OROFACIAL CLEFTS

Individuals with Special Needs: Orofacial Clefts

Andrea Loving
DHY185
January 9, 2019
OROFACIAL CLEFTS

Individuals with Special Needs: Orofacial Clefts

Our job as dental professionals is to provide personalized care for each of our patients, all

while being sympathetic, understanding, and nonjudgmental of each individual’s circumstances.

Being knowledgeable of the different special needs is crucial to ensure that all our patients are

being given the best treatment they can possibly receive. Individuals who are born with orofacial

clefts have special complications that require additional assessments for caries, possible intraoral

appliances, and appropriate instruction for oral home care.

Out of all possible defects that infants can be born with, orofacial clefts are the most

prevalent in the United States. Approximately one in six hundred babies is born with a cleft

abnormality, whether that be the lip, the palate, or both (Darby and Walsh). This birth defect is

more commonly seen in males than females and it is more commonly seen among American

Indians, non-Hispanic whites, and Asians than other ethnic groups (Darby and Walsh, 2020).

Babies born with clefts are more prone to dental complications as well as feeding difficulties

early on before surgeries can be performed. Today, orofacial clefts are a treatable birth defect

due to advancements in cosmetic and orthognathic surgery (Darby and Walsh, 2020). This is

typically completed within the first year of life for those suffering with cleft lip, and for cleft

palate surgery is usually accomplished during the six to eighteen months age range (Wehby,

2019).

Cleft lip or palate occurs when a baby’s lip or mouth does not properly form while in

utero. The lip forms between weeks four and seven (Darby and Walsh, 2020). As the baby

grows, the tissues form from each side and meet in the middle. If this process is not completed

properly, cleft lip occurs, leaving a slit in the baby’s upper lip (CDC, 2018). This slit can vary in

size from small to large. When a baby is born with a cleft palate, it is caused by a disturbance
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during weeks six through nine (CDC, 2018). During this time, the lateral palatine processes have

failed to fuse together, leaving an open space between the nasal and oral cavities. This deformity

may be attributed to late horizontal movement of the palatal shelves. Micrognathia and

macroglossia could also be a factor, blocking the shelves and preventing fusion of the palatine

processes (Darby and Walsh, 2020). It is not completely understood what directly causes

orofacial clefts. However, there are some factors that can increase the possibility of the

abnormality such as smoking or drinking while pregnant, poor nutrition, environmental

influences, or genetic predisposition (Darby and Walsh, 2020).

Those born with this defect have an increased risk of dental caries particularly in the

areas near the cleft. Children born with a cleft have 3.5 times more decayed surfaces than those

who have proper cleft development (Darby and Walsh, 2020). The oral clearance in this area is

less efficient, causing longer retention of fermentable carbohydrates. With frequent dental

cleanings every three to four months, fluoride, nutritional counseling, and dental sealants, a

patient who has an orofacial cleft can decrease their risk of caries development (Darby and

Walsh, 2020).

Properly educating the caregiver of oral home care techniques is crucial to maintain oral

wellness during the times when the patient is not in the office. The Fones technique along with

sulcular methods are typically chosen for this type of patient (Darby and Walsh, 2020). A small

toothbrush head may provide better access to the area, and interdental cleaning is also important

as well (Darby and Walsh, 2020).

Financial problems can be an additional issue that those with orofacial clefts experience

(Wehby, 2019). With lack of insurance coverage or low income, it can be almost impossible for

individuals to receive the proper care they need. Another barrier they experience is lack of
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access to properly trained care providers. Many providers are comfortable giving routine care to

these patients but are not confident in providing cleft specific services (Wehby, 2019).

Receiving additional training may be necessary to provide for these patients.

As mentioned previously, orofacial clefts are one of the most common birth defects in

our country. Therefore, many individuals will require our specialized care services. As dental

professionals, we must become aware of the accommodations and services we must provide to

these patients. As with all the patients we treat, we must be empathetic, kind, and understanding

of their special need and do our best to make the patient feel comfortable in our chair.
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References

Bowen, D. M., Pieren, J. A., & hygiene, D. undefined. (2020). Darby and Walsh dental hygiene:
theory and practice. Maryland Heights, MO: Elsevier.
Facts about Cleft Lip and Cleft Palate. (2019, December 5). Retrieved from
https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html.

Nidey, N., & Wehby, G. L. (2019, April 10). Barriers to Health Care for Children with Orofacial
Clefts: A Systematic Literature Review and Recommendations for Research Priorities ||
Oral Health and Dental Studies || Rivera Publications. Retrieved from
http://riverapublications.com/article/barriers-to-health-care-for-children-with-orofacial-
clefts-a-systematic-literature-review-and-recommendations-for-research-priorities.