Cleft Lip and Palate Flashcards
what is the dentist’s role on a craniofacial team?
-be a liaison btw the team and the family dentist or private peds dentist who provides the child’s routine dental care.
what % of clefts are cleft lips only?
20-30%
what % of clefts are cleft lip and alveolus?
1-10%
what race is most likely to get clefts?
2:1 whites than non-whites
what is a class I cleft lip?
vermilion border
what is a class II cleft lip?
Vermilion border + part of the lip
what is a class III cleft lip?
Unilateral complete cleft lip
what is a class IV cleft lip?
Bilateral cleft of lip only
what is a class I cleft palate?
soft palate only
what is a class II cleft palate?
Unilateral soft and hard palate/lip
what is a class III cleft palate?
Unilateral soft/hard thru alveolus
what is a class IV cleft palate?
total bilateral palate/lip thru alveolus
what is the tx of a cleft for a newborn
palatal molding/lip bands
what is the tx of a cleft for 2-3 month old
surgical correction
what is the tx of a cleft for early childhood?
pharyngeal flap
what is the tx of a cleft for 7-10 years?
alveolar bone graft
what is the tx of a cleft for childhood?
orho tx and prostodontics
what is the tx of a cleft after growth?
orthognathic surgery, cosmetic surgery, dental restoration
what is the rate of caries like for cleft lip/palate pts?
high prevalence in primary and permanent teeth
*poor hygiene, delayed oral clearance, nutritional issues (high caloric diet to gain weight), higher level of sucrose and starches in diet, colonization of appliances, parent overindulgence
which teeth have the highest prevalence for caries in cleft lip/.palate pts?
- incisors then second molars
* no good studies on prevention of CLP
what is perio disease like in CLPs?
no sig differences among different type of cleft regarding plaque control, calculus, gingivitis, attachemnt loss and perio microbiota
***one exception is that probe depths are shallower in CLP pts who have not had ORTHO tx
what is the importance of prevention for CLPs?
ultimate success of bone graft dependent on controlling/eliminating gingivitis before the graft
*perio status is normalized after bone grafting
what are the ways to prevent disease for CLPs?
- diet
- oral hygiene
- fluride
- early intervention (tooth deftects)
- recall frequency
- patient/parent education
is it the dentist’s tole to provide dental home services to families?
yes
what is facing the parents of CLP and you as the dentist?
- shock, loss, grief and worry in accomplishing daily tasks
- development of a concept of normalcy for their child
- buy in on the need for them to be experts in care
- buy in to be able to make informed choices for their child
what are the frustrations for families of CLP?
- repetition of health history for multiple providers
- dealing with varying understandings of CLP by providers **
- less available quality social support
- family stresses on marriage
** families place high value on the quality of knowledge of health providers
by what age do kids with CLP have dissatisfaction with facial appearance and psychosocial problems significantly associated
10-15
in girls with CLP, self-worth seems to decline when?
teens
*in boys it goes up
are parents of CLP pts more/less tolerant of behavior problems
less
what is the realistic approach you should take of your pts with CLP?
- perfection is not always achievable
- small improvements may be significant
- parents accept small improvement
- broaden your concept of success
- accept non-dental accomplishments as part of your job
what is the main role of treatment of CLP pts that are school aged children?
- adjustments to appearance and function to facilitate assimilation into the school environment
- fabrication of an obturator, ant tooth replacement, encourage effective speech, discussion of the timing fo surgeries
what do you do for a school aged CLP pt post graft?
PROSTHETIC HABILITATION
- tooth recontouring
- make canine/premolar look like lateral incisor/canine
- coorect crowding/spacing
- early implants// later implants
- fixed vs removable prost
