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Houston Cranio Facial

Dental and Orthodontic Treatment for Children with Cleft Lip and Cleft Palate

Most parents who have a child with a cleft lip and/or palate will ask what the surgeries for their child will entail without realizing that there is more to it than just the lip and palate. Children need to also have their dental health carefully taken care of while they grow up. Here is a timeline of what to expect based on your child’s age.

Newborn to 1 year old

  • Start Nasal-Alveolar Molding (NAM) within 2 weeks old: Follow up appointments for adjustments every 1-2 weeks until surgery
  • The first surgery is at 3-6 months old to repair the cleft lip and nose
  • Baby teeth erupt at around 6 months old: It is very important to brush teeth that erupt
  • Avoid dental cavities by not putting your infant to bed with a bottle.
  • The cleft palate will be repaired during this time frame.

Ages 2-3 years old

  • Your child’s first dental visit will be at about 2 years old
  • Regular 6 month visits with the dentist in addition to the cleft team are important.
  • At this age, almost all baby teeth have erupted Children with a cleft of the palate and gums often have delayed eruption of baby teeth and adult teeth.
  • The cleft palate makes it difficult to clean the teeth leading to a higher risk of cavities.
  • It is very important to have good dental hygiene to prevent loss of teeth, even baby teeth.

Ages 3-5 years old

  • Regular 6 month visits with the dentist for cleanings and preventing cavities are important.
  • Child should brush teeth twice a day and begin flossing daily!
  • Avoid unhealthy foods like soft drinks and sugar to prevent cavities

Ages 5-8 years old

  • Continue with regular 6 month visits with the dentist for cleanings
  • Referral to orthodontist for beginning of treatment in preparation for alveolar bone grafting (bone graft to the cleft in the gum line).
  • Orthodontist will help with movement of the dental arch and teeth using: Dental x-rays, Palatal expander, Braces.
  • Alveolar bone graft takes place when unerupted adult teeth are almost formed and ready to erupt.
  • Some baby teeth may need to be removed prior to alveolar bone graft
  • Children should continue to brush twice to three times daily with flossing daily

Ages 9-11 years old

  • At this age, children have both baby and adult teeth called mixed dentition
  • Follow up with the craniofacial team to plan for surgery
  • This is the most likely age for alveolar bone grafting
  • Continue with regular 6 month visits with the dentist for cleanings
  • Children should continue to brush twice to three times daily with flossing daily
  • Orthodontist will continue to move the teeth into position prior to bone graft
  • Some teeth may need extraction at this age by your dentist or oral surgeon

Ages 12-15 years old

  • The orthodontist will continue to position the teeth for a great smile
  • Typically, children with a cleft will be missing some adult teeth
  • Good dental hygiene by brushing twice/three times daily and flossing is important!
  • Follow up with craniofacial cleft team for planning jaw surgery if necessary
  • Continue with dentist visits every 6 months to prevent dental cavities and clean teeth.

Ages 16-21 years old

  • Continue to have regular 6-12 month visits with the cleft team for jaw and nose surgery.
  • Regular visits with the dentist every 6 months
  • Good dental hygiene by brushing twice/three times daily and flossing
  • Oral surgeon evaluation for possible wisdom teeth extraction if necessary
  • Corrective jaw surgery when skeletal maturity reached (final growth spurt completed)
  • Restorative dental implants if necessary after jaw surgery
  • Continue to wear retainer after orthodontia braces are completed

The health of your child’s teeth cannot be stressed enough for someone who has a cleft palate. The bone health depends on the health of the teeth. Therefore, if the teeth are lost, then it will lead to someone wearing dentures at a very young age.