Ortho- Cleft Flashcards
How common is cleft?
1:7000 live births.
20% bilateral 80% unilateral
What method do we use to describe the cleft and how does it work?
LASHAL
this describes the structures that the cleft passes through.
L-Lip.
A-Alveolus.
S-Soft palate
H-Hard palate.
What do lower case letters mean in the LASHAL method?
that the cleft doesn’t pass fully through.
List some causes of cleft?
genetic- syndrome. Family history. Sex ratio CLP M>F. CP F>M
environment- smoking. alcohol. low socioeconomic demographic
What are the implications of UCLP?
Aesthetic- baby can’t be breast fed.
dental- missing teeth/crowding .
speech- air needs to be stopped going through the palate to get those plosive sounds (PH TH)
other anomalies = 40% will have heart defects.
hearing- more prone to glue ear
What are the dental impacts of Cleft?
missing teeth- teeth in the line of the cleft don’t erupt (commonly lateral incisors). We can also get funny teeth beside it. e.g. small lateral incisor.
impacted teeth- crowding & supernumeraries at the cleft site stops tooth eruption.
growth- palate scarring restricts maxillary growth.Class III
caries - misaligned teeth make it harder to clean. teeth are often hypoplastic
crowding - due to small compressed jaw and scarring
What is the patient journey for cleft treatment
3 months- close lip
6-12 months close palate.
8-10 years alveolar bone graft
12-15 definitive orthodontics
18-20 surgery.
Why is the palate closed after 6 months?
because babies are obligate nasal breathers - closing it would cause the lip to swell & the patient wouldn’t be able to breathe
Who are the members of the dental team involved in treating cleft?
paediaric dentist
dental therapist
orthodontist.
orthodontic therapist.
restorative dentist
oral surgeon
At what age does the oral surgeon complete bone grafting and expansion.
not before the patient is 8/9 as we don’t want to damage the growing teeth. we want the canine to be half formed as it moves most quickly at this point.
what is the treatment for a good jaw grower?
Space closure/ opening.
Class I incisor relationship.
what is the treatment for a poor jaw grower?
We use orthodontics to line up the patient’s teeth but leave them in a class III position.
what is the treatment for a borderline jaw grower?
we tend to orthodontically line up the dentition to see the aesthetic
What is the risk of orthognathic surgery in cleft patients?
risk of affecting speech- the soft palate its less flexible in cleft patients so if we move forward the jaw it might no longer be able to hit the back of the pharynx.
