The most common facial birth defect in the UK is cleft lip and palate as it affects 1 in 700 babies. The severity of this condition varies with some infants only presenting with a cleft lip while others have a combination of cleft lip and cleft palate.
The cleft is seen as a gap on the upper lip and/or on the roof of the mouth and is believed to be caused by environmental and genetic factors. The changes in the facial structure also has a bearing on a child’s teeth and gums and these need to be monitored or addressed at certain stages to improve function and form as well as aesthetics.
Some of the dental issues that cleft lip and palate patients face include speech problems, difficulty in feeding/eating and a variety of unfavourable changes in the upper jaw and teeth.
Some patients can have problems in pronouncing words and their voice may turn out nasally. This problem is usually addressed by surgery and a speech therapist can help them develop and improve their speech as they get older.
Eating and drinking can also be challenging especially for patients who have a cleft palate because there is a communication between the mouth and the nose. To ensure that everything goes down to the stomach as they eat, dental appliances (like a palatal obturator) can be used. Infants can also be fed with baby bottles and nipples designed to facilitate proper feeding.
Teeth formation can also be influenced with the nearest ones to the cleft more prone to dental decay. This is due to the improper development of the enamel – the hardest and outermost part of our teeth.
Disturbances in the eruption pattern of teeth can also occur as inadequate space may prevent the timely eruption of teeth. Tooth shape can also be altered, much more so on those nearest to the cleft and there can also be malpositioning or missing teeth.
The development of the upper jaw can also be affected as the arch can be shortened if no surgical intervention is made to gain back its normal shape, height and thickness. The relationship of the upper jaw with the lower jaw can also be affected and a person’s bite can change. Orthodontic treatment after the addressing the cleft is usually required for this dental issue.
Treatment of cleft lip and palate is a multi-specialty approach that needs a group of specialists in both the medical and dental field. Nurses, speech therapists, cosmetic surgeons, psychologists, oral surgeons and dentists will have to collaborate to make sure that a treatment time table is followed starting from birth until the patient’s dental issues are addressed in puberty.