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AIIMS workshop trains over 100 orthodontists

Abha Gupta. Dated: 8/26/2019 3:13:54 PM

Every year in India, more than 35,000 kids are born with cleft lip/cleft palate, a condition when the two sides of the lip, developing in an unborn baby, do not completely fuse. It adversely affects nutrition, leads to chest infections, ear problems, poor speech and inability in proper chewing.

Hundreds of thousands of children with untreated clefts live in isolation as they cannot afford/ receive the required comprehensive treatment, said Prof OP Kharbanda, an eminent cleft craniofacial orthodontist and chief of the Centre for Dental Education and Research at AIIMS here.

With an aim to provide comprehensive treatment for such facial deformities in children, a "first-of-its-kind" three day workshop was held at the AIIMS to train more than 100 orthodontists from across the country and neighbouring Nepal.

Specialists from medical and dental fraternity, including plastic surgeons, cleft orthodontists, pediatricians, clinical geneticist and clinical psychologists, contributed as course faculty to sensitise participants about complete protocols of the cleft treatment with greater emphasis on correcting deformities of face due to poor dental alignment and unintelligible speech.

The abnormal arrangement of teeth, poor jaw relations and facial aesthetics make a child socially and functionally handicap. Cleft lip and palate anomaly constitute nearly one-third of all congenital malformations of the craniofacial region with an average worldwide incidence of 1 in 700, said Prof Kharbanda.

Its incidence in the Asian population is reported to be around 1.7 per 1,000 live births or higher. In India, more than 35,000 cleft children are born every year, and they add to huge existing patients, many of whom may not have received the required comprehensive treatment, the doctor said.

"Only a fortunate few have the opportunity to get comprehensive cleft care. Although most patients nowadays get cleft surgery treatment, the outcomes are not necessarily reflective of quality care. They remain deprived of the two major aspects -- correction of disfigurement of the face due to poor dental alignment and poor speech," he said.

Dr Tradib Jayapal, an eminent orthodontist from Cochin and vice president of the Indian Orthodontic Society, said, "There exists treatment protocol of varying standards, and this programme will lay down a blueprint to start holistic cleft management." He also emphasised the need for a uniform protocol across the country.

The workshop was held in collaboration with the Indian Orthodontic Society.

A multi-centric hospital-based study from different cities conducted by the AIIMS as part of an Indian Council of Medical Research's task force India-Cleft project revealed that around 35 per cent of patients show poor outcomes like a hole remaining in palate and complex dental disfigurement after cleft surgery. Also, about 70 per cent of patients presented with difficulties in speech.

A study published online by JAMA Facial Plastic Surgery too echoes similar observation as it notes that the rate of unrepaired CL/Ps ranged from less than 3.5 per 100,000 population in Kerala and Goa to 10.9 per 100,000 population in Bihar.

"The results describes the prevalent unmet need for cleft surgery in India by each state and includes patients older than the surgery target ages of 1 and 2 years for cleft lip and cleft palate repair, respectively," said researcher Barclay T. Stewart from the University of Washington. The study said that safe, timely and effective surgery can result in successful outcomes.