Dental care for children with clefts

Understanding Cleft Lip and Cleft Palate

Cleft lip and cleft palate are birth abnormalities of the mouth and lip. In the United States, nearly 6,800 babies are born with oral-facial clefts each year.

Cleft lip and cleft palate occur early in pregnancy when the sides of the lip and the roof of the mouth do not fuse together as they should. A child can have cleft lip, cleft palate, or both. It's important to know that most babies born with a cleft are otherwise healthy. The most common early problem associated with cleft is feeding your baby.

Cleft Palate

Cleft palate occurs when the roof of the mouth doesn't completely close, leaving an opening that can extend into the nasal cavity. The cleft may involve either side of the palate. It can extend from the front of the mouth (hard palate) to the throat (soft palate). Often the cleft will also include the lip. Cleft palate isn't as noticeable as cleft lip because it's inside the mouth. It may be the only abnormality in the child, or it may be associated with cleft lip or other syndromes. In many cases, other family members have also had a cleft palate at birth.

Cleft Lip

Cleft lip is an abnormality in which the lip does not completely form during fetal development. The degree of the cleft lip can vary greatly, from mild (notching of the lip) to severe (large opening from the lip up through the nose). As a parent, it may be stressful to adjust to the cleft, as it can be very noticeable.

What Are the Causes?

The exact cause of cleft lip and cleft palate isn't completely understood. Cleft lip and/or cleft palate may be caused by multiple genes inherited from both parents. They also can be caused by environmental factors that scientists don't yet fully understand. When a combination of genes and environmental factors causes a condition, it is called "multifactorial." Because genes are involved, the chance for a cleft lip and/or cleft palate to happen again in a family is increased. A genetic counselor can offer more information.

Cleft Complications

Beyond appearance, cleft lip and cleft palate may cause other problems:

  • Feeding difficulties: These occur more with cleft palate. The baby may be unable to suck properly because the roof of the mouth is not formed completely.

  • Ear infections and hearing loss: Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Recurrent infections can lead to hearing loss.

  • Speech and language delay: Because of the opening of the roof of the mouth and the lip, muscle function may be decreased. This can lead to a delay in speech or abnormal speech.

  • Dental problems: Teeth may not erupt normally. A cleft may affect the alveolar ridge (upper gum and bone containing the teeth). Because of this, some teeth may be incorrectly shaped, out of correct position, or entirely missing. There may even be extra teeth. Orthodontic treatment is usually needed.

Managing and correcting cleft abnormalities is handled by a team of health care providers. The team may include oral and maxillofacial surgeons, an orthodontist, a pediatric dentist, and a speech and language specialist. Your child's pediatrician will follow your child as he or she grows and help coordinate the specialists involved.

 

Sources:

"Parents and Individuals:About Cleft Lip and Palate." Cleft Palate Foundation, October 12, 2007. http://www.cleftline.org/parents-individuals/. Accessed 2013.

"The First Four Years." Cleft Palate Foundation, 2008. http://www.cleftline.org/docs/Booklets/FFY-01.pdf.Accessed 2013.

"Frequently Asked Questions." Cleft Palate Foundation, December 9, 2008. http://www.cleftline.org/parents/frequently_asked_questions. Accessed 2013.

"Prevalence (Number of Cases) of Cleft Lip and Cleft Palate." National Institute of Dental and Craniofacial Research, December 20, 2008. http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/CraniofacialBirthDefects/PrevalenceCleft+LipCleftPalate.htm.Accessed 2013.

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