Cleft Lip & Palate

Question 1

What history should be taken for a child with cleft lip and palate?

Answer 1

• medical history
  
  • surgeries and hospitalisations
  • upcoming surgeries
  • other specialties visited
  • medications
  • allergies
• pain history
• dental history
  
  • previous treatment
  • dentally anxious
  • parental dental attitude
• diet history
• social history
  
  • social work involvement
• family history
  
  • clefts

Question 2

What dental findings are more commonly found with a cleft lip and palate?

Answer 2

• hypodontia
• supernumerary teeth
• increased caries rate
• enamel defects
• malocclusion
• crowding
• delayed eruption
• ectopic teeth
• misshapen teeth
• shortened roots
• larger crowns
• taurodontism

Question 3

Who is involved in the multidisciplinary care of patients with cleft lip and palate?

Answer 3

• GDP
• orthodontist
• cleft surgeon
• ENT
• speech therapy
• plastic surgeon
• psychologist
• specialist restorative dentistry
• audiology

Question 4

When do patients undergo surgical treatment and what procedures are involved?

Answer 4

• 6-12 months
  
  • lip repair surgery
• 18 months
  
  • palate repair surgery
    
    • gap in palate closed
    • muscles and lining rearranged
    • bone graft in alveolar ridge
• 12-15 years old
  
  • ortho treatment
  • monitoring jaw growth
• rhinoplasty can be considered to improve nose shape

Question 5

What support is available for children and families with cleft lip and palate?

Answer 5

• clinical psychologist
• support nurse
• CLAPPA
• Facebook support groups

Question 6

What is the caries risk of patients with cleft lip and palate?

Answer 6

high caries risk

Question 7

What preventive plan should patients with cleft and palate be on and what does it involve?

Answer 7

• enhanced prevention regime
  
  • high caries risk
• fluoride varnish
  
  • 22,600ppmF
  • 4 times annually
• fluoride toothpaste
  
  • 2,800ppmF or 5,000ppmF
  • must be over 10 years old
• fissure sealants
  
  • all first permanent molars on eruption
    
    • occlusal pits and fissures
    • palatal of upper
    • buccal of lower
• toothbrushing advice
  
  • spit don’t rinse
  • 2 minutes twice a day
• check ups
  
  • every 3 months

Question 8

How can caries in deciduous molars be managed in patients with cleft lip and palate?

Answer 8

• do nothing
  
  • pain
  • infection risk
  • not recommended
• extraction
  
  • LA
    
    • over multiple appointments
  • inhalation sedation
    
    • consider contraindications
  • GA
• SDF carious lesions
• SSC
  
  • must be enough tooth tissue to support
    
    • more than 2/3 marginal ridge
    • if broken down must be extracted
  • mostly enamel caries
    
    • must have clear band of dentine
    • between caries and pulp