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Objective To examine family functioning related to sociodemographic and clinical characteristics in youth with cleft lip and/or palate (CL/P) Design Cross-sectional, multi-site investigation. Setting Six U.S. cleft centers. Patients/Participants A diverse sample of 1200 children with CL/P and their parents. Main Outcome Measure Parents completed the Family Environment Scale (FES), which assesses three domains of family functioning: cohesion (or closeness), expressiveness (open expression of feelings), and conflict. Demographic and clinical characteristics were also assessed including race, ethnicity, type of insurance, and surgical recommendations. Results The FES scores for families seeking team evaluations for their youth with CL/P (mean age = 11.6 years) fall within the average range compared with normative samples. Families receiving surgical recommendations for their youth also had FES scores in the average range, yet families of children recommended for functional surgery reported greater cohesion, expressiveness, and less conflict compared with those recommended for aesthetic surgery (P < .05). For cohesion and expressiveness, significant main effects for race (P = .012, P < .0001, respectively) and ethnicity (P = .004, P < .0001, respectively) were found but not for their interaction. No significant differences were found on the conflict domain. Families with private insurance reported significantly greater cohesion (P < .001) and expressiveness (P < .001) than did families with public insurance. Conclusions Family functioning across domains was in the average range. However, observed differences by race, ethnicity, type of insurance, and surgical recommendation may warrant consideration in clinical management for patients and families.

Fear of dental treatment is a significant problem in the United States, impacting patients as well as oral health care providers. The purpose of this study was to identify the already-acquired knowledge, attitudes, and level of confidence of practicing dental hygienists with respect to the treatment of patients with dental anxiety. A paper survey was developed, pilot tested, and administered at a state-wide annual dental hygiene continuing education (CE) course in North Carolina. The survey domains studied included demographics, practice setting, practice behaviors, dental anxiety awareness, and opinions and attitudes. Item responses included multiple choice, a Likert Scale ranging from \"extremely frequent to never\" and \"strongly agree to strongly disagree,\" and free response questions. Results were tabulated and descriptive statistics were performed. Of the 157 attendees, 153 met the inclusion criteria (n=153) for a participation rate of 97%. Dental anxiety questionnaires were used \"often\" or \"always\" by 20% of the respondents. Less than half (43%) of the respondents stated that they knew the common signs and symptoms of a patient suffering from dental anxiety. However, 92% of the respondents (n=140) indicated confidence in their ability to perceive whether a patient felt stressed. A little more than half (58%) believed their dental hygiene education prepared them for treating patients with mild dental anxiety, 38% with moderate dental anxiety, and 22% with severe dental anxiety. Although the majority of dental hygienists in this study felt confident in their abilities to perceive stress in patients seeking dental care, they were less knowledgeable in recognizing the full range of signs and symptoms of dental anxiety. Questionnaires designed to specifically identify this population were used infrequently. Dental hygiene curricula and continuing education programs should include content on anxiety management for patients exhibiting all levels of dental anxiety.

Introduction Nasoalveolar molding (NAM) is a treatment option available for early cleft care. Despite the growing debate about the efficacy of nasoalveolar molding, questions remain regarding its prevalence and the demographic characteristics of families undergoing this technique prior to traditional cleft surgery. Objectives To determine the number of teams currently offering nasoalveolar molding and to identify salient clinical and sociodemographic variables in infants and families who choose nasoalveolar molding compared with those who choose traditional cleft care across three well-established cleft centers. Results Via phone surveys, 89% of the U.S. cleft teams contacted revealed that nasoalveolar molding is available at 37% of these centers. Chart reviews and phone correspondence with caregivers indicate that the average distance to the cleft center was 65.5 miles and caregiver age averaged 30.9 ± 5.7 years. Of families who chose nasoalveolar molding, 85% received total or partial insurance coverage. No difference in caregiver education, income, or distance to the clinic between treatment groups was found. On average, infants receiving nasoalveolar molding and cleft surgery had larger clefts and had more clinic visits than infants receiving traditional cleft surgery. Infants who were firstborn and those who did not have other siblings were more likely to receive nasoalveolar molding than were infants who were residing with other siblings. Conclusions Currently more than one-third of U.S. cleft centers offer nasoalveolar molding. Although the cleft size was larger in the nasoalveolar molding group, no treatment group differences in education, income, and distance to the clinic were found.

Objective To examine social issues in the conduct of cleft and craniofacial care through relief programs in disrupted crisis contexts. Method Social, health policy, and ethical analyses. Results At best, craniofacial team care is multidisciplinary, coordinated, and sustained, requiring a long-term relationship between team members, patients, and families. Disasters and societal turmoil interrupt such relationships, causing craniofacial care to become a secondary concern. Providing craniofacial team care in a crisis setting requires rebuilding disrupted coordination and communication. Crisis relief care involves a complex set of expectations and responsibilities and raises issues such as (1) quality assurance, infection control, appropriate standards of care, and follow-up care/continuity; (2) equity of access to services and clinical ethics in the context of war and/or deprivation; (3) training of visitors in the local nation or site; (4) disciplinary composition of teams, interprofessional communication/rivalry, and credentials of clinicians; (5) ownership of the site and local visitor relations; (6) fundraising and marketing strategies; and (7) ethical issues in the doctor-patient relationship. Conclusions Specific ethical standards for international cleft and craniofacial care delivery also apply to domestic and global crisis relief contexts. Guidance on issues related to professional experience, informed consent, and continuity of care will help care providers address social and ethical issues raised in crisis relief programs. This paper proposes that the Position Paper of the American Cleft Palate-Craniofacial Association (ACPA) on International Treatment Programs should be used as a template to develop and disseminate a set of standards that apply to crisis relief.

Chronic musculoskeletal pain (CMSP) is associated with work stress and burn-out among registered dental hygienists, with prevalence estimates ranging between 64 to 93%. Complementary and alternative medicine (CAM) therapies can be helpful in managing CMSP. The purpose of this study was to determine if dental hygienists who use CAM have greater career satisfaction compared to conventional therapy (CT) users. ADHA members (n=2,431) in North Carolina (n=573) and California (n=1,858) were surveyed. Data were analyzed using univariate and bivariate analyses and logistic regression. A response rate of 25.3% (n=617) was obtained, revealing that 76.5% (n=472) suffered from CMSP. The use of CAM or CT was reported among 80.7% (n=381) of dental hygienists with CMSP. CAM users reported greater overall health (79.3% vs. 54.0%, p<0.001), career satisfaction (59.2% vs. 39.0%, p<0.001) and were able to work the hours they wanted (69.8% vs. 64.0%, p<0.001) compared to CT users. Of those with CMSP, 36.4% (n=172) considered a career change and 13.0% (n=59) reported having left dental hygiene. Those with CMSP were less likely to recall that ergonomics were taught or reinforced during clinical training. CAM therapies may improve quality of life, reduce work disruptions and enhance career satisfaction for dental hygienists who suffer from CMSP. Ergonomics education may help reduce the number of hygienists who suffer from CMSP. Increased student awareness of CMSP risk is needed to reduce CMSP in the future by enhancing ergonomics education and incorporating CAM, such as yoga stretches, into the classroom and clinic routine.

Cleft care is generally characterized by staged, carefully timed surgeries and long-term, team-centered follow-up. Acute and chronic crises can wreak havoc on the comprehensive team care required by children with craniofacial anomalies. In addition, there is evidence that crises, including natural disasters and chronic disruptions, such as political turmoil and poverty, can lead to an increased incidence of craniofacial anomalies. The purpose of this article is to delineate the impact of acute and chronic crises on cleft care. Hurricane Katrina in New Orleans, Louisiana, in 2005, resulted in an acute crisis that temporarily disrupted the infrastructure necessary to deliver cleft care; chronic turmoil in the West Bank/Palestine has resulted in an absence of infrastructure to deliver cleft care. Through these central examples, this article will illustrate—through the prism of cleft care—the need for (1) disaster preparedness for acute crises, (2) changing needs following acute crises that may lead to persistent chronic disruption, and (3) baseline and long-term monitoring of population changes after a disaster has disrupted a health care delivery system.

Dental hygienists report a lack of confidence in initiating Tobacco Dependence Counseling (TDC) with their patients who smoke. The purpose of this study was to determine if the confidence of dental hygiene students in providing TDC can be increased by Standardized Patient (SP) training, and if that confidence can be sustained over time. This 2-parallel group randomized design was used to compare the confidence of students receiving SP training to stu dents with no SP training. After a classroom lecture, all subjects (n=27) received a baseline test of knowledge and confidence. Subjects were randomly assigned to test and control groups with equivalent mean knowledge scores. The test group subjects participated in a SP TDC session. Both groups gained parallel experience to treating patients who were smokers and giving TDC in clinical scenarios during the 6 month time period. One week end-training and 6 month post-training assessments were administered to both groups. ANCOVA compared mean confidence scores. End-training scores at 1 week showed a statistically significant increase (p=0.002) in overall mean confidence following SP training for individuals in the test group. The 6 month follow-up test results showed a slight decline in confidence scores among subjects in the test group and an overall gain in confidence for control group participants. However, overall confidence scores were comparable for the groups. SP training improved dental hygiene students' initial confidence in providing TDC and was sustained, but not to a significant degree. Clinical experience alone increased confidence. Further studies may help determine how the initial confidence gained by SP training can be sustained and what the role of clinical experience plays in overall confidence in providing TDC.

The purpose of this study was to determine if the confidence of dental hygienists in providing Tobacco Cessation Counseling could be increased by incorporating Standardized Patient (SP) training into the dental hygiene Tobacco Cessation Counseling (TCC) curriculum.