Dental care for cleft lip and palate Flashcards
What is the UK incidence of cleft lip +/- palate?
1:700 livebriths
1000 new cases per year
What are the classifications of cleft lip+/- palate?
soft palate soft and hard palate cleft lip cleft lip and alveolus cleft lip and palate
Is cleft lip +/- palate more common in girls or boys?
Boys
Is cleft palate more common in girls or boys?
girls
T/F. Cleft palate is associated with a wide range of chromosomal abnormalities? what is the percentage and wha are the syndromes?
True 15% are associated with other syndromes sticklers van der woudes pierre robin di george 22q and VCFS more than 400 syndromes
In which race is cleft lip +/- palate most common?
Indian and oriental subpopulations
Are right or left sided clefts more common?
Left
What are the two phases of palatogenesis?
- Primary palate - lip and alveolus
2. Secondary palate - hard and soft palate
At what stage in utero does palatogenesis take place?
5-12 weeks in utero
What occurs in the formation of the primary palate?
fusion of the maxillary and median nasal processes
What occurs in the formation of the secondary palate?
shelf formation
shelf elevation
shelf fusion
How do the palatal shelves fuse?
MEDIAL EDGE EPITHELIUM DEGENERATION
there is programmed cell death, cell migration and epithelial mesenchymal transformation
What are the causes of cleft lip+/- palate?
- Genetic predisposition
- associated with chromosomal abnormalities
- Teratogens
- increased paternal age
- maternal smoking/rubella
What surgical procedures are there to reduce clefts?
- Lip repair (3months): correct muscle layer, aesthtics, functionals appliance eg milliard, delaire
- Palate repair (6/9-12 months): close the palate to achieve velopharyngeal competance where ONF closed for speech
- Alveolar bone graft (8-9 years)
- Pharyngoplasty
- orthognathic surgery
- Lip adhesions
- Lip revision
- Nasal surgery
Additional problems for patients with clefts?
speech and hearing defects
up to 20% have additional abnormalities such as skeletal/cardiac/renal/CNS
Which teams look after patients with cleft lip+/- palate?
max fax ENT Speech and hearing therapists ortho dentists
What are the oral health status of cleft lip+/- palate patients?
OH is poor
poor self-cleansing
high caries prevalence
what dental complications can patients with cleft lip and palate get?
- increase in natal/neonatal teetj
- absent teeth
- supernumeraries
- anomalies in tooth morphology
- rotated teeth adjacent to the cleft
- Mobile premaxilla/ increased bilateral overbite
- cross bites
What would these mean:
- LAHSAL
- L…..
- ….al
- ..hs..
- complete bilaterial cleft lip, and palate
- right complete cleft lip
- left incompleye cleft ip and alveolus
- incomplete cleft hard and soft palate
What is the incidence for unilaterial cleft lip and palate?
25%
WHat is the incidence for billteral cleft lip and palate?
10%
WHat is CLP?
craniofacial malformation
WHat is the aetiology behind cleft lip and palate?
Genetic: complex, syndromic, non syndromic, >400 single gene causes
environmental: smoking, diet, seasonal, illness, Low SES, drugs, phenytoin, thalidomide, rubella, increased maternal and paternal age
What happens at birth for children with CLP?
contact within 24 hours specilaist nursing breast feeding rarely possible use special soft bottles sympathetic support
What type of factors are seen in people with cleft lip and palate speech?
nasal emission
nasal turbulence
hypernasality
nasal grimace
cleft type charactersitics: anterior errors, non errors, and passive errors
What is the care pathway for cleft lip and palate?
cuounselling at birth after scan 3/12 lip repair 6-9/12 palate repair speech and language therapy 5 yr audit 7-11 years alveolar bone graft 10 audit checks orthodontics 15 audit checks orthognathic surgery 2- audit checks
how can you diagnose clp prenatally?
from ulftrasound
What is the pathophysiology behind cleft lip?
develops at 3-7 weeks due to failure of 4 processes to unite maxilliary lateral nasal pricess medical nasal process frontonasal process
WHat is the pathophisiology behind cleft palate?
forms at 5-12 weeks
Problem with maxillary PROMINENCE
Primary: Maxilliary process with Medial Nasal process forms the philtrum
Sedondary: shelves form from front to back
What is the orthodontic treatment for cleft lip and palate?
pre surgical orthopeadics
pre bone graft orthodontics
orthodontics
orthodontics with osteotomies
What is pre surgical orthopaedics?
to help with growht and facilitate feeding and reduce the gap aiding surgery but not sure how much benefit
Happens at birth to 3/6months
what is the caries rate in cleft lip and palate children compared to Bristol and west midlands?
CLP bristol 1.6 vs normal 1.1
CLP WM 2.3 vs 0.9
WHat is the purpose of alveolar bone grafting? and what are the benefits?
bone graft into the alveolar cleft allows non prosthetic alignement
allows permanent canine to erupt
intact maxilla
closes any residual ONF
stabalises the premaxilla in BCLP and improves alar base support
What is the purposeof the pre bone graft ortho?
expand the upper arch laterally
corerct anterior x bite
retain corrections
splint incisors in BCLP
What is the purpose of osteotomy in orthodontics?
those will skeletal class 3
prior to this need ortho to decompensate teeth and then treat when growth is comeplete
What type of speech errors do people with cleft lip and palate have?
Anterior and posterior
What are rhe posterior errors?
Non oral and passive
What are the anterior errors?
Oral
What is the DMFT for CLP in Bristol?
1.6
