the findings of the Clinical Standards Advisory Group [12]. Conversely, a general enhancement in psychological, surgical, facial proportions, and speech and language outcomes were noted [13–15]. From a global perspective, Mossey [16] highlighted the universal challenges in the orofacial cleft field, such Page 2 of 10 as the absence of awareness, the failure to differentiate between orofacial cleft sub-phenotypes, and the lack of standardization of cleft classification. Primary prevention of non-syndromic clefts involves intensive research into the genetic and environmental fac (...truncated)