Orthodontic Treatment

Text supplied by: Heather Keall, Orthodontist Middlemore Hospital and Peter Fowler, Orthodontist Christchurch Hospital

The vast majority of children born with a cleft (either lip and/or palate) will need some form of orthodontic treatment.  Most will need to wear braces in their teenage years.

Orthodontics is the specialty in dentistry concerned with the growth and development of the jaws, straightening of teeth and correction of the way that teeth fit together.
The Orthodontist sees some babies with clefts in the first few weeks of life in order to make a plastic plate used to re-shape the mouth so that the best plastic surgery result possible may be obtained when the cleft is closed. It can also aid with feeding.  At the first appointment a dental impression is taken of the baby’s mouth and the plate is fitted later in the week.
Plates are usually acceptable to babies and many are unhappy when they are taken out.  Plates are worn from around 2 weeks of age until the first operation at about 3-5 months.  Adjustments to the plate by the orthodontist are required during this time.

Around 3 months of age it may be necessary to place some elastic strapping across the upper lip in order to mould the middle part of the jaw into a more normal relationship with the side parts.  The strapping sometimes involves the making of a cotton bonnet (full instructions given) that fits the baby’s head well and a removable piece of elastic that is attached to the bonnet on each side.  This moulds baby’s upper lip and the front part of the jaw.  When the lip is repaired, the early treatment is complete.
The child is seen at regular intervals at the cleft clinic and the dental development is monitored.  Children should be enrolled at the school dental clinic at age 1 for routine dental check-ups and treatment if necessary for tooth decay or with a private family dentist or a private paediatric specialist dentist. (Note: treatment with a private dentist is not free).  This allows an optimal preventive program to be tailored to your child’s needs.  The management of some of the dental problems associated with cleft lip and palate (eg extra teeth or malformed teeth in the line of the cleft) may be best carried out by a dentist.  It is important that you as parents take good care of your child’s teeth through regular brushing from an early age, and by keeping sweet foods and drinks to a minimum.

Some children with clefts require a bone graft to the gum area where the cleft was repaired in order to have a chance of developing a full arch of healthy teeth.  This involves a course of orthodontic treatment and begins when the upper eye tooth begins to develop a root - somewhere between 8 and 11 years.  The orthodontic treatment is followed by graft surgery.
Most children with clefts require some orthodontic treatment to straighten their teeth.  Braces are usually placed when all permanent teeth are present at approximately 12 years of age.  Orthodontic treatment usually takes about two years with adjustments needed every four to eight weeks (about the same as their friends without clefts).
Some young people with clefts have significant growth discrepancy between the upper and lower jaws and it becomes apparent at adolescence or sooner that the lower jaw is larger than the upper.  Usually these people have orthodontic treatment later in their teenage years when growth is nearing completion.  The oral and maxillofacial surgeon adjusts the bone of the jaws so that normal bite is achieved.
Summary of Orthodontic Treatment:
1. Early treatment with a plate before lip surgery.
2. A course of brace treatment before bone graft to gum between 8 and 11 years.
3. Orthodontic treatment with braces for 2 years at about 12 years.
4. Some people have later brace treatment and jaw adjustment surgery by an oral and maxillofacial surgeon when they are fully grown.