Chapter 19: Dental Care

The correct care of your child's teeth and mouth plays an important part in the overall management of the cleft problems. Well-cared-for teeth are necessary for efficient chewing and good development of the jaws and face, speech, self-image and appearance. Keeping one's own teeth is an asset for anyone. For the person who had a cleft of lip or palate, it is more than an asset: it is essential. One aim of treatment and care should be to try to avoid the loss of any natural teeth, and thus, to avoid the need for artificial dental replacement (this will be discussed more later). Primary 'baby' teeth will be lost naturally and replaced by permanent teeth. The primary teeth are important, however, as they maintain space in the dental arch while the permanent teeth are forming and while the jaws are growing.

In a child with a cleft lip, front teeth, especially permanent teeth, are occasionally poorly formed, crooked, missing or increased in number. This is especially so in the region of the cleft. It is extremely important that the teeth adjacent to the cleft are maintained; otherwise, the bone around the cleft will disappear and this will result in a sinking-in of the overlying lip.

Your child's teeth are just as strong as any other child's at first, but because they may be malpositioned or crowded they are more difficult to keep free from dental plaque. Dental plaque is a white or cream-coloured coating that contains many bacteria. Some bacteria produce acids that cause dental decay and others produce toxins leading to inflammation of the gums (gingivitis) and periodontitis (disease of the bone below the gum line around the roots of the teeth).

Tooth decay and gingivitis can be prevented:

Encourage the child to eat nutritious foods and avoid those that can hasten decay and gingivitis. Children who consume foods with a high sugar content such as sweets, juices, jam, soft drinks, chewing gum, chocolates and ice cream, are at risk of poor nutrition. The emphasis should be on natural not processed foods. Avoid sticky, sweet snacks, biscuits and fast foods. Some breakfast cereals can be high in sugar. Children should not be put to bed with a bottle of juice or other sweet drink to act as a pacifier, as this is notorious in leading to severe tooth decay. The same applies to putting sweetsubstances on the dummy.

Resist putting a young child to sleep with a feeding bottle filled with plain milk this can also be harmful to the teeth. When the milk is held around the teeth for a length of time it breaks down, forming acids which will produce tooth decay.

Maintain good oral hygiene. Cleaning the teeth should begin as soon as the primary teeth start to appear. For the very young child, this can be accomplished with a soft cloth or cotton gauze, or a small, soft toothbrush and toothpaste (any recognized brand that contains fluoride). Even when your child grows older, it is best to continue to use a toothbrush that has a small head containing many soft bristles, all with rounded ends. If the teeth are properly cleaned to remove dental plaque, then the gums, or gingivae, will also be kept free of this plaque.

The acid that plaque bacteria produce causes tooth decay very soon after sugar is taken into the mouth. It is, therefore, recommended that teeth are cleaned as soon as possible after any meals or snacks.

Almost everyone brushes his or her teeth regularly but not so many people take care to also brush along the gum line around each tooth. Much dental decay develops along this gum or gingival line. The gingivae is also very liable to become infected leading to gingivitis with redness, easy bleeding and some swelling. The longer that gum brushing is neglected, the more likely gingivitis will become worse and develop into periodontal disease under the gingivae. Periodontal disease is progressive and is the reason for loosening of teeth among adults.

In addition to encouraging the habit of tooth brushing and gum brushing, you should be helping your child learn how to use dental floss, which provides the only effective way of cleaning between adjacent teeth.

Remember, too, that children learn habits of good health care by following the good examples of their elders.

Consult your family dentist regularly, at least once each year, about your child's dental health (this can begin at the age of two years, or earlier) and whenever you have questions about abnormalities of the teeth.

Fluoridation is another important aid to stronger teeth. It has long been known that fluoride increases resistance to tooth decay, and the best results are seen if the fluoride is started from a very early age. In some areas drinking water may not be fluoridated; your local council will be able to tell you whether yours is. If your water is not fluoridated, it is essential that your child has fluoride daily, which can be given as a tablet or as drops. The appropriate daily dose of fluoride is 0.5 milligrams up to 12 months of age; 1 milligram from 1 to 2 years and 2 milligram for 2 to 18 years. Fluoride toothpaste is also of benefit and your dentist will apply a special fluoride coating to the teeth at the time of check-ups.

No doubt your child will require more care of the teeth because of the cleft, but with regular check-ups, sensible diet and careful oral hygiene, you can expect your child to have healthy teeth for the rest of his or her life.

Further Information

To obtain further information on "Cleft Lip and Palate: A Parent's Guide", please contact Belinda Liston:

Belina Liston
Cleft Palate Clinic Coordinator
The Cleft Palate Clinic
The Children's Hospital at Westmead
Locked Bag 4001
WESTMEAD NSW 2145
AUSTRALIA
T: + 61 2 9845 2079
F: + 61 2 9845 2078
E: BelindaS4@chw.edu.au