Cleft Palate

Orthodontist and Braces

The Role of the Orthodontist

Tooth development is affected in children with a cleft lip and palate. 

When the cleft runs through the gum line, the normal 'horseshoe' shaped of the dental arches is disrupted.  

Many children with a cleft are born with a missing tooth (lateral incisor) and occasionally a child maybe born with an extra tooth.  Many children will have crooked teeth, crowded teeth and dental arches that are collapsed.  The children will not have enough bone to support the development of permanent teeth.

The orthodontist plays a critical role in:

• Naso-Alveolar Molding to help the surgeon with the cleft lip repair 
• Braces to align the teeth properly
• Working with the surgeon to repair the gum line with bone so that the dental roots will be better supported 
• Working with the surgeon to support the jaw surgery in adolescence Working with the prosthodontist for dental implants and dental bridges in young adulthood

Role of an Orthodontist

An Orthodontist is a dentist that specializes in straightening teeth and correcting irregularities in the alignment of teeth and the jaw. Non-straight teeth and irregularities in the alignment of teeth can make speaking and eating difficult. 

Goals for Treatment

Our  goal is to straighten teeth and align the jaw to improve dental function and appearance, and prepare patients for surgery, if necessary. 

Treatment

Our Orthodontists work closely with plastic surgeons, jaw surgeons, and prosthodontists. Orthodontists are involved at every step of your child's treatment plan to monitor the growth of the jaw and teeth. 

Treatment is individualized to your child's needs based on severity and age. Early treatment is important because more treatment options are available for younger children.

Having straight teeth is important for healthy gums  and to reduce the risk of gum disease and cavities.  

Braces

During the pre-teen and teenage years, your child might need braces to further help teeth grow straight and stay in place. Braces can either be put on the front or the back of teeth, depending on how teeth need to be moved. Braces are made of small brackets that are cemented onto teeth and connected with a wire. Over time, the wire will be tightened to help shift teeth and the jaw into place. Sometimes, your child may be asked to wear rubber bands on their braces to shift teeth into place.

Braces can help fix an overbite, an underbite, a crossbite and other irregularities in the alignment of teeth and the jaw. Braces do this by applying pressure on teeth to move teeth and the jaw into place. Moving the jaw into place is important so that biting pressure is equal over all the mouth. 

Palate Expander

If a crossbite is present, your child may need a palatal expander before braces. In a crossbite, upper teeth are narrower than lower teeth, and may be inside or behind lower teeth. Upper teeth should be wider than lower teeth for proper function and bite. A palatal expander widens the roof of the mouth so that the upper and lower teeth can fit together properly

There are 3 age groups orthodontist are typically involved in children born with cleft lip and palate:

1. Infants (0-1 year)
2. Childhood (6-12years) 
3. Teenage Years (15-18 years) 

Infants

Before the cleft lip repair, some infants may benefit with and orthopedic appliance to mold the lip, palate and nose.  This is called Nasal Alveolar Molding or NAM for short.  Some children may only need a palatal plate appliance to stabilize the alveolar dental arch segments.  The care and treatment of each infant who is born with a cleft lip and palate is individualized and is guided by the surgeon and the orthodontist working together.

Childhood

In later childhood, ages 6 to 12, when baby teeth are being replaced by permanent teeth, the orthodontist is involved at this stage.  The goals of Phase I orthodontic treatment include:

1. Correct the width of the palate which is often collapsed using a palatal expander
2. Initial alignment of teeth 
3. To work with the plastic surgeon to fix the cleft in the gum line with a bone graft (Cleft Alveolar Bone Graft Procedure) 
4. It is important to repair the gum line before the canine tooth erupts.  The earlier the bone graft that can be done, the better it is.  The bone graft stabilizes the dental arch and the teeth along the cleft margin

Adolescence

When all the permanent teeth are in, the plastic surgeon and the orthodontist will follow your child for how the jaws develop.  In some children with facial clefts, the upper and lower jaws do not develop properly and jaw surgery is needed.  While in some children the jaws develop appropriately.

Having straight teeth is important for healthy gums  and to reduce the risk of gum disease and cavities.