Cleft Lip and Cleft Palate
It is a distressing experience for the mother to see her new baby with a cleft lip and palate. Such a deformity is very obvious, and often the parents have a feeling of guilt or shame. It would be reassuring for the parents to know just how much can be done to remedy the condition. Surgical treatment to close the lip defect is made early— often before the child leaves hospital with its mother for the first time. This is, of course, a good psychological factor for the mother and for other members of the family, and lessens the risk of ‘rejection’ of the child as not quite belonging. However, the time of surgery and its nature depends on the condition of the child—a decision to be made by the surgeon. The immediate problem at birth is that of feeding, and lip closure surgery helps this.
Satisfactory treatment of the cleft palate/lip of child requires a team effort and may involve all or any of the following: family doctor, paeditrician, dentist, orthodontist, prosthetist, oral surgeon, ENT surgeon, community service, plastic surgeon, speech therapist, dental technician and dental hygienist.
An appliance is necessary in a large proportion of cases to close the defect in the palate and this may be constructed in the form of a partial denture attached to the teeth. Often the teeth are displaced and may be so malaligned that they are difficult to clean and could easily decay. It is essential that careful preventive measures for preservation of the teeth are observed so that tooth loss is avoided. These teeth, whether first teeth or second, are needed for retention and support of the obturator which aids speech. Regular visits to the dentist and hygienist for plaque control and applications of fluoride are essential.
Of the one in 750 births where cleft palate occurs, some are due to genetic factors and others may be due to environmental accidents such as the taking of certain drugs during pregnancy or other outside influences. After such a birth the family doctor and the parents should investigate whether there is any genetic defect and, if so, consider whether they should risk further pregnancies.
If your child is specially-abled in some way you must mention it to the dentist and special care will be taken. Dental hygienists are trained to care for children with different handicaps and they will explain to the parent any special home dental care that is required. The practice may also demonstrate individually designed brushes or holders for those who have difficulty in gripping ordinary brushes. If your general dentist is not able to attend to handicapped children or even normal children for one reason or another, or if he believes your child is a ‘special’ case requiring specialist treatment, he may refer you to a paedodontist who is a specialist in children’s dentistry.