title: Global oral health inequalities: challenges in the prevention and management of orofacial clefts and potential solutions.
abstract: The birth prevalence of orofacial clefts, one of the most common congenital anomalies, is approximately one in 700 live births, but varies with geography, ethnicity, and socio-economic status. There is a variation in infant mortality and access to care both between and within countries, so some clefts remain unrepaired into adulthood. Quality of care also varies, and even among repaired clefts there is residual deformity and morbidity that significantly affects some children. The two major issues in attempts to address these inequalities are (a) etiology/possibilities for prevention and (b) management and quality of care. For prevention, collaborative research efforts are required in developing countries, in line with the WHO approach to implement the recommendations of the 2008 Millennium Development Goals (www.un.org/millenniumgoals). This includes the "common risk factor" approach, which analyzes biological and social determinants of health alongside other chronic health problems such as diabetes and obesity, as outlined in the Marmot Health inequalities review (2008) (www.ucl.ac.uk/gheg/marmotreview). Simultaneously, orofacial cleft research should involve clinical researchers to identify inequalities in access to treatment and identify the best interventions for minimizing mortality and residual deformity. The future research agenda also requires engagement with implementation science to get research findings into practice.
authors.affiliation: University of Dundee Dental Hospital & School, Scotland, UK. p.a.mossey@dundee.ac.uk
authors.forename: P A
authors.initials: PA
authors.lastname: Mossey
authors.forename: W C
authors.initials: WC
authors.lastname: Shaw
authors.forename: R G
authors.initials: RG
authors.lastname: Munger
authors.forename: J C
authors.initials: JC
authors.lastname: Murray
authors.forename: J
authors.initials: J
authors.lastname: Murthy
authors.forename: J
authors.initials: J
authors.lastname: Little
mesh_terms: D002971:Cleft Lip / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D002972:Cleft Palate / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D018865:Dental Research; D005260:Female; D020022:Genetic Predisposition to Disease; D014943:Global Health; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D007391:International Cooperation; D009748:Nutrition Disorders / Q000150:complications; D009909:Oral Health; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D015995:Prevalence; D012959:Socioeconomic Factors; D057170:Translational Research, Biomedical