Cleft Lip - Handling This Congenital Anomaly In Children

Teeth are important accessories that develop in humans, much before they are born, and depend entirely on how well they are used and looked after. In children, tooth development begins in the womb, but they appear much later, when the baby attains the age of 6 to 9 months. The complete set of 20 primary teeth in children (called milk teeth or baby teeth) comes in usually by the age of 3 years.

Unlike the normal healthy growth of teeth in children and milestones that occur at specific ages, children with developmental disorders of the mouth do have a delayed or impaired growth of teeth.

Cleft Palate is one such congenital disorder of the mouth where the cleft occurs in the lip, gum (alveolus) or palate/roof of the mouth resulting in a variety of dental problems. Children are often born with this defect, and the anomaly may affect the way their teeth develop, affect speech and also eating.

TYPES OF CLEFTING

Cleft palate may affect the number of teeth, their size, shape, and also position of both the baby and permanent teeth. The teeth that are most commonly affected by the clefting process are those surrounding the area of the cleft, mainly the lateral incisors. Clefts occur between the cuspid (eye tooth) and the lateral incisor. In some cases, it is also seen that the lateral incisor may be entirely absent. In other cases, there may be a “twinning” of the lateral incisor, so that one is present on each side of the cleft. In a majority of the cases, the incisor may be present but poorly formed with an abnormally shaped crown and/or root. Finally, around the area the area of the cleft, the teeth may be displaced, resulting in them coming up in abnormal positions when permanent teeth erupt.

As it is often seen, although a cleft palate is a visible albeit minor facial deformity, not much attention is given to the way it may affect teeth growth or placement, which in turn can result in biting and swallowing problems in children and also speech issues at a later stage in life.

It is important to evaluate the cleft and take any preventive measures to ensure that this anomaly doesn’t affect the child in the long run.

HOW DOES DENTAL CARE DIFFER IN CLEFT PALATE

There is no difference between a regular child and someone with cleft palate, except that these children require a preventive and restorative care that is more specific than the others.

The evaluation by a paediatric dentist for these children must start early, because of the malformed, missing and mis-positioned teeth, and accompanying problems that these children are sure to face.

EARLY DENTAL CARE

Following a regular routine of cleaning, good nutrition and fluoride treatment, children with cleft lip or palate can have healthy teeth. Besides this, the following will help,

• Appropriate and regular cleaning with a soft, -bristled toothbrush should begin as soon as teeth erupt.
• First visit to a paediatric dentist must happen on completion of one year of age, or even earlier
• Oral hygiene instructions and preventative counselling prescribed by a dentist must be regularly followed
• Treatment prescribed may differ from one child to the other. Some may need only preventative care while others may require filling or tooth removal

ORTHODONTIC CARE

Even before the teeth erupt, orthodontic intervention will look into the development and growth of the jaws, thereby focusing entirely on facial growth. This is done to prepare the mouth to accommodate the natural growth of the teeth. If the child’s upper teeth for example, don’t fit together or occlude with the lower ones, the dentist can suggest an early treatment to correct this. Later as the natural growth of teeth occurs, plans can be made for the child’s short term and long term dental development.

SURGICAL CARE

There are instances when a bone defect has given rise to the cleft palate, which can cause resultant mis-positioning of teeth. At such times, surgical intervention in conjunction with dental care can be done, where reconstruction of the cleft defect is accomplished by a bone graft performed by a surgeon. Surgical care to correct the cleft defect is to be done under the supervision of a paediatric dentist and only when absolutely necessary.

At adolescence, medical care can be provided in such a way where an orthodontist and surgical dentist can work together to ensure the teeth are aligned and any intervention given appropriately, for them to grow normally.

PROSTHODONTIC CARE

Having tried orthodontic intervention, if it is observed that additional support is required, then a  maxillofacial prosthodontist  can help, by making artificial teeth and appliances that not just improve the appearances of individuals with cleft, but also aid in speech, and functional requirements like eating. Oral appliances such as “speech bulbs” or “palatal lifts”, help close the nose from the mouth so that speech will sound more normal or a dental bridge can be created to replace missing teeth. In all of this, the dentist ensures that everything comes together to help the child be as normal as possible in speech and eating.

As seen above, the treatment of cleft palate is a co-ordinated effort by a number of specialists brought together by a dentist who can identify and advocate the right course of treatment. This treatment and looking after the development of teeth, has to begin at a very young age, in order to ensure that the child’s speech and oral development progresses as naturally as possible.

Crowns for Baby Teeth

What is a crown?

A crown, sometimes also called a cap, is a restoration which covers the entire tooth. In enables the tooth to be used for normal biting and chewing. It also improves the appearance and strengthens and protects the tooth underneath. 

Most people are familiar with crowns for adult teeth. With advances in children's dentistry people are becoming more aware  of the importance of saving baby teeth until they fall out naturally. See previous post - Are Baby Teeth Important? (click for link) 

New techniques and materials have led to crowns for baby teeth which have improved appearance and fit.

When do baby teeth require crowns?

• When teeth are severely decayed, worn or fractured and there is not enough tooth surface to adequately hold a filling. 
• Teeth with severe developmental problems of the enamel and dentine may also require crowns. 
• Teeth which have had the nerve removed due to severe decay and infection (see Root Canal Treatment for baby teeth - Pulpectomy) are more brittle and prone to fracture and usually also require a crown.

Advantages of Crowns

• Preserves tooth until it is ready to fall out naturally, maintaining space for adult tooth to come through into.
• Stronger and longer lasting than large fillings.
• Enables normal functioning of tooth for eating and speaking.
• Improves appearance and therefore self-esteem.

What types of crowns can be used for baby teeth?

Crowns for adult teeth are usually made in a dental laboratory after taking an impression mold of the prepared tooth. Crowns for baby teeth can be made in the same way, however, this procedure takes two visits and can be difficult for young children. Therefore, ready made, or pre-formed, crowns are often used.

Pre-formed metal crowns

Ready made metal crowns have been used, mostly for back molar teeth, with a high success rates for many years. They are relatively inexpensive and provide a good fit with minimal tooth preparation and adjustments. They are strong and will last many years, until the tooth is ready to fall out naturally.




However, many people do not like the appearance of the metal. With advances in dental materials, tooth coloured crowns are becoming more popular.

Metal crowns may be modified by replacing the front area with white filling material or by bonding a tooth-coloured facing to the area visible when smiling. The aim is to keep the strength of the metal but improve the appearance. Some metal usually still shows at the edges and on the back of the tooth. Tooth coloured facings sometimes de-bond and fall off. 

Tooth coloured crowns

Strip crowns, also called acid etch crowns, are often used for front teeth. They are made directly in the mouth from composite filling material using a celluloid crown former with the desired shape of the tooth. By choosing the right shade of filling material a very good colour match can be achieved. The durability of a strip crown depends on how much tooth is left and how well the tooth was prepared for the crown. Care must be taken as this type of crown is prone to being broken, loosened or dislodged if too much pressure is applied to the tooth. 

Pre-formed tooth coloured crowns

At Small Bites we are always keeping up with the latest advances in dentistry. We have introduced high quality, pre-formed white crowns made from zirconia for children's teeth. These are imported from the USA and available for both front and back teeth. Zirconia is a hard, tooth-colored material similar to ceramic, but stronger.

The crowns are pre-made to specific sizes and the teeth require a small amount of preparation before the crown is fitted. 

Although more expensive than other crowns they have the appearance of a natural tooth. Only your dentist will know that it is a crown. 

Zirconia crowns give improved fit, tooth shade matching and durability.

If you would like to know more please comment or visit us at Small Bites - exclusive dental care for children in Bangalore.

The Small Bites Difference

Small Bites is the first Exclusive Dental Centre for children in Bangalore. Dr. Premila Naidu, a specialist paediatric dentist, started the clinic in 2007 out of a belief that children deserve the very best preventive dental care. 

In June 2014 Dr. Premila received the National Dental Excellence Award for Best Paediatric Dentist in Bangalore.

Child-friendly Environment

Our clinic is specially designed for children, with their needs in mind. Parents find that, even though their little one may be anxious initially, they soon feel at home and don't want to leave when their visit is over.

Each member of the Small Bites team takes time to understand and reassure children, especially those who are anxious or have special needs. Treatment options are also carefully explained to parents.

Preventive Dental Care

We emphasis prevention, both by educating children and their parents on dental health issues and using preventive treatments, such as fluoride varnish and fissure sealants.

At Small Bites, we are always keeping up to date with the latest materials and techniques.

What do our clients say?

Don't just take our word for it. Here are some reviews from our clients:

"I find that Dr.Naidu is really friendly and calm and that rubs off on the kids. Her office also has a well decorated and well stocked play area. So my son loves coming to the dentist."

"My son always feared going to dentists until he visited Dr Premila Naidu. The ambience of the clinic and her way with kids has made it easy for us to take him for his procedures. No issues with the treatment until today."

"The play area is pretty good for kids at the clinic. Doc gives time to understand the problem and clearly explains."

"good clinic is well maintained. kids really love to play there. they are not feared of medical equipment. they feel comfortable. getting a appointment is also quite easy , through phone or internet. also communication regarding our appointment timings through sms is nice."

"Amazing pediatrician, if your kid has severe cavities she analysis and acts and creates a regime for improving the oral health so that there are no future cavities."

So, if you are looking for a caring, child-friendly dental practice in Bangalore, come and visit us and experience the Small Bites Difference.

Your child's first dental visit.

At what age should children first visit the dentist?

How can you help to make it a positive and enjoyable experience? 

The American Academy of Pediatric Dentistry recommends that the first visit should be around one year old, or six months after the first tooth comes through.

If at all possible, take your child for their first visit before they have any problems. Tooth decay can start to develop soon after the first teeth enter the mouth. Sadly, too many children develop cavities before their parents realise there is a problem.

 Early and regular check-ups help your child to become comfortable with the dentist and the environment. Your dentist can also assess risk factors for your child developing dental decay and give personalised preventive advice.

Many parents are anxious about the first dental visit as they are not sure how their child will behave. Children are not born with a fear of going to the dentist. However, young children are naturally anxious about new situations and people and look to their parents and other adults for reassurance. If you are positive it is more likely your child will be too.

Help prepare your child

Talk to your child about why they need to look after their teeth and tell them that the dentist is there to help them. There are many good children's books and videos available which can help children to understand about going to the dentist.

For young children, you could "play dentist" at home. You and your child can take it in turns to "be the dentist" and check each other’s teeth. Also try using your child's favourite soft toy or a puppet and "check their teeth." You can buy small plastic mouth mirrors for this, or just use your toothbrush. 

If your child has a sibling, cousin or friend who is good with the dentist it may be helpful watch them have a check-up first. 

Tips to make the first visit successful

 Try to schedule the appointment at the best time for your child. Small children especially do not do so well if they are tired and hungry. 

It is also better to go at a time when the practice is not too busy, this avoid too much waiting and allow the dentist to spend more time with you and your child. 


You will be asked to fill out a health questionnaire for your child. In case of any medical problems or current medication, remember to bring details with you.

Arrive 10 minutes early if possible. This will allow time for you to fill in any forms while your child plays in the waiting area.   

 The first visit should ideally be short, a chance to get used to the environment and meet the dentist and other staff. A quick check-up can be done either in the dental chair or on a parent’s lap.

 For children four years and under, the best way to see the teeth is often for a parent to hold their child on their lap while they lay their head back onto the dentist’s lap.   

The dentist will assess your child’s dental health and development and give advice. If early signs of decay are seen, it may be possible to prevent it progressing to become a cavity. 

If you would like to schedule a check-up for your child, or have any questions, please contact us at Small Bites - exclusive dental care for children.