A cleft palate often creates problems with the upper jaw and teeth. These problems can almost always be solved over time by treatment from a skilled pediatric dental team.
Your child's pediatric dental team is an important part of the Children’s Healthcare of Atlanta Craniofacial team. Members of a pediatric dental team may include a pediatric dentist, an orthodontist, a prosthodontist, dental hygienists and assistants, and a craniofacial surgeon.
Your child's pediatric dental team can take a number of steps (which may be spaced over years) to correct problems with your child's teeth and jaws.
- Poor Occlusion
Occlusion is the way the upper and lower teeth fit together when the mouth is closed. A cleft palate may affect the size and shape of the upper jaw and cause a poor fit.
- Altered Facial Appearance
The shape of your child's face may be affected by a cleft in his upper jaw. Such problems can be treated and corrected over time.
- Early or Late Appearance of Teeth
The teeth in the cleft area may appear earlier or later than the teeth around them. This is caused by how they are positioned in the jaw. These teeth may grow into a normal position. More often, however, they will need to be straightened.
- Missing, Extra and Poorly Formed Teeth
Like any other child, a child with a cleft palate may have a number of problems as teeth grow into the mouth. Poorly formed teeth are more likely to develop tooth decay. Your pediatric dentist will discuss all problems and review treatment options with you as needed.
Teach your child about good oral hygiene as soon as possible. This means keeping the teeth and mouth clean. It begins when your child's first baby tooth appears, and it includes:
- Brushing with a toothbrush and toothpaste at least twice each day
- Using dental floss after meals to clean between teeth
- Visiting the pediatric dentist twice each year for routine checkups and cleanings
Oral hygiene can prevent many problems and help your child achieve the best possible results from treatment.
Your child's orthodontist at Children's will perform different types of treatment as your child grows older.
A baby with a cleft lip and palate may have trouble feeding. If the palate is split, food may escape through the nose. Also, an opening in the roof of the mouth can weaken a baby’s ability to suck.
To correct such problems, your pediatric dentist or orthodontist can insert an obturator in your child’s mouth. This is a plastic device that fits over the roof of the mouth and acts as a palate. It helps babies create suction for feeding and prevents most food from escaping through the nose. A special dental paste is sometimes used to hold it in place.
After an obturator is placed, your pediatric dentist or orthodontist will check it often and adjust it as needed. An obturator is worn until the cleft palate is surgically closed at about 6 to 9 months old.
Your child’s upper lip may need to be "molded" to reduce stress on it. This is often done by stretching a piece of foam tape over the lip. Other devices may also be used for this. Your Craniofacial team will decide which type of molding is best for your child.
Your dental team at Children’s will watch your child’s teeth develop for several years until it is time for the bone graft.
- This is surgery to insert bone into the area of the cleft.
- To prepare for the bone graft, the Craniofacial team will study X-rays, photographs and models of your child's mouth.
- From these studies, the craniofacial team will make a treatment plan that is best for your child's needs.
Quite often, a child's upper jaw must be expanded before a bone graft may be done. There are a number of devices for this. The pediatric dental team will explain the device that is best for your child.
- An expansion device is usually worn for several months before the bone graft is done.
- After the bone graft, the device is left in place as a "retainer" for several more months.
- Your child may need to wear a retainer until the final phase of treatment is done during his mid-teens.
Other treatments may also be needed at this time to correct your child's teeth and jaws. This phase of treatment can take up to a year and a half.
The final phase of treatment is usually begun after all adult teeth appear. The orthodontist will study X-rays, photographs and models of your child’s mouth. From these studies, the orthodontist will make a treatment plan that is best for your child’s needs.
During this phase of treatment, your child will likely be fitted with braces. More expansion of the upper jaw may also be needed.
If your child needs pediatric dental surgery, it will occur about one to one and a half years after braces are fitted. Braces will remain in place after surgery.
If your child is missing teeth, the problem may be corrected with some type of implant. It depends on how many and which teeth are missing. Your pediatric dental team will discuss types of implants with you as needed.
This phase of treatment often takes two to three years.