Dental Health & Orthodontics

Good oral health is important for all children, but this is especially true for children with a cleft, as they are more vulnerable to tooth decay and other issues.

Your family dentist will be looking after your child’s dental health most of the time, but in some cases the treatment a child with a cleft needs is complicated, and they may need more specialised care.

The Paediatric Dentist with the Cleft Team will have seen your child several times already. They will see them again at 7.5 years and again at 10 years to make sure that everything possible is being done to keep your child free of tooth decay and pain. Any future treatment your child may have will be easier if their oral hygiene is to a high standard, and if no teeth have been lost to decay.

It’s important for your child to have regular dental check-ups with a General Dental Practitioner (family dentist); if you’re having trouble accessing local dental care because of long waiting lists, it may be helpful to present them with this template letter explaining how vital dental care is for people born with a cleft.

Good Dental Health

Paediatric Dentists will aim to prevent tooth decay and therefore prevent pain as well as the need for fillings or extractions. This helps to maintain the bone in which the teeth are embedded and will make orthodontic treatment easier. Your family dentist should be aware of any issues caused by your child’s cleft, and can advise them on how to prevent tooth decay.

Most children won’t be able to brush their own teeth efficiently until they are nine or ten, so you may want to compromise by allowing them to brush their teeth independently in the morning but then helping in the evening until you’re confident they’re reaching their teeth properly. Even if children are reluctant to brush their teeth, it’s worth insisting as prevention is much better than cure. Flossing shouldn’t be necessary until adult teeth start coming through, and then it can help a great deal with preventing plaque building up between the teeth.

Top Tips for Dental Health:

• The less time the teeth spend ‘under attack’ by bacteria the better, so try to stick to only three meals a day and avoid snacking between meals.
• If your child needs to eat between meals, stick to foods that don’t contain much sugar, and watch out for ‘hidden’ sugars in foods like tomato sauce, savoury biscuits and even dried fruit.
• Be extra careful with drinks that contain sugar, such as fizzy drinks or fruit juice. Sipping on a drink throughout the day (unless it is water) can cause tooth decay. Milk is a good thing for children to drink, but it does contain a natural sugar, and if it is regularly drunk at night time it can cause tooth decay.
• If your child has already had problems with tooth decay, discuss with your dentist if they need additional fluoride. This is usually in the form of a mouth rinse to be used daily. Rinsing is especially effective during orthodontic treatment, as braces can make it difficult to clean the teeth well.
• Wearing a custom-made mouth guard during sports will reduce the likelihood of your child’s teeth being damaged.

Orthodontics

Orthodontics is a type of dentistry that corrects the position of teeth. Orthodontists correct irregular teeth by using orthodontic appliances, and the most commonly used is a ‘fixed appliance’, usually called braces. These help to align the teeth.

Children with a cleft that might affect their teeth will have been seen by a specialist orthodontist from an early age to monitor and manage any issues that come up.

What kind of orthodontic treatment your child will need depends largely on whether or not their cleft affects the alveolus, which is the socket in the jawbone where the teeth are set. Children born with a cleft that went through the gum and affects their teeth will usually need more extensive orthodontic treatment. This normally includes an Alveolar Bone Graft (ABG) surgery between the ages of 8-12. This surgery aims to fill the gap in the gum before the child’s adult teeth come through. To prepare for this surgery, an orthodontist may need to widen the area around the cleft to allow the surgeon to access it easier, and this can involve your child wearing braces for a while before surgery.

After the majority of permanent adult teeth have come through in early adolescence, the orthodontist will look at any issues such as missing, irregular or discoloured teeth and work closely with the dentists and surgeons in the Cleft Team to see what can be done about any problems. Treatment for these will depend on the child’s individual needs, and might include braces, crowns, and even surgery to realign the jaws (orthognathic surgery) in their late teens.

If your child will need this kind of treatment, you should be in regular contact with an orthodontist who can best advise you on how to support your child at this time.