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Dental care for cleft lip and palate Flashcards

1
Q

What is the UK incidence of cleft lip +/- palate?

A

1:700 livebriths

1000 new cases per year

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2
Q

What are the classifications of cleft lip+/- palate?

A 
soft palate
soft and hard palate
cleft lip
cleft lip and alveolus
cleft lip and palate
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3
Q

Is cleft lip +/- palate more common in girls or boys?

A

Boys

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4
Q

Is cleft palate more common in girls or boys?

A

girls

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5
Q

T/F. Cleft palate is associated with a wide range of chromosomal abnormalities? what is the percentage and wha are the syndromes?

A 
True
15% are associated with other syndromes 
sticklers
van der woudes
pierre robin
di george 22q and VCFS
more than 400 syndromes
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6
Q

In which race is cleft lip +/- palate most common?

A

Indian and oriental subpopulations

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7
Q

Are right or left sided clefts more common?

A

Left

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8
Q

What are the two phases of palatogenesis?

A
  1. Primary palate - lip and alveolus

2. Secondary palate - hard and soft palate

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9
Q

At what stage in utero does palatogenesis take place?

A

5-12 weeks in utero

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10
Q

What occurs in the formation of the primary palate?

A

fusion of the maxillary and median nasal processes

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11
Q

What occurs in the formation of the secondary palate?

A

shelf formation
shelf elevation
shelf fusion

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12
Q

How do the palatal shelves fuse?

A

MEDIAL EDGE EPITHELIUM DEGENERATION

there is programmed cell death, cell migration and epithelial mesenchymal transformation

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13
Q

What are the causes of cleft lip+/- palate?

A
  1. Genetic predisposition
  2. associated with chromosomal abnormalities
  3. Teratogens
  4. increased paternal age
  5. maternal smoking/rubella
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14
Q

What surgical procedures are there to reduce clefts?

A
  1. Lip repair (3months): correct muscle layer, aesthtics, functionals appliance eg milliard, delaire
  2. Palate repair (6/9-12 months): close the palate to achieve velopharyngeal competance where ONF closed for speech
  3. Alveolar bone graft (8-9 years)
  4. Pharyngoplasty
  5. orthognathic surgery
  6. Lip adhesions
  7. Lip revision
  8. Nasal surgery
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15
Q

Additional problems for patients with clefts?

A

speech and hearing defects

up to 20% have additional abnormalities such as skeletal/cardiac/renal/CNS

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16
Q

Which teams look after patients with cleft lip+/- palate?

A 
max fax
ENT
Speech and hearing therapists
ortho
dentists
17
Q

What are the oral health status of cleft lip+/- palate patients?

A

OH is poor
poor self-cleansing
high caries prevalence

18
Q

what dental complications can patients with cleft lip and palate get?

A
  1. increase in natal/neonatal teetj
  2. absent teeth
  3. supernumeraries
  4. anomalies in tooth morphology
  5. rotated teeth adjacent to the cleft
  6. Mobile premaxilla/ increased bilateral overbite
  7. cross bites
19
Q

What would these mean:

  1. LAHSAL
  2. L…..
  3. ….al
  4. ..hs..
A
  1. complete bilaterial cleft lip, and palate
  2. right complete cleft lip
  3. left incompleye cleft ip and alveolus
  4. incomplete cleft hard and soft palate
20
Q

What is the incidence for unilaterial cleft lip and palate?

21
Q

WHat is the incidence for billteral cleft lip and palate?

22
Q

WHat is CLP?

A

craniofacial malformation

23
Q

WHat is the aetiology behind cleft lip and palate?

A

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

24
Q

What happens at birth for children with CLP?

A 
contact within 24 hours
specilaist nursing
breast feeding rarely possible 
use special soft bottles
sympathetic support
25
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
26
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 ```
27
how can you diagnose clp prenatally?
from ulftrasound
28
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 ```
29
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
30
What is the orthodontic treatment for cleft lip and palate?
pre surgical orthopeadics pre bone graft orthodontics orthodontics orthodontics with osteotomies
31
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
32
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
33
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
34
What is the purposeof the pre bone graft ortho?
expand the upper arch laterally corerct anterior x bite retain corrections splint incisors in BCLP
35
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
36
What type of speech errors do people with cleft lip and palate have?
Anterior and posterior
37
What are rhe posterior errors?
Non oral and passive
38
What are the anterior errors?
Oral
39
What is the DMFT for CLP in Bristol?
1.6

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