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Chromosomal and Genetic Conditions

Cleft Dental Problems

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    Do Children with Cleft Lip and Palate Experience Any Special Dental Problems?

    Children with clefts can have a number of dental problems.

    They are at greater risk for cavities. Their teeth often have small weak or defective areas in the enamel (hard coating) that are more prone to decay. Their saliva can be thicker, which reduces its natural washing action in the mouth. Their teeth can be crowded, which can make it hard to brush well.

    These children also have a high risk of some tooth irregularities such as missing or extra teeth, abnormally shaped teeth or teeth in unusual positions. Our specialists are familiar with techniques for managing these dental problems.

    How Can Cleft Lip and Palate Affect How the Teeth Look?

    There is a great variation in how the teeth will look.

    All primary (baby) teeth will commonly show up in good alignment but usually with a little gap in the area of the cleft. Sometimes there is some disturbance in the formation of the enamel of the teeth in the cleft area and those teeth may be more prone to cavities.

    Teeth in the cleft area might also be a little slower to grow into their positions in the mouth. This is still considered normal.

    The shape of a tooth close to the cleft is sometimes a little different from the tooth on the noncleft side. Sometimes there are teeth missing that were never formed.

    Permanent (adult) teeth may have more irregularities, and most children with a cleft will sooner or later require orthodontic treatment.

    We recommend that an orthodontist on our team see a child with a cleft when the child is around 2 years of age. This allows us to coordinate dental and orthodontic needs with other treatments such as surgery to maximize benefits.

    Phases of Orthodontic Treatment

    Orthodontic treatment may include the following:

    Infancy

    Nasoalveolar molding before the first surgery uses a plastic device like a small retainer to improve the position of the lip and the nose. The alveolar is the part of the jaws where the teeth grow. This molding helps the surgeon achieve the best result possible during the cleft lip repair.

    6 to 10 years

    The cleft of the tooth-bearing part of the jaw needs to be repaired with an alveolar bone graft if this has not been done at an earlier age.

    To prepare for this bone-graft surgery, it's often necessary to put the tooth-bearing segments in better position in relation to each other so the jaw has a more normal shape. The front teeth in the upper jaw may need to be aligned if they are irregular.

    The orthodontist will take X-rays of the face and teeth to evaluate the growth of the face and to get information about the teeth that have not yet grown in. Children with a cleft are always at risk of having less growth of the maxilla (upper jaw) than of the mandible (lower jaw).

    If this growth difference is large, the child might develop an underbite. An underbite at an early age may need early orthodontic treatment.

    12 to 18 years

    Final orthodontic treatment is done. Some children with a cleft will need a combination treatment with orthodontics and jaw reconstruction surgery to restore a normal relationship between the upper and lower teeth.

    Who Treats This at Seattle Children's?

    Should your child see a doctor?

    Find out by selecting your child’s symptom or health condition in the list below:

    Spring 2014: Good Growing Newsletter

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