Cleft Lip and Palate

Question 1

What is the cleft lip and palate classification system?

Answer 1

LAHSHAL

Lip, alveolus, hard palate and soft palate.
Soft pallet, hard palate, alveolus and lip.

Question 2

What etiological factors are thought to contribute to CL&P?

Answer 2

Genetic- family history
Environment- social deprivation, smoking, alcohol

Question 3

What are the main issues associated with cleft lip and palate?

Answer 3

Speech- lots of air escapes through the nose while speaking- hyper nasal.
Feeding- babies cannot suckle
Aesthetics
Hearing/airway

Question 4

What departments are part of the MDT for CL&P?

Answer 4

ENT
Audiologist
Speech therapist
Orthodontists
Paediatric dentists
GDP
Restorative consultant
CNS
Psychology
Genetics
Co-ordinator

Question 5

At what age would a lip closure surgery occur?

Answer 5

3 months

Question 6

At what age would a palate closure surgery occur?

Answer 6

6-12 months.
Cannot be done before 6 months because babies are obligate nasal breathers until they are 6 months old.

Question 7

At what age would alveolar bone grafting surgery take place?

Answer 7

8-10 years old.

Question 8

What further surgery is optional for Cl&P?

Answer 8

Orthodontics- 12-15 years old.
Surgery after 16 years old for aesthetics.

Question 9

What are the dental implications of cleft lip and palate?

Answer 9

Hypodontia
Impacted teeth
Supernumeraries- usually distal to the cleft, usually lateral incisors.
Crowding
Caries
Enamel hypoplasia
Growth- 20% have a class 3 growth tendency
Delayed oral clearance
Microdontia or macrodontia

Question 10

What support is available for children and their families?

Answer 10

CLAPA website.
Facebook groups
Support nurse associated with the family
Organised support group meetings

Question 11

What caries risk level would a patient have if they had a cleft lip and palate?

Answer 11

High caries risk- follow the enhanced prevention pathway.