Jonathan Alexander Abt formerly served as a locum orthodontic consultant at Luton and Dunstable Hospital, treating complex cases such as cleft lip and palate as well as surgical orthodontic cases. This article will take a closer look at treatment options for individuals with cleft lip and palate and the special care that must be taken by people with the condition to maintain good oral health and hygiene.
In the UK today, approximately one in every 700 infants is born with a cleft lip and/or palate. It is the most common congenital abnormality affecting the face, with approximately 1,200 babies born with the condition in the UK annually according to the British Orthodontic Society.
Cleft means split, cleft lips and palates arising from different parts of the face failing to fuse together as they should in early pregnancy. Cleft palate, which affects the roof of the mouth only, is the most common form of the condition. The least common form, bilateral cleft lip and palate, affects both sides of the lip as well as the roof of the mouth.
Scientists have yet to determine the precise cause of cleft lip and palate. Research suggests that a variety of different factors play a part, including both environmental and genetic influences. Experts are quick to point out that a baby’s cleft is extremely unlikely to have been caused by anything the parents did or omitted to do, with a weight of medical evidence proving that they can arise in even the healthiest, best-planned pregnancies.
People with a cleft lip or palate can suffer from dental anomalies and speech disorders as well as hearing difficulties, impaired facial growth, and difficulties in psychological wellbeing and socialisation. Treatment pathways for babies affected by cleft lip or palate generally start before birth, when the condition is detected via antenatal scans. These infants are treated by specialist cleft teams who provide surgery and specialist care to ensure affected individuals achieve good feeding from birth. These specialists also strive to ensure that patients have a good facial appearance, normal speech, satisfactory hearing and psycho-social wellbeing.
Treatment of cleft lip and palate includes operations, with babies born with the condition needing at least one operation to repair the cleft and some requiring more as they grow up. If the cleft affects teeth and gums, they will need extra treatment and support such as restorative dentistry or braces. Children born with a cleft palate may benefit from speech therapy. They may also require help with hearing as well as psychological support. Patients and their families are generally supported by cleft-specialist clinical psychologists throughout the entire treatment pathway. Children will need to attend regular outpatient appointments so their condition can be monitored closely, enabling caregivers to detect and deal with any issues swiftly.
Management of cleft lip or palate demands the involvement of various different medical specialities throughout growth and development to the age of at least 20. Routine care generally extends to adults for a number of years.
Care for the condition covers a wide range of specialties and procedures, chief among them orthodontics. The patient’s treatment will be prescribed by a lead consultant orthodontist who is responsible for overseeing each regional team. The aim of care is to ensure the highest level of orthodontic treatment as part of an integrated treatment plan involving other specialties needed for effective cleft care. In addition, orthodontists working in cleft teams may offer ancillary services, such as speech plates to aid speech where surgery is not a viable option. They may also advise on accessing other aspects of dentistry and preventing dental disease, particularly dentil caries which can be a significant problem for individuals with a cleft lip or palate.
