Dental Care for a Child with Cleft Lip and Palate How Does Cleft Lip/Palate Affect the Teeth?  A cleft of the lip, gum (alveolus), and/or palate in the mouth can produce a variety of dental problems. These may involve the number, size, shape, and position of both the baby teeth and the permanent teeth. The teeth most commonly affected by the clefting process are those in the area of the cleft, which usually occurs between the cuspid (eye tooth) and the lateral incisor. Some of the teeth may be extra, missing , misshapen or erupt in the wrong place.

What Does this Mean for Future Dental Care?  A child with a cleft lip/palate requires the same regular dental care as the child without a cleft. However, since children with clefts may have special problems related to missing, malformed or malpositioned teeth, they require early evaluation by a dentist who is familiar with the needs of a child with a cleft

Early Dental Care  ​With proper care, children born with a cleft lip and/or palate can have healthy teeth. This requires proper cleaning, good nutrition and fluoride treatment. Appropriate cleaning with a small, soft -bristled toothbrush should begin as soon as teeth erupt. The early evaluation is usually provided through the Cleft Palate Team.

Nasoalveolar moulding

Nasoalveolar molding is a nonsurgical way to reshape the gums, lip and nostrils with a plastic plate before cleft lip and palate surgery. Pre-surgery molding may decrease the number of surgeries your child needs because it makes the cleft less severe.

It reduces the cleft inside the mouth.
It reduces the gap in the upper lip.
It lifts and narrows the nose.

Surgery is done after the molding is complete, when your child is around age 3 to 6 months.

NAM is used mainly for children with large or wide clefts, and has greatly changed cleft repair.

Orthodontic Care with braces
Orthodontic care is given to achieve the best esthetics, function and stability of a child’s bite. This treatment may include traditional braces, orthopedic appliances designed to affect growth of the jaws, or simple removable appliances. 

​Since facial growth is an important aspect of orthodontic care, the first orthodontic evaluation may take place even before the child has any teeth. As the baby teeth and later, the permanent teeth begin to erupt, the orthodontist monitors the child’s dental and facial development, and intervenes with treatment when necessary. Thus, it is not unusual for a child with a cleft to have two or even three carefully planned phases of treatment. Each phase will have specific goals, and in between phases, appliances are removed. The final phase of treatment begins near the time when all permanent teeth have erupted. Orthodontic care must be carefully coordinated with any surgical or prosthodontic care to achieve the best results. 

Orthognathic surgeries: Jaw surgery, also known as orthognathic surgery, corrects irregularities of the jaw bones and realigns the jaws and teeth to improve the way they work. Making these corrections may also improve your facial appearance.

Jaw surgery may be a corrective option if you have jaw problems that can't be resolved with orthodontics alone. In most cases, you also have braces on your teeth before surgery and during recovery after surgery until healing and alignment are complete. Your orthodontist can work with your oral and jaw and face (maxillofacial) surgeon to determine your treatment plan.

Jaw surgery is appropriate after growth stops, usually around ages 14 to 16 years for females and ages 17 to 21 years for males.

Prosthodontic Care 

Prosthodontic care is given to replace missing teeth and other oral structures with prosthetic or artificial appliances. Implants, crowns or bridges designed to replace missing teeth. The prosthodontist must coordinate treatment with the surgeon, orthodontist and speech-language pathologist to assure the best possible result. Good dental care is essential so that the teeth holding the appliance are healthy. 

How Can I Get the Best Care for My Child?  Children with cleft lip and /or palate require the coordinated care of a number of specialists. For this reason, many parents seek care for their child at a cleft palate or craniofacial treatment center. At such a center evaluation, treatment planning and care are provided by an experienced multidisciplinary team composed of representatives from a variety of dental, medical and other health care specialties. Even if you do not have such a center locally, the care your child will receive in such a center may be well worth the inconvenience of traveling to another city. 

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Dentistry for the child and Adolescent 

Advanced Care for Cleft Lip Palate and Craniofacial Anomalies