Children born with cleft lip and/or palate require additional and specialized dental care. Their care starts earlier than most children and generally has more components that non-cleft children. Cleft lip and/or palate is one of the most common birth differences seen. Approximately one in 700 children born will have a cleft of the lip and/or palate. The cleft can be limited to a small notch on the lip or be a complete separation of the lip and palate all the way from the front of the face to the back of the mouth. Ideally, every child with a cleft should be followed by a team of specialists who can schedule and coordinate care for the best outcomes.
Dental treatment for children with cleft lip and palate comes in phases.
- The Newborn: Newborn children can have their upper gums (jaw) and nose reshaped prior to the first surgery. The gap in the jaw can be reduced. The cartilage of the nose can be molded and the shaped changed for the first 2 to 3 months of life. After the fourth month, the shape of the nose cartilage will remain the same for the rest of the child’s life. The first surgery for a cleft lip & palate child is usually done around age four months. The first dental care is a Nasal Alveolar Molding appliance or NAM. The NAM appliance can be used to reduce the gap in the gums, and reshape the cartilages of the nose. It can raise the tip of the nose on the effected side and reshape the flattened side (alar) cartilage. The first surgery closed the lip, but leaves a hole in the gums until the child is older.
- Pediatric Dentistry: Your child should see a pediatric dental specialist for routine care starting at age 6 months. Pediatric dental care will continue until the child is transitioned to a family dentist.
- Mixed Dentition Orthodontic Treatment: When your child is 6 to 7 years of age they will be seen for the first orthodontic evaluation. Often the front tooth next to the cleft will be turned sideways. Also, the upper jaw will be narrow due to the scars from the initial cleft surgery. The orthodontist will coordinate the best timing for starting treatment. The first orthodontic treatment is usually between age 8 and 11 determined by when adult teeth are moving close to the hole in the gum. The orthodontic treatment is used to align the segments of the upper jaw and move the front teeth out of traumatic occlusion prior to the alveolar bone graft which closes the hole in the gums.
- Adolescent Orthodontic Treatment: At age 12 to 14 when the adult teeth are all erupted, they can be aligned with braces. Often there will be an underbite due to under-development of the upper jaw. This underbite will remain until the child’s face has completed growth in the late teens.
- Adult orthodontic Treatment: After the face has completed growth in the late teens, the underbite can be corrected. This requires braces and a surgery to move the upper jaw forward. The surgery is done in the middle of the braces as the surgeon will want to use the braces for the first couple months after the surgery.