From birth to the mixed dentition stage

Cleft lip and palate is one of the commonest congenital abnormalities. Around 1 in every 700 live births in the UK has a cleft of the lip and/or palate. The type of cleft can range from a simple incomplete cleft of the soft palate, which is not clinically obvious and may be undiagnosed in the early days, to a bilateral complete cleft involving both the soft and hard palate, alveolus and lip. Management of the patient with a cleft is best carried out by a multi-disciplinary team of healthcare professionals who undertake the cleft care from birth through to adulthood. Specialties represented on the cleft team in the UK vary from region to region but the core members of the team are the surgeon, orthodontist, speech and language therapist, and ENT specialist. The Royal College of Surgeons Steering Group on Cleft Lip and Palate recommends that the care of children with clefts should be carried out by a team whose members are able to provide dental care, audiology, specialised counselling and clinical genetics.

The pre-mixed dentition years. Within the first few days after the birth, parents of babies born with a cleft lip and palate will receive advice in hospital from the surgeon and orthodontist on the immediate and long-term management of their child. This will often be supplemented by written information on the condition itself, and related aspects including oral health and dental care. The orthodontist is usually the first dental specialist whom the family will encounter. The health visitor and general medical practitioner will give post-natal support to the family and advice on feeding.

Parents of babies with a cleft appear to welcome opportunities for discussion and support regarding their child's dental development. They are also mentally preparing for the necessary lip surgery at about 3 months after birth, and palate repair later in the first year. Parents appreciate the opportunity to ask questions and to have time to discuss any concerns about their child's teeth. Parents can be particularly anxious about teething and what the teeth might look like when they eventually erupt. They often focus on the anticipated future appearance of their child's teeth. Establishing the correct dental habits from an early age will help to ensure the health of the primary and permanent dentition.

Medical history

The child with a cleft may have associated anomalies. An understanding of the medical condition is essential to allow for appropriate dental management and treatment planning. This requires good communication between the hospital and dentist providing regular care. It is important to obtain details concerning the child's prescribed medication. The regular administration of sucrose-containing medicines will give rise to dental caries. It is essential to explore the possibility of a sugar-free alternative in these cases.

Social history

Each patient and their family have their own particular needs. Some parents feel isolated with their problem, while others cope very well. The Cleft Lip and Palate Association is a support group formed by parents of children with a cleft and professional staff caring for these patients. Contact with other parents and children in a similar situation is helpful for some families.

Date: 2016-06-12; view: 10