Dental

While dental treatment is free for under 18s, adult patients may find it hard to get the treatment they need from their local NHS dentist, especially for issues caused by a cleft which can be very complex. Some adults seek out private treatment instead, but this can be expensive and you won’t necessarily get the most appropriate specialist care.

Sometimes, patients with a cleft will have had so many hospital visits that they neglect dental health, and will only seek treatment when they have serious issues like pain or missing teeth. If you have a cleft, good oral health is extremely important, and it’s vital that you have regular check-ups with a dentist. The Clinical Psychologist in your Cleft Team can help you to overcome any phobias in this area, or you can try the Oral Health Foundation.

Common Issues & Treatments

If your cleft affects your gum, your teeth on either side might be in the wrong place or twisted. You may also have teeth missing.

If you haven’t had an alveolar bone graft or orthognathic surgery, these could be starting points for your treatment, depending on your needs.

Specialist care (orthodontics, oral and maxillofacial surgery and sometimes restorative care) will usually be carried out by your Cleft Team free of charge, but the provision of restorative dental care (bridges, implants and veneers) varies from area to area, so you should talk to your Cleft Team for more information.

If your dentist says a type of treatment is necessary, you should not be asked to pay for it privately – these should always be available at the usual NHS rates, and they should be of the same high standards as private treatments. This includes treatment that is usually considered cosmetic (such as implants), as long as it is for problems caused by your cleft.

Questions About Pricing

If you have questions about private or NHS charges for dental treatment, check the NHS Choices website for clarification about what is available, and how the charges work.

You can also contact NHS Dental Services directly via email or their helpline if you have a more specific question about your circumstances.

Finding a Dentist

NHS Choices is the best place to start when looking for a local dentist taking on NHS patients.

Some adults with a cleft can have problems finding a dentist that understands their particular issues and can provide appropriate treatment. If you’re having trouble finding a dentist that can help you, talk to your Cleft Team, as there will be a specialist dentist and/or orthodontist who may be able to advise you going forward. There is some inconsistency across the UK when it comes to where and how any dental care for patients with a cleft will be carried out, and you may be sent out of your local area to get complex care on the NHS.

If you are having trouble finding a local General Dental Practitioner to register with, it may be helpful to present them with this template letter explaining how vital dental care is for people born with a cleft.

Further Support

NHS Choices: Visit www.nhs.uk to find a local dentist and other resources to promote good oral health, as well as information on the costs of dental treatment under the NHS.

Oral Health Foundation: visit their website at www.dentalhealth.org/get-advice

Click here for our ‘Teething Issues: All You Need To Know About Dentistry’ Cleft Talk podcast

FAQs

How often should I go to see my General Dental Practitioner (family dentist)?

• Generally, up to twice a year for check-ups and cleaning. Your dentist will tell you if they need to see you more often.

What dental/orthodontic treatment may be available to me as an adult through the Cleft Team dentist/orthodontist?

• Even if you think there might not be any options for your teeth, or you’ve been told many years ago that there’s no further treatment available for you, it’s worth checking with the Cleft Team dentist and/or orthodontist.
• Some options include dentures, crowns, bridges, braces, and in some cases, veneers. A veneer is material added to a tooth to change the colour of the shape of the tooth. Veneers are most commonly made from composite (a type of plastic), but also can be made from porcelain or laminate.
• Remember that cleft-related treatment conducted by the Cleft Team is free of charge, so always check with the Cleft Team first before exploring private treatment.

When should I see my General Dental Practitioner vs the Cleft Team specialist dentist?

• You should visit your General Dental Practitioner for all the same reasons that somebody without a cleft would see the dentist. For example, for check-ups, cleaning, to check for caries and cavities or because you’re experiencing sensitivity and pain not related to cleft (e.g. an abscess in one of your lower teeth).
• You should see the Cleft Team specialist dentist for anything that you believe has happened as a result of being born with a cleft, e.g. missing or extra upper teeth, differences in the shape of the upper teeth, pain or sensitivity in teeth near the cleft site, etc. If you’re unsure, contact your Cleft Team for advice on who to see.

What will it cost to visit the dentist?

• Services through the NHS Cleft Team: no charge
• General Dental Practitioner Services: These vary depending on whether you live in England, Northern Ireland, Scotland or Wales. Search ‘NHS dental treatment costs’ and the country or region you live in to find up to date information.

What can I do if I’m scared of going to the dentist?

• A fear or phobia of going to the dentist is very common, even for people who weren’t born with a cleft.
• Go with a trusted friend, partner or family member for support, and/or talk to your dentist beforehand, as they could have some strategies to help you calm down if you’re feeling nervous. Some dentists may specify that they welcome nervous or phobic patients.
• Ask your dentist if you can listen to music if this is something that relaxes you.
• Speak to your Cleft Team Clinical Psychologist if you are particularly worried about visiting the dentist, especially if fear prevents you from visiting the dentist as often as you should.
• The Oral Health Foundation has a webpage for people to seek help and advice on dental issues.

Private Treatment

This section provides an overview of what private treatment is, how to tell if the person doing your treatment is suitably qualified, and what you should consider before going ahead with any private treatment.

What is Private Treatment?

• Any treatment done outside of the NHS Cleft Team is private treatment.
• You usually have to pay for private treatment, although services paid for by a health insurer, or any free treatment through a charity would also be considered private treatment. Please note that CLAPA cannot fund or part-fund any treatment costs.
• Private treatment can include Speech Therapy, Clinical Psychology/Counselling/Psychotherapy, Orthodontics, Dentistry, as well as surgery, medical tattooing or lip fillers. If you access any of these services through the NHS Cleft Team, this is not regarded as private treatment.

 Should I tell my Cleft Team if I’m thinking about having Private Treatment?

• If the procedure or treatment is cleft-related, it’s likely it would be available free of charge through the Cleft Team, so it’s worth asking them first.
• If it is not available on the NHS, it’s still recommended you talk to your Cleft Team so they can make sure that it is the right thing for you.
• Do not feel guilty, or worry that the Cleft Team will be offended by you seeking treatment elsewhere. NHS teams understand that patients may choose private treatment for a huge number of reasons. Some may be able to recommend private clinicians with appropriate experience.
• If you’re looking into private treatment because you’re unhappy with your current Cleft Team clinician(s), you are entitled to seek a second opinion from a different specialist within your team, or from another Cleft Team. Select another team (using the map in this pack, or visit com/cleftteams) and get in touch to ask about arranging a consultation. Please note that although you are entitled to seek a second opinion, it may not always be possible to receive treatment from a different team.

 Will Private Treatment achieve something that the NHS Cleft Team can’t?

• It’s important to understand what your hopes and expectations are for the treatment you’re seeking and to manage these appropriately. Even if the procedure is a success, there is always a risk that you’ll find yourself disappointed with the results of treatment.
• Your Cleft Team Psychologist can help talk you through this, even for private treatment.
• In most cases, the NHS Cleft Teams are your best option for specialist, comprehensive treatment. Your Cleft Team will have a good understanding of your medical history, individual needs, and the particular issues involved with treating a patient with a cleft. A private practitioner may not have this understanding, and may make recommendations based on incomplete information.
• If your Cleft Team are firm about not performing any more surgery for a particular issue, this may be disappointing. However, if you wish to seek surgery from elsewhere, carefully consider the risks in going against your team’s recommendations. If you do decide to seek private treatment, make sure your private practitioner is informed about the reasons behind the Cleft Team’s decision so this can be taken into account.
• If you’re unhappy with what your Cleft Team have told you, we would recommend seeking a second opinion from another team before considering private care.

 Are Private Practice Practitioners always qualified?

• Most healthcare professions in the UK are protected titles. This means that a practitioner must be registered with a recognised professional body to be able to call themselves a practitioner and to practice in the UK, including in private practice. These professional bodies include the General Medical Council, Nursing & Midwifery Council, Health & Care Professions Council (HCPC) etc.
• If someone has the title “Dr”, this does not necessarily mean they are a medical doctor. Some people who use the title “Dr” have a non-medical professional doctorate degree for a different clinical profession (e.g. dentists and clinical psychologists). Others may have an academic PhD which does not relate to clinical practice. Confusingly, surgeons who do have a medical degree (so were once called “Dr”), traditionally revert to using the title Mr/Mrs/Ms if they complete their training in the UK.
• A good clinician will make their job title and qualifications clear, and will not be offended if you ask them to clarify this.
• Some practitioners are not health professionals and do not have to be registered with the HCPC. This includes beauticians, who may do procedures such as lip fillers or lip tattooing, or nutritionists who give dietary advice. In these professions, there are vast differences in the amount of training different practitioners have had, so you want to be sure that you are going with someone reputable who has done your procedure many times before. Some local authorities regulate beauty salons, many others do not. Contact your local authority if you have any questions about a particular beauty salon.

What happens if something goes wrong with private treatment?

• Make sure you understand and are happy with the follow up care you will receive and what is included in the cost of your treatment. This includes what may happen if things don’t quite go as planned, as you may have to pay for extra appointments.
• Ask what you should do if you start experiencing a problem suddenly, or out of hours, as there may be situations where it is best to attend an A&E department.
• Some treatments are more complicated or need to be done differently when somebody has been born with a cleft. Make sure you feel comfortable that the practitioner understands, and is experienced with, cleft.

Why does the private clinic say I should have something done when the Cleft Team don’t think I do?

• Unlike the NHS, private practices are generally run as businesses. If you are on the fence about treatment, it is often (not always) in their interests to sell you treatment.
• Some people report having treatments suggested on top of those they had come to discuss, even if this is not something they had ever thought about before. This is called ‘upselling’. Be aware that their recommendation could be driven by a business model, rather than an issue you didn’t know you had.
• Give yourself time and space to carefully consider what is being offered, and talk through your options with someone you trust.