Dr. Ellis was asked to answer some of the most common questions that we hear from parents. Here are his answers:
There is a tooth in the roof of my child’s mouth/ in the cleft/ growing sideways/, what should I do?
It is very common for extra teeth to form and erupt in the area of the cleft. Often times these teeth will be extracted before the bone graft or at the time of the bone graft (around age 7-9). It is important to keep these teeth clean. They can be brushed just like any of the other teeth. Your dentist and surgeon will help determine the best time to remove the extra teeth.
What is the proper age to begin braces?
Orthodontic treatment is common in kids with cleft lip and palate and may begin as early as 6 years of age. Often orthodontic treatment involves various phases, typically starting with palatal expansion done to normalize the width of the palate. Later, braces are put on to place the teeth in their proper position. Your orthodontist will discuss timing of the phases of treatment with you.
What is Maxillary Expansion and why do I need it?
A palatal expander, also known as a rapid palatal expander, rapid maxillary expansion appliance, orthodontic expander, or hyrax, is used to widen the upper jaw allowing for the optimal positioning of cleft segments and reorientation of teeth collapsed into defect
Patients that have cleft lip and palate experience narrowing of the upper arch due to palatal scar tissue contraction. The objective of the palatal expansion is to widen the upper jaw creating adequate space for the placement of a bone graft. Since palatal expansion is very case specific, your orthodontist and surgeon will work together to determine if you need expansion before your bone graft.
What is it you are observing when waiting for the for the proper time to do a bone graft? (I came last year and they told me to come back in a year.)
Your orthodontist/ surgeon are waiting for the root of the canine to be 1/3 to 2/3 formed. This is the upper canine on the cleft side. An x-ray is needed to make this determination. It is important to remember the dental age of children with cleft lip and palate is usually behind their chronological age.
When will I be ready for a bone graft?
Because every child is different, the best age at which to do the alveolar bone graft will be different for every child. Most children who have an alveolar bone graft are between the ages of 7 and 9 years old. Usually upper jaw expansion with an expander is completed prior to the bone graft being placed. Your surgeon and orthodontist will help determine the best time to expand and place the bone graft.
Will my child need braces?
Orthodontic treatment is necessary in most children with cleft lip and palate. The cleft disrupts the position of the teeth and jaws. Braces allow for the correct positioning of the teeth. They facilitate coordination of the upper and lower jaws. Your orthodontist will help determine the best time for placement of braces.