Children must receive dental care from professionals familiar with cleft lip and/or palate care: Q&A with Dr Larry H. Hollier

FDI and oral health non-profit Smile Train are working together to provide new resources on the integration of dental care for children and adults with clefts. FDI spoke with Dr Larry H. Hollier, a board-certified plastic surgeon who currently serves as chairman of the Medical Advisory Board for Smile Train about oral health as an essential component of achieving ideal surgical outcomes in cleft care.

Dr Larry H.Hollier

Dr Larry H.Hollier, board-certified plastic surgeon specialised in cleft surgery and chairman of the Smile Train Medical Advisory Board.

While rehabilitation and care of children living with clefts involves the core specialties of nursing, plastic surgery, speech therapy, and orthodontics, quality oral healthcare is also essential to ensure successful long-term health outcomes.

FDI and oral health non-profit Smile Train are working together to provide new resources on the integration of dental care for children and adults with clefts. Smile Train is an international children’s charity that provides training, funding, and resources to empower local doctors in 85+ developing countries to deliver cleft repair surgery and comprehensive cleft care in their own communities.

FDI spoke with Dr Larry H. Hollier, a board-certified plastic surgeon who specializes in plastic and reconstructive surgery, including cleft surgery, craniofacial surgery, and pediatric hand surgery. Dr Hollier currently serves as chairman of the Medical Advisory Board for Smile Train. Since 1996, he has participated in numerous surgical capacity building trips to Haiti, Africa, Central America, and Southeast Asia for treatment of craniofacial and hand deformities.

Dr Hollier shared his thoughts on oral health as an essential component of achieving optimal surgical outcomes in cleft care.  

First, for a little background, could you share more about oral health in the context of cleft lip and palate care?

Well, I’ll start off by just emphasizing something everyone at FDI knows—oral health is an essential pillar of overall health. It impacts our day-to-day life, our self-esteem, and our mental health. Anyone who has ever had an oral health disease or even a toothache has experienced what not having oral health can mean. Beyond the immediate problem, it also causes long-term health problems.

1 in 700 babies are born with cleft lip and palate worldwide. It’s the most common birth difference affecting the mouth area. And due to a combination of genetics and environmental disposition, these babies, children, and adults are all more likely to experience serious oral health problems – cavities, periodontal disease, dental anomalies, and other challenges that can impact their health for life. This is especially a problem in low- and middle-income countries where there isn’t equitable access to care. 

Given these unique needs and increased risk, it’s important that children receive dental care services from professionals who are familiar with cleft lip and/or palate and that their caregivers are closely involved.

Unfortunately, many children with clefts, particularly those who live in low- and middle-income countries, lack access to surgical care and dental care.

How does this relate to surgical outcomes?

Cleft lip and palate can impact emotional well-being—self-esteem and mental health—and functional well-being—the ability to sleep, eat, and speak.
As a surgeon, I know the incredible impact that surgery can have on a patient and how it can shape the rest of their life. But the ideal outcome in a cleft surgery is not an ideal cleft surgery. It’s a happy, healthy person who lives a full life with no long-term health problems.

A treated cleft palate doesn’t make a child happy and healthy if pain in their teeth and gums keeps them up at night or interferes with their chewing, speaking, and eating. A treated cleft lip doesn’t increase self-esteem if a teenager is worried about the position of their teeth when they smile at their friends, or the sound of their voice when they speak at school.

To achieve the ideal surgical outcome in cleft care, you need oral health integrated at every stage.

What is Smile Train’s approach to oral health and cleft lip and palate?

Our oral health programmes for people with cleft lip and palate begin from birth with pre-surgical infant orthopedics, as needed. We encourage our partners to be proactive with teaching their patient families at a very young age about maintaining a healthy mouth. We also support orthodontic services for the alignment of teeth, monitoring of facial growth, and related surgical procedures like bone grafts or jaw surgery, as the child grows and their face develops.

For all of our medical programmes, Smile Train partners with local medical professionals to provide care to children in their own communities. This local partnership model and long-term capacity building allows for the integrated, long-term care that is so essential to ensuring overall health and well-being for patients. Our programmes are focused on people with clefts, but since our approach is centered on capacity-building, it raises the standard of care for patients beyond those we directly support.

How does the partnership between Smile Train and FDI, with support from GSK Consumer Healthcare, support this approach and address the challenges patients with clefts face?
Smile Train, FDI World Dental Federation and GSK’s partnership to create comprehensive guidelines and training materials on cleft oral health are a tremendous contribution to the global cleft and dental communities.

First, it’s significant to note that these guidelines are for both non–oral health providers and oral health providers. They present an interdisciplinary approach that includes the whole cleft care team, parents, and patients themselves involved in quality oral healthcare. This aligns with Smile Train’s investment in a comprehensive, person-centered approach that puts people and communities at the core of our work.

It also empowers members of the entire team to understand and address oral health challenges. It empowers families and patients. This integrated approach lends itself well to long-term changes within health systems, where everyone is a part of the oral healthcare continuum.

The guidelines also focus on both prevention and treatment, which is essential. While Smile Train supports costs associated with seeking and receiving treatment—extending to transportation, food, and lodging—the reality is that time to attend regular treatment sessions is in and of itself a luxury that many people can’t afford. If you can prevent an oral health problem before it ever occurs, you save time, stress, pain, and financial resources.

In late September, around the FDI World Dental Congress 2021, we will release the final materials from the partnership. They’re training materials that follow our trusted “Train the Trainer” model, so they will be yet another resource that empowers providers and builds this long-term capacity for oral healthcare.

With an oral health resolution on the agenda at WHO’s 74th World Health Assembly (WHA74), what needs to happen to ensure that people with cleft lip and palate aren’t left behind?

It is wonderful to see an oral health resolution on the agenda at WHA74. The leadership of Member States including Sri Lanka, and of organizations like FDI, IADR, and others, show a much-needed commitment to addressing the pervasive and devastating global burden of oral health.

We were also glad to see the inclusion of cleft lip and palate within statements by FDI, IADR, and Sri Lanka at the 148th session of the WHO Executive Board (EB148) back in January. We know that oral health is an essential part of cleft care, and it’s equally true that cleft must be integrated as part of any comprehensive global strategy to achieve oral health for all.

Without inclusion of cleft within a multilateral or national oral health agenda, we risk leaving a vulnerable and highly marginalized population behind and we miss an opportunity to advance health equity. 

Additionally, as noted by IADR in their statement at EB148, a comprehensive research agenda to reduce risk factors and prevent cleft lip and palate is an important action item for advancing oral health.

Together, prevention and treatment of cleft lip and palate will reduce widespread health inequities. More broadly, it will help achieve significant progress towards reducing the global burden of oral health disease and realizing universal health coverage and the Sustainable Development Goals.

This interview has been edited for length and clarity. The interviewees views do not necessarily reflect the views of FDI World Dental Federation.