A cleft of the lip and/or palate can produce multiple of dental problems. These may involve the shape, size, position and number of primary (baby) and permanent teeth. Clefts occur between the canines (eye tooth) and the lateral incisor and most commonly affect those teeth. The lateral incisor can either be misshaped, displaced or entirely absent. Due to the dental problems, children with clefts require early evaluation by a dentist who is familiar with the needs of the child with a cleft.
Children born with a cleft lip and/or palate require proper cleaning, good nutrition, and fluoride treatment. Oral hygiene instructions and preventative counseling can be provided by a pediatric dentist or a general dentist. Many dentists recommend that the first dental visit be scheduled at about one year of age or even earlier if there are special dental problems. The early evaluation is usually provided through the Cleft Palate Team. Routine dental care with a local dentist begins at about three years of age. The treatment recommended depends upon many factors. Some children require only preventative care while others will need fillings or removal of a tooth.
The first orthodontic evaluation may be scheduled even before the child has any teeth. The purpose of the orthodontic visit is to assess facial growth, particularly the growth of the jaws. Later as teeth begin to erupt, the orthodontist will make plans for the child’s short and long-term dental needs. For example, if a child’s upper teeth do not fit together (occlude) properly with the lower teeth, the orthodontist may suggest an early period of treatment to correct the relationship of the upper jaw to the lower jaw. It is not unusual for this initial period of treatment to be followed by a long rest period when the orthodontist monitors facial growth and dental development. With the eruption of the permanent teeth, the final phase of orthodontics completes alignment of the teeth.
Coordinated Dental-Surgical Care
Coordination of treatment between the surgeon and dental specialist is important since several procedures may be completed during the same anesthesia. Restorations or dental extractions can be scheduled at the same time as other surgery.
Coordinated Orthodontic-Surgical Care
Coordination between the surgeon and the orthodontist becomes most important in the management of the bony defect in the upper jaw that may result from the cleft. Reconstruction of the cleft defect may be accomplished with a bone graft performed by the surgeon. The orthodontist may place an appliance on the teeth of the upper jaw to prepare for the bone graft. A retainer is usually placed after the bone graft until full braces are applied.
When the child approaches adolescence the orthodontist and the surgeon again coordinate their efforts if the teeth do not meet properly because the jaws are in abnormal positions. If the tooth relations cannot be made normal by orthodontics alone, a combined approach of both orthodontics and surgical repositioning of the jaws is necessary. Such surgery is usually performed after the pubertal growth spurt is completed.
Information taken from Cleft Palate Foundation website