Keeping Optimal Dental Health with a Cleft Lip or PalateMarch 6, 2020 12:51 pm
For parents of a child diagnosed with a cleft lip or palate, the prospect of surgery and future corrective work can seem alarming. However, while each case is different, modern medical cleft palate and cleft lip treatments mean that most children recover and lead a normal adult life. One big impact of these conditions, however, is on the health of the child’s teeth. It’s important to be educated about dental hygiene and best practices, in order to give your child’s teeth the best possible beginning for later life.
- What is it?
A cleft lip or cleft palate is a common birth defect that happens when a baby is still in the early development stages, before being born. It occurs when the bones and tissue of the baby’s upper jaw, mouth and nose don’t fuse together properly – a cleft lip is a gap in the lip, and a cleft palate includes the bony part of the roof of the mouth. It’s possible to have one or both problems as they develop separately. The condition is often discovered during an ultrasound, though it may be missed until the baby is born. The CDC (Centers for Disease Control and Prevention) in the US says that one in every 940 babies is born with a cleft lip every year. For a cleft palate, it’s one in every 1500. The causes of cleft lip and palate are still unknown, though they are thought to be down to genetics or environment – for example, certain medications are believed to be a contributing factor. For both conditions, surgery will be required within the first year, and often within the first few months. The best cleft lip dental care will normally correct the problem via one or two surgeries, though a cleft palate will often require further work later on, up until 18 years of age.
- The effect on teeth
Cleft lip and palate can cause a number of problems for teeth, though with the right awareness and support, the impact on your child can be minimised. With either condition, it’s possible to have too many, too few, or misaligned teeth, both in baby teeth and adult sets. For cleft palate, it’s also common for the upper incisor to be missing. Some teeth may have ‘hypoplasia,’ meaning the tooth tissue is not as strong as usual. A malformed palate can also mean that bone support for the teeth is not as good as it should be.
- Starting dental care early
As for all children, it’s important to establish good dental hygiene early on, in order to maintain the best possible mouth health through life. Keeping teeth in great condition also makes the rest of the treatment more likely to be successful. This is best achieved through daily teeth brushing (as soon as they start to show), regular dentist appointments, and a good diet. When brushing, it’s important not to avoid the cleft area – as a parent you may be worried about hurting your child, but it’s more important than ever that the area is kept clean and free of decay-causing bacteria. In fact, it’s best to establish a routine where each individual tooth is cleaned, rather than the conventional brushing across the tooth arch. The lip may need to be moved aside to help this, and a mirror used to make sure nothing is missed. A ‘toothette,’ a small sponge with a handle, may be recommended by your dentist to clean hard-to- reach teeth, especially if a normal child’s toothbrush doesn’t work. To ensure the best cleft lip dental care, most dentists also suggest supervised cleaning until the child is at least seven years old.
- Later on
For your dentist, it’s all about prevention. If signs of decay start to show as your child gets older, your dentist might suggest a food diary to identify problem areas, and might also make recommendations for ways to reduce sugar in your child’s diet. Your dentist can also help show you where cleaning needs to be done extra carefully. A baby toothbrush or a brush with a small head may be necessary to make sure the cleft area is kept clean. Your dentist may also choose to apply fluoride varnish, or prescribe a fluoride mouthwash, to help keep teeth in good condition.
- Orthodontic care
Orthodontics means the repositioning of teeth that are in the wrong place. The first orthodontic appointment will often be required before baby teeth start to show, with the aim being to line up both upper and lower sets of teeth in a harmonious way. For a cleft palate, a bone graft may be needed later to close the gap between the roof of the mouth and the floor of the nose – to prepare for this, an orthodontist may use an appliance to make space in the mouth. Once adult teeth start to come through, braces are usually needed to ensure the teeth move into the correct spaces. An artificial tooth might be added to the brace, in order to save space for any missing teeth that will be fixed later.
Oral surgery to correct a cleft palate or lip is carried out early, helping reduce the work required later on and reducing the level of scarring also. For a cleft palate the first surgery is between the ages of 9 months and one year to create a functional palate. Then, at around eight years old, a bone graft may be needed to support the development of adult teeth. After the bone graft, the adult teeth will be able to push through in the cleft area. The final repairs will be in the teenage years. It is hugely important to keep teeth clean throughout these processes – for instance, if teeth are not really clean before a bone graft, then any traces of gum disease may affect the success of the graft. Mouthwash may be prescribed by your dentist around this time, as a preventative measure. Later on, a combination of crowns, veneers or bridges may be used at the end of treatment, to make aesthetic improvements. It’s very important for your child to have stable dental health in order for this to be done successfully.
- Prosthodontic care
A prosthodontist will help solve the problem of missing teeth. In cases of cleft palate, a prosthodontist may need to make a dental bridge. A bridge could cover areas of missing teeth or close off the gap between the nose and mouth – this is known as a ‘speech bulb’ or ‘palatal lift’. For a baby, a temporary bridge called an obturator may be used – this helps the baby feed before surgery can be performed.
- A coordinated effort
In all cases, the different elements of the cleft palate or cleft lip treatments team will have to work together – your orthodontist will talk to the dentist, the prosthodontist will consult the oral surgeon, and so on. This managed approach is essential so that all the elements of treatment are performed at the right times and in the right order. It’s very important to choose a clinic that can manage the various elements of the treatment process, and ensure the very best cleft lip dental care is achieved.
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