Facilitators and Barriers to Providing Orthodontic Care for Patients with Craniofacial Anomalies

Hypothesis and Objective: The objective of the study was to conduct a survey of orthodontists in private practices in the state of Illinois to identify facilitators and barriers to rendering orthodontic care to those with craniofacial anomalies as well as reveal communication gaps between private practice practitioners and cleft/craniofacial teams. We hypothesized that practice characteristics and practitioner’s affiliation with a cleft/craniofacial team were associated with facilitators and barriers to providing orthodontic care for those with cleft/craniofacial anomalies. Methods: A 19-item questionnaire was developed to capture information on the facilitators and barriers to orthodontic care. The survey was administered electronically via Qualtrics Survey Software to active orthodontists practicing in the state of Illinois through AAO Partners in Research Program and the Illinois Orthodontics Alumni Association. The associations between various practice characteristics and facilitators/barriers to providing orthodontic care were examined by descriptive statistics such as frequency distribution (%), cross tabulations and exact Chi-square tests. A qualitative content analyses of the open-ended responses was also conducted. Results: The response rate was 23% (57 valid and complete responses out of 249 person sample size). 64.9% of respondents have experience in providing craniofacial orthodontic care. 45% of respondents currently provide orthodontic care to these patients. Most respondents (94.7%) are not formally affiliated with a craniofacial team. 3 respondents (5%) were formally affiliated with a team. Facilitators included wanting to help, personal connection/experience, past exposure, and community engagement. Barriers include proximity to cleft/craniofacial team, lack of experience, lack of training, insurance issues, and financial implications. There was a significant association between experience with providing craniofacial orthodontic care and the length of time practicing the orthodontic specialty (p=0.005), as well as more experienced practitioners currently treat craniofacial patients (p<0.001). Conclusions: The facilitators and barriers shed light on the decreased access to orthodontic care for craniofacial patients. Training and experience have a strong influence on a practitioner’s willingness, preparedness, and confidence to provide care for these patients. The more experienced a practitioner is, the more likely they are to feel comfortable treating cleft/craniofacial patients. IRB and/or ACC Protocol #: 2020-0596