Orthodontics

Most of us are aware of the role the orthodontist plays in straightening children's teeth through the use of "braces" and/or "retainers." In a broader sense, orthodontics is the specialty area of dentistry that deals with the growth and development of the face, jaws, and dental arches (teeth). Because clefts often affect parts of the mouth which play roles in the growth of teeth, the orthodontist plays a very special role on your cleft palate team.

The child with a cleft lip or palate may be observed or treated by the orthodontist at several points along the road to adulthood.  As the child grows and the baby teeth erupt ("come in"), continuing orthodontic observation is needed, and some limited orthodontic treatment may be required. This may involve moving a few rotated teeth which are interfering with biting and chewing, or fitting the child with an appliance to cover a hole in the palate that interferes with speech. The contribution which the orthodontist can make to the speech-learning process is another indication of the advantages offered by the team approach to treating cleft lip and cleft palate.

For the most part, though, the bulk of orthodontic work with cleft conditions takes place after the permanent (adult) teeth erupt. Correcting rotated teeth and crossbite, and aligning the upper and lower teeth for adequate chewing and improved appearance are some of the goals of orthodontic treatment. Where there are missing teeth, orthodontic treatment can either close spaces or prepare the teeth for later placement of selected replacement teeth (fixed or removable). The appliances supporting these "replacement teeth" are made by the general dentist/prosthodontist, another member of the cleft palate team.

The Orthodontist's Role as Team Consultant

As the growth and development specialist for the facial area, the orthodontist consults with the surgeon about the need and best time for certain surgical procedures.

In some children, the missing bone in the cleft of the upper dental arch requires replacement by a bone graft. The time to do this operation depends, in part, on the development of the permanent teeth in adjacent areas. At times, the bone graft is done before the eruption of a permanent tooth. This can allow the new tooth to "come in" through the new bone which provides support for the tooth. Otherwise, the tooth would eventually be removed due to the lack of bone support.

In the growing child with a cleft, the upper jaw does not always grow as much as the lower jaw. The resulting differences in the upper and lower dental arches can present problems in appearance, speech, or chewing. Sometimes, orthodontic treatment alone can correct the problem. In other cases, however, the child may require a combined orthodontic and surgical treatment for adequate alignment of the jaws and teeth. When required, the surgical procedure is usually done in the late teen-age years. In this orthognathic surgery, a deficient upper jaw can be moved forward, or a lower jaw that has overgrown the upper jaw can be set back appropriately.

In all of these instances, decisions about the timing and nature of surgery are based largely on the opinions of all consulting members of the cleft palate team during conferences. The treatment plan for your child is individualized according to his or her specific growth and development pattern.

 Glossary