Cleft lip and cleft palate are among the most common birth defects. The National Institute of Dental and Craniofacial Research (NIDCR) cites CDC estimates that about 1 in every 1,050 U.S. babies is born with cleft lip with or without cleft palate, and about 1 in 1,600 with cleft palate alone. Care often continues from infancy into the teen years, and dental and orthodontic care is a big part of it. This guide explains what to expect.
What a cleft is
The NIDCR explains that early in pregnancy there is normally a split (cleft) between the right and left sides of the lip and the roof of the mouth (palate). Sometime during the 6th to 11th week, it comes together. If the tissue doesn’t join, a cleft lip or palate results.
- A cleft lip can be a small slit or a large split extending into the nose, on one or both sides or in the middle.
- A cleft palate may affect the front, back or both parts of the palate.
- A baby may have one or both.
Causes
According to the NIDCR, causes include inherited gene changes and genetic syndromes. Clefts appear in more than 400 syndromes, and about 30 percent are associated with one. A mother’s poor health in early pregnancy, drinking alcohol, smoking or certain anti-epileptic medicines may increase the risk. MedlinePlus adds drugs, viruses or other toxins, and notes a higher chance with a family history.
Effects on feeding, hearing, speech and teeth
The NIDCR says children with clefts may have trouble eating and breathing and may later have speech and language delays. They are more likely to have ear infections, hearing loss and dental problems. MedlinePlus lists feeding problems, milk flowing through the nose during feeding, poor weight gain, repeated ear infections, speech difficulties and poorly aligned teeth.
Diagnosis
The NIDCR says a cleft lip may be seen on a routine pregnancy ultrasound and is usually visible at birth. Some types of cleft palate aren’t easily visible and may be found later.
Treatment
A team approach
The NIDCR says children are often referred to a team that may include an ear, nose and throat doctor, plastic surgeon, oral surgeon, speech pathologist, pediatric dentist, orthodontist, audiologist, pediatrician, nutritionist and psychologist or social worker. Genetic counseling is recommended because clefts are so often part of syndromes.
Surgery
- MedlinePlus says cleft lip surgery is often done between 2 and 9 months of age. The NIDCR says it’s usually before the first birthday.
- Cleft palate is most often closed within the first year so speech develops normally (MedlinePlus). The NIDCR says before 18 months.
- A temporary prosthetic device sometimes closes the palate so a baby can feed and grow until surgery (MedlinePlus).
- More surgeries, dental and orthodontic care and speech therapy may be needed later (NIDCR).
Dental and orthodontic care
MedlinePlus says children who had a cleft palate repair may need to see a dentist or orthodontist, and teeth may need correcting as they come in. Practical steps:
- Establish a dental home early. See your child’s first dental visit and pediatric vs general dentists.
- Ask the cleft team when orthodontic evaluation should start. See when kids should see an orthodontist.
- Keep up daily brushing and cleaning between teeth. See how to brush your teeth.
Hearing and speech follow-up
MedlinePlus says hearing problems are common, so children should have an early hearing test, repeated over time. Speech problems can persist after surgery because of palate muscle problems, and speech therapy helps.
Tips for families
The NIDCR suggests asking for advice if your baby has trouble nursing or bottle-feeding, asking the care team to explain anything you don’t understand, and seeking support from family, friends and other parents.
Frequently asked questions
Will my child do well?
The NIDCR says that with treatment, most children with cleft lip or palate do well and lead a healthy life.
Will my child need braces?
Possibly. MedlinePlus says teeth may need correction as they come in. Your cleft team will advise.
Sources
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Newborn baby sleeps in a basket” by Elizabeth, via Wikimedia Commons, licensed CC0. Resized and compressed for the web.
Our guides are written and reviewed by the Dentist Review editorial team. We research each topic using public, authoritative sources such as the CDC, the National Institutes of Health (NIH/NIDCR), the American Dental Association (ADA) and CMS, and we update guides when guidance changes. Guides are for general information only and are not dental or medical advice; please read our disclaimer and learn more about us.