Dental Care and Orthodontia

Children with oral Clefting often undergo dental and orthodontic treatment to help align the teeth and take care of any gaps that exist because of the cleft.

Routine dental care may get lost in the midst of these major procedures, but healthy teeth are critical for a child with Clefting because they're needed for proper speech.

A child with oral Clefting generally needs the same dental care as other children - regular brushing supplemented with flossing once the child's 6-year molars come in. Depending on the shape of your child's mouth and teeth, your child's dentist may recommend a toothette, a soft sponge that contains mouthwash, rather than a toothbrush. As your child grows, you may be able to switch to a soft children's toothbrush. The key is to make sure that your child brushes regularly and well.

Children with cleft palate often have an alveolar ridge defect. The alveolus is the bony upper gum that contains teeth, and defects can:

• displace, tip, or rotate permanent teeth
• prevent permanent teeth from appearing
• prevent the alveolar ridge from forming

These problems can be fixed by grafting bone matter onto the alveolus, which allows the placement of your child's teeth to be corrected orthodontically.

Orthodontic treatment usually involves a number of phases, with the first phase beginning as the permanent teeth start to come in. In the first phase, which is called an orthopalatal expansion, the upper dental arch is rounded out and the width of the upper jaw is increased. A device called an expander is placed inside the child's mouth. The widening of the jaw may be followed by a bone graft in the alveolus.

Your child's orthodontist may wait until the remainder of your child's permanent teeth come in before beginning the second phase of orthodontic treatment. The second phase may involve removing extra teeth, adding dental implants if teeth are missing, or applying braces to straighten teeth.

In about 25% of children with a unilateral cleft lip and palate, the upper jaw growth does not keep up with the lower jaw growth. If this occurs, your child may need orthognathic surgery to align the teeth and help the upper jaw to develop.

For these children, phase-two orthodontics may include an operation called an osteotomy on the upper jaw that moves the upper jaw both forward and down. This usually requires another bone graft for stability.

Speech Therapy

A child with oral Clefting may have trouble speaking - the Clefting can make the voice nasal and difficult to understand. Some will find that surgery fixes the problem completely.

Catching speech problems early can be a key part of solving them. It's a good idea to take your child to a speech therapist between the ages of 18 months and 2 years. Many speech therapists like to talk with parents at least once during the child's first 6 months to provide an overview of the treatment and suggest specific language- and speech-stimulation games to play with the baby.

Shortly after the initial surgery is completed, the speech pathologist will see your child for a complete assessment. The therapist will evaluate your child's developing communication skills by assessing the number of sounds he or she makes and the actual words your child tries to use, and by observing interaction and play behavior.

This analysis helps determine what, if any, speech exercises your child needs and if further surgery is required. The speech pathologist will often continue to work with your child through additional surgeries. Many children who have clefts work with a speech therapist throughout their grade-school years.

Dealing With Emotional and Social Issues

Our society often focuses on people's appearances, and this can make childhood - and, especially, the teen years - very difficult for someone with a physical difference. Because a child with oral Clefting has a prominent facial difference, your child may experience painful teasing, which can damage self-esteem. Part of the cleft palate and lip treatment team includes psychiatric and emotional support personnel.

Ways that you can support your child include:

• Try not to focus on your child's cleft and do not allow it to define your child as an individual.
• Create a warm and supportive home environment, where each person's individual worth is openly celebrated.
• Let your child know that you feel good about who he or she is by showing acceptance and by not trying to make your child into your idea of who he or she should be.
• Encourage your child to develop friendships with people from diverse backgrounds. The best way to do this is to lead by example and to be open to all people yourself.
• Point out positive attributes in others that do not involve physical appearance.
• Encourage autonomy by giving your child the freedom to make decisions and take appropriate risks, letting your child's own accomplishments lead to a sense of personal value. By providing opportunities for your child to make decisions early on - like picking out what clothes to wear - he or she can gain more confidence and the ability to make bigger decisions down the road.

You might also consider encouraging your child to present information about clefting to his or her class with a special presentation that you arrange with the teacher. Or perhaps your child would like you to talk to the class. This can be especially effective with young children.

If your child does experience teasing, encourage discussions about it and be a patient listener. Give your child the tools to confront the teasers by asking what he or she would like to say and then practicing those statements.

If your child seems to have ongoing self-esteem problems, you may want to consult with a child psychologist or social worker for support and information. Together with the members of your child's treatment team, you can help your child through tough times.

Also, it's important to keep the lines of communication open as your child approaches adolescence so that you can address any concerns he or she may have about appearance.