This information was printed with permission from our speaker. The information contained in her
handout is printed here in its entirety. This information is strictly that of our speaker's.
Oral Care for a Lifetime
Infant Care--begin cleaning the oral cavity with a wet wash cloth after each feeding
even before the teeth erupt. Once the teeth erupt, you may either continue to use a washcloth or a very soft small toothbrush
without toothpaste to cleanse the gums and teeth. You eventual goal is to allow each feeding to take no more than 15-20
minutes. Prolonged exposure to breast milk or formula can lead to dental decay by the age of 18-24 months.
Toddler Care--brushing the toddler's teeth always presents a challenge.
It is the unusual child at this age that enjoys tooth brushing. It is worth the battle to have an adult brush for the
child twice daily. pay special attention to the area of the cleft palatae. It is not unusual to have a tooth erupt
inside the cleft or up under the lip if the alveolar bone is also involved in the cleft. If your child has a bilateral
cleft of the palate, you will need to stabilize the anterior segment (pre-maxilla) by placing a thumb or finger behind the
front teeth while brushing the front of the teeth and placing the thumb or finger on the front of the teeth while brushing
the backs of the teeth. You do not have to use toothpaste; however, if you elect to use it, do so sparingly or use infant
toothpast that does not contain flouride. Swallowing flouridated toothpaste, in an area where the water is flouridated,
over a a prolonged period will lead to something called Dental Flourosis in the permanent teeth. It creates either white
or tan striations of the enamel which do not go away.
Pre-Schooler Care--continue to brush for your child at least twice a day with
a minimum amount of toothpaste eath time and teach them to spit the toothpaste out thoroughly. the best way is to allow
them to brush first so they can begin to develop the coordination they are going to need to eventually do this alone; then
have the adult go back and re-brush their teeth well. Children do not have the ability to do a good job
of brushing until they are six years old. Anywhere where your child's teeth touch together, you should be flossing for
them. Remember to do this gently so this will be a good experience; flossing should never hurt! You can get tooth
decay in between teeth even at this age.
Grade-Schooler Care--at age six your child can brush on their own with occasional
checks by the parent to ensure they are doing a good job. If you have concerns about your child's ability to do a good
job, make a solution with several drops of food coloring and water (1:3 ratio) and, using a Q-tip, paint this on the teeth
after they brush. The food color will stick to the teeth wherever there is still plaque remaining. It is then
easy for your child to go back in and clean off the remaining plaque. This teaches them good brushing techniques for
a lifetime.
Middle-Schooler Care--by the age of twelve, most children should be able to brush
without any adult supervision; hoever, if your child is not responsible at this age, continue to monitor brushing until you
are satisfied they are doing well on their own.
Flouride Supplementation
Flouridated Area--your child does not need to have a flouride supplement if you
live in an area where the water supply has been optimally flouridated (1.0 ppm) such as Lincoln, NE. The exception to
this is the child who is being breast-fed only and has no water or other formula supplement. You need to speak
with your physician or pediatrician to get a prescription for a flouride supplement.
Non-flouridated Area--even areas that are not flouridated their water supply or
those with well water have small amounts of flouride in their water supply. Check with your dentist or county extension
office in smaller communities for the flouride content in your town's water supply. If you have well water, have your
extension office test for flouride content at the same time they are testing for nitrates. Bring the results of your
testing or your research along with you when you visit your dentist or physician, so they may prescribe the optimal amount
of flouride for your child at that age. Prescription dosages will vary at different ages. You should update your
prescription annually.
Filtered Water or Reverse Osmosis Water--if you have any type of filtration system
on your water supply and it filters out nitrates, it also filters out all of the flouride as well. Be sure to tell your
physician or dentist this so they may prescribe the correct amount of flouride supplement for your child.
The Tooth Factor in Clefts
Supernumerary (Extra) Teeth or Misshapen Teeth--it is not unusual for a child
with a cleft palate to have extra teeth or malformed teeth in the cleft area, either erupted or up inside the bone.
These can be either permanent teeth or baby teeth. Unless they are impossible to care for or are severaly decayed, the
baby teeth are typically left in the area of the cleft, and beyond keeping them clean, require not special care. Extra
permanent teeth, whether they are malformed, misshapen, or not, typically will require intervention. There are times
when these teeth can be left to erupt on their own and then extracted; however, more often than not, they will need to be
surgically removed. This is typically done once the dentist or oral surgeon can determine, by monitoring with x-rays,
which tooth is the "best" tooth to remove. there are many factors which influence their decision such as adequate root
development of the tooth, which tooth is the best shaped of those present, which tooth has the best chance of erupting, etc.
Congenitally Missing Teeth--It is also not unusual for a child with a cleft palate
to have teeth missing in the cleft area. There are several different options for replacement of these missing teeth.
Your child may need one or more temporary solutions before the final permanent solution can be done. Temporary solutions
may include a removable primary (baby) partial denture sometimes called a "flipper partial", cosmetic bonding of a primary
(baby) tooth, or placing a bonded bridge. Flipper partials can replace one or more missing teeth and can be easily removed,
cleansed and reinserted. Cosmetic bonding of a primary tooth can be used to give a baby tooth, which has no replacement
in the permanent (adult) dentition, the appearance in size and shape of the missing permanent tooth. A bonded bridge
using either composite or porcelain can be attached to primary (baby) teeth to replace a missing tooth or teeth. Permanent
solutions include fixed bridges, removeable partial dentures, or implants to replace one ore more missing teeth.
Tooth Eruption in Children with Cleft Palate
Delayed Eruption Sequence--It is normal for children with clefts to experience
delays in tooth eruption, especially in the cleft area. These delays may be minor (1-2 months slow) to major (1-2 years
slow). the delays are a factor when considering when to do bone grafting (usually done around age 8-9) or when to get
started with orthodontic care (braces). Each child is different and will need to be evaluated by your child's dentist,
oral surgeon, or orthodontist.
Bone Grafting--It is normal for a child with a unilateral or bilateral cleft to
require bone grafting which involves a surgery accomplished by either an oral surgeon or plastic surgeon. Tissue is
moved aside in the area of the cleft, bone is implanted in the area and the tissue is put back into place and sutured to keep
everything intact. This grafting allows for more stability and support for teeth erupting in the cleft area; for a more
nomal appearance of the gum tissue and structures surrounding the teeth in the arch; or for increased support for an implant.
Orthodontic Care--Orthodontic care can be initiated at a very young age.
It is usual for a child with a unilateral cleft to require expansion of the upper jaw. This can be started sometimes
as early as 3-4 years, but is more typcially initiated when the first permanent molars have erupted in far enough to place
an orthodontic band around them, typically age 6 1/2 to 7 years of age. The child with a bilateral cleft will always
require upper arch expansion. It is more typical to start at the very young age in children with bilateral clefts.
If the arch collapse is severe this can be started at times when very few, if any, teeth have erupted, using removeable devices.
Once there are teeth erupted, the expansion devices are more typically fixed to the teeth, but can be done with removeable
devices as well. The greater majority of children with unilateral or bilateral clefts will require further orthodontic
care beyond the initial arch expansion. Ths care (braces or functional appliances) can be started early (age 7-8 years)
or later (10-12 years) depending on your child's eruption sequence.
It's important to remember to ask questions of your health professional throughout your child's
growth. If you need information or need something clarified, do it! You are your child's best advocate!
Thank you to Dr. Sveen for her time and effort in providing this information! She can be reached
at her office at (402) 434-3367.
