Medical Professionals Treating Children with Cleft Lip and Palate

Oral Health Fact Sheet for Medical Professionals Treating Children with Cleft Lip and Palate

Cleft lip is a congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominence; thought to be caused by faulty migration of the mesoderm in the head region. It can include cleft palate that is a congenital fissure of the soft and/or hard palate, due to faulty fusion (ICD 9 code 749)

Oral Manifestations and Considerations

Oral

• Congenitally missing teeth
• Supernumerary teeth
• Malformed teeth
• Fistulas may be obturated
• Ectopic eruption of primary maxillary anterior dentition

Other Potential Disorders/Concerns

• Many conditions may have an associated cleft
• Understanding the condition is critical to dental management of the patient.

Oral Side Effects of Commonly Prescribed Medications

Medication

Persons with clefts may have other conditions for which they need medication, but typically no special medications are taken.

Parent/Caregiver Support and Guidance

• Surgical scarring may limit mobility of maxillary lip and vestibule. Advise caution when manipulating this area.
• Discourage consumption of cariogenic foods and beverages.
• Prescribe sugar-free medications, if available.
• Recommend preventive measures such as topical fluoride and sealants.
• Advise the use of fluoridated toothpaste twice daily and support the family in following dental care instructions.
• Instruct caregiver on appropriate protocol following dental trauma (locate/preserve missing tooth and putbin cold milk; seek immediate professional care).
• Review safety issues appropriate to the age of the child, such as mouth guards to prevent oral-facial trauma.
• Recommend rinsing with water thoroughly after taking each dose of sugar containing medication andnfrequent water intake for patients taking xerostomic medication.
• Discuss habits that may harm the child’s teeth such as propping baby bottles, putting child to bed with bottle.

References

• Policy on management of patients cleft lip/palate and other craniofacial anomalies. Pediatr Dent. 2008-2009;30(7 Suppl):238-9. American Academy on Pediatric Dentistry Clinical Affairs Committee; American Academy on Pediatric Dentistry Council on Clinical Affairs.
• Reisberg, D.J, Dental and Prosthodontic Care for Patients With Cleft or Craniofacial Conditions, Cleft PalateCraniofac J:2000Nov; 37 (6): 534–537. Review.
• Precious, D.S, Goodday, R.H, Morrison, A.D,. Davis, B.R. Cleft lip and palate: a review for dentists. J Can Dent Assoc. 2001 Dec;67(11):668-73. Review
• Rivkin, C.J, Keith, O, Crawford, P.J, Hathorn, I.S. Dental care for the patient with a cleft lip and palate. Part 1: From birth to the mixed dentition stage. Br Dent J. 2000 Jan 22;188(2):78-83. Review.
• Rivkin, C.J, Keith, O, Crawford, PJ, ,Hathorn, I.S. Dental care for the patient with a cleft lip and palate. Part 2: The mixed dentition stage through to adolescence and young adulthood. Br Dent J. 2000 Feb 12;188(3):131-4

Additional Resources

• NIH Institute for Cleft Lip and Palate
• Special Care: an Oral Health Professionals Guide to Serving Young Children with Special Health Care Needs
• Bright Futures Oral Health Pocket Guide
• American Academy of Pediatric Dentistry: 2011–2012 Definitions, Oral Health Policies and Clinical Guidelines
• MCH Resource Center
• ASTDD – Special Needs
• Block Oral Disease, MA
• Free of charge CDE courses: MCH Oral Health CDE (4 CDE hours) NIDCR CDE (2 CDE hours)