Dental Care for Children with a Cleft Palate

Dental care is an important part of the treatment needed for children with cleft palates. So, what do you need to know about it? Read on to learn the answers!
Dental Care for Children with a Cleft Palate
Vanesa Evangelina Buffa

Written and verified by the dentist Vanesa Evangelina Buffa.

Last update: 10 October, 2022

Children with cleft palate require special dental care. This malformation in the mouth predisposes them to suffer some alterations that, with proper and timely attention, can be avoided or counteracted.

A cleft lip or cleft palate are congenital defects of unknown origin, although they could be associated with various risk factors. Thanks to pregnancy controls, they can usually be detected through ultrasound scans before the child is born, which helps to be more prepared at the time of birth.

The lack of continuity in the lip or palate not only affects the appearance of these children. Eating and speaking complications and dental problems are other obvious consequences of this disorder. Its timely resolution improves the quality of life of the little ones. So, what should you keep in mind when it comes to dental care in children with cleft palates?

What is a cleft palate?

A cleft lip and cleft palate are two similar anomalies that arise during the gestational stage. In the first case, it affects the lip tissues; in the second, it affects the roof of the mouth. However, both can occur at the same time.

When the baby is developing in the mother’s womb, the bones and soft parts of the nose and mouth fail to fuse together to form the palate and upper lip. Thus, because they don’t fuse properly, an opening or separation persists in these structures.

This space is known as a cleft. It can have different sizes and affect different tissues:

  • A small fissure involving only the lip
  • A cider fissure involving the lip and extending to the nose
  • A cleft in the palate – this can be anterior (hard palate), posterior (soft palate) or complete (both areas)

These defects, in turn, can occur on only one side of the mouth (unilateral) or on both (bilateral fissures). Either way, their presence implies many problems in the oral functions of the child. Breastfeeding, feeding, speech, hearing, and the formation of teeth are aspects that are altered.

In addition, and especially when the lip is involved, the cleft is a very obvious malformation that affects the aesthetic level. Thus, there are often repercussions when it comes to a person’s social relations, self-esteem, self-confidence, and in their entire quality of life.

A baby with a cleft palate
The timely intervention of babies with cleft palate allows for improving their quality of life in the future.

The causes of cleft palates

The specific cause of this type of malformation isn’t entirely known. However, there are several genetic and environmental factors associated with it:

  • Genetic predisposition and family inheritance
  • Consumption of certain medications or drugs by the parents
  • First gestation
  • Exposure to toxins
  • Contact with certain viruses

Dental problems in children with cleft palates

Cleft lips and cleft palates are often accompanied by multiple disadvantages for those who suffer from it. From the moment of birth, the setbacks are evident. Therefore, seeking timely solutions will counteract the consequences.

Breastfeeding is one of the first complications that these babies and their families must face. The lack of lip closure or communication of the palate with the nostrils makes it difficult to suck and swallow breast milk.

Feeding in general and ear problems are other inconveniences caused by this malformation. Treatments and controls at the indicated times allow for overcoming these difficulties.

At the time of starting to speak, pronunciation and articulation of several phonemes are also affected. Treatments and interventions prior to this stage help to reduce the consequences of this malformation in oral communication.

However, regarding dental problems, the teeth closest to the cleft are usually the most affected. Other consequences are also generated, such as the following:

  • Increased prevalence of cavities and periodontal problems
  • Enamel hypoplasias
  • Abnormalities of shape, size, and number of teeth
  • Dental malpositions

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Cleft palate treatment

Thanks to technological advances, the diagnosis of a cleft lip and cleft palate is usually performed through obstetric ultrasound scans, before the birth of the child. This is a great advantage to planning the approach to the problem in advance.

If this hasn’t been possible, the diagnosis is made at the time of birth. The lack of union of these structures can be detected rough physical examination of the mouth, nose, and palate, From the moment of birth, interdisciplinary care of the child begins to improve the prognosis of his condition.

The therapeutic team is usually composed of pediatricians, maxillofacial surgeons, pediatric dentists, otolaryngologists, speech therapists, audiologists, and psychologists. If the case requires it, geneticists and social workers may also be involved.

Treatment is divided into two main stages. One is the surgical phase, which includes the necessary surgeries to close the clefts. The other corresponds to all other treatments and therapies for the rehabilitation of the child’s various functions.

Surgical treatment

The aim of the surgeries is to close the clefts. Depending on the type and extent of the malformation, surgery is performed in several stages or surgical times. The first operation is performed to resolve the cleft lip and is called a “cheiloplasty.”

This operation requires general anesthesia in the operating room. It’s usually performed before the baby’s first birthday. When the cleft lip closes, the shape of the upper lip and nose improves, and only a small scar remains.

If the child also has a cleft palate, a second surgery called a “palatoplasty” will be necessary. This is usually performed between 12 and 18 months of age before the child begins to speak.

This procedure closes the defect in the palate and the resulting communication of the mouth with the nostrils. This improves the child’s ability to eat, as it prevents food from going into the nose.

Many times, throughout the child’s life, new interventions to touch up the tissues will be necessary. These procedures are intended to improve the patient’s functions or appearance.

Other treatments

Surgical treatment corrects a large part of the defect. However, this intervention alone is not enough to recover the normal functions of the mouth. This is why it must be complemented with the participation of other disciplines specialized in the subject.

  • Childcare: Although it may be difficult, children with cleft lip and palate can be breastfed. This is the most advisable form of feeding. The nursery nurses must accompany and educate the mother to feed her baby correctly.
  • Temporary prosthesis: The placement of temporary prosthetic plates temporarily closes the communication between the mouth and the nose until the time of surgery. This allows the child to feed without the risk of food passing into the nostrils.
  • Dentistry and orthodontics: Monitoring the development of the jaws and dental eruption is essential to avoid mishaps in the mouth. The use of orthodontic appliances helps guide bone growth and reposition malpositioned teeth.
  • Hearing controls: Ear infections are very common in these children. Regular check-ups with the audiologist or otolaryngologist are essential.
  • Speech therapy: Due to the defect in the lip or palate, some people with this condition have difficulty speaking. Speech therapy exercises and treatments help to solve these complications.
  • Psychology: For both the child and his family, it can be very difficult to accept and assume this type of visible malformation and the treatments it requires. Psychological support provides useful tools to cope with this condition.

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Dental care in children with a cleft palate

Children with cleft palate should start dental care early. As mentioned above, the shape, number, size, and position of the teeth will most likely be affected. In addition, the risk of hypoplasia, cavities, or gum problems is also frequent.

For this, the intervention and support of a trained and qualified pediatric dentist are essential. In addition, the active participation of the parents or caregivers is necessary.

Dental care by the pediatric dentist in children with cleft palates

From the moment a child with cleft lip is born, the approach and treatment is carried out by a multidisciplinary team. The pediatric dentist is part of this care among several professionals and has a very important role.

He/she will be in charge of following the growth of the face, the jaw, and the eruption of the patient’s teeth. In this way, oral complications associated with this malformation can be detected in time to schedule appropriate therapies.

The placement of prosthetic plates to promote feeding is one of the first contacts of the pediatric dentist with the cleft child. Subsequently, other possible interventions are as follows:

  • Preventive treatments
  • Dental fillings
  • Exodontia
  • Placement of space maintainers
  • Rehabilitation with a prosthesis
  • Orthodontic treatment

The dentist must maintain fluid communication with the rest of the team, especially with the surgeons in charge of maxillofacial reconstruction. He or she must also work in coordination with the orthodontist to promote the growth of the jaws or the repositioning of misaligned teeth.

The dentist’s task will last throughout the child’s life, so establishing a relationship built on trust is essential. The pediatric dentist will follow and accompany the evolution of the growth of the teeth and jaw until after adolescence.

Regular dental check-ups are part of dental care for children with cleft lip or palate. According to the needs of each stage, the professional will indicate the periodicity of the visits.

Dental care in children with cleft palates
The pediatric dentist is part of the multidisciplinary team that treats cleft lips or palates in children.

Dental care for children with a cleft palate at home

Parents also play a very important role in the oral care of these children. Their accompaniment and commitment to the treatments, as well as home practices to keep the mouth healthy, are fundamental.

Complying with the indications of the health team and attending check-ups are one of the most important aspects. Looking for a center specialized in this type of condition can also help parents to find a quality service for their children.

In these spaces, families can find several specialties in the same place, which allows a coordinated work to provide wellness to the patient. In addition, it’s also more comfortable for the caregivers and the family.

If it’s not possible to find this type of site, it’s essential to search separately for each of the services needed for treatment. Among other things, it’s necessary that parents take care of maintaining optimal oral hygiene for their children.

Pediatric dentists will show them the correct way to do it. It will also be a good idea to use fluoride, according to the dentist’s recommendations, and to take care of nutrition to prevent diseases in the mouth.

Patience is a key part of dental care in children with cleft palates

Dental care is particularly important in children with cleft lips or palates. In addition to having to cope with the consequences of having a gap in the lip or palate, these children often suffer from other complications in the mouth.

Beginning early treatment by a specialized multidisciplinary team is key to achieving better health. Although the procedures demand time, perseverance, and a lot of patience, most of the little ones respond successfully and with little or no sequelae.

The changes may not be immediate, but recovery will come. Be patent and stay strong! It’s well worth being constant and accompanying the transformation in your child’s mouth with responsibility and love.

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The contents of this publication are for informational purposes only. At no time can they serve to facilitate or replace the diagnoses, treatments, or recommendations of a professional. Consult with your trusted specialist if you have any doubts and seek their approval before beginning any procedure.