Oral health-related quality of life in adults with cleft lip and/or palate: A systematic review

Abstract

BACKGROUND: Cleft lip and/or palate (CL/P) is a prevalent congenital craniofacial anomaly that affects facial esthetics, function, and psychosocial well-being. Oral health-related quality of life (OHRQoL) is a critical measure reflecting the impact of oral health on daily functioning and overall life quality. Despite extensive treatment, adults with CL/P may continue to face challenges affecting their OHRQoL. OBJECTIVE: To systematically evaluate and synthesize the existing evidence on OHRQoL in adults (>/=18 years) with CL/P. MATERIALS AND METHODS: A systematic search was conducted across Scopus, Embase, Web of Science, and PubMed until March 2025. Eligible studies included those assessing OHRQoL in adults with CL/P, using validated questionnaires such as Oral Health Impact Profile-14 (OHIP-14) and Oral Impacts on Daily Performances. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the protocol was registered in PROSPERO. Risk of bias was assessed using a modified Newcastle-Ottawa Scale for cross-sectional studies and the National Heart, Lung, and Blood Institute Quality Assessment Tool for pre-post studies. Due to heterogeneity in methodologies, a narrative synthesis approach was adopted. RESULTS: From 407 identified records, 9 studies met the inclusion criteria. The majority were cross-sectional (n = 7), with 2 pre-post intervention studies. Most used the OHIP-14 questionnaire. Findings consistently showed that adults with CL/P report diminished OHRQoL, particularly in physical and psychological domains. Interventions like orthognathic surgery and prosthetic rehabilitation improved specific outcomes, but did not fully resolve functional or psychosocial challenges. Factors such as female gender, low income, limited social support, and the extent of dental decay were associated with worse outcomes. CONCLUSION: Despite receiving specialized, multidisciplinary treatment, adults with CL/P continue to experience impaired OHRQoL. These findings underscore the need for a more holistic, patient-centered care approach that includes psychological support and long-term follow-up. Future research should focus on longitudinal studies and explore strategies to address persistent psychosocial impacts in adulthood.