When a child is born with a cleft lip or palate, families quickly learn that care happens in stages and involves many specialists. Orthodontic treatment is one of those stages, and it often continues through childhood and the teen years as the teeth and jaws develop.
This guide explains what cleft lip and palate are, how they can affect the teeth, and where orthodontic care fits into a child’s overall treatment plan.
What Are Cleft Lip and Cleft Palate?
Early in pregnancy, the tissues that form the lip and the roof of the mouth normally come together. When they do not fully join, the result is an opening called a cleft. A cleft lip can range from a small notch to a split that extends into the nose, and it may affect one or both sides. A cleft palate can involve the front, back, or entire roof of the mouth. Some children have one condition, and some have both.
Cleft lip and palate are among the most common birth defects. About 1 in every 1,050 babies in the United States is born with cleft lip with or without cleft palate, and about 1 in 1,600 is born with cleft palate alone, according to CDC estimates cited by the National Institute of Dental and Craniofacial Research in its cleft lip overview. Genes, genetic syndromes, and certain health and environmental factors during pregnancy can all play a role.
How Clefts Can Affect the Teeth and Jaws
Depending on the size and location of the cleft, children may have challenges with feeding, speech, hearing, and tooth development. Dental concerns commonly seen with a cleft include
- missing or unusually small teeth
- a narrow upper jaw
- crowded or out-of-position teeth
- a gap in the bone that supports the teeth near the cleft
- an opening between the mouth and nasal cavity, called a fistula
- bite problems such as crossbites
Bite concerns can become more noticeable with growth, so orthodontic monitoring often continues for years.
The Team Approach to Cleft Care
Children with a cleft are usually cared for by a team. That team may include an ear, nose, and throat doctor, a plastic surgeon, an oral surgeon, a speech pathologist, a pediatric dentist, an orthodontist, an audiologist, a pediatrician, a nutritionist, and a psychologist or social worker. The team coordinates timing so treatments build on one another.
Families can search for teams that meet recognized standards through the American Cleft Palate Craniofacial Association’s approved team finder. In Birmingham, the cleft and craniofacial center at Children’s of Alabama provides multidisciplinary care for children born with craniofacial differences.
Where Orthodontic Care Fits In
Cleft treatment typically unfolds in stages. Surgery to repair the lip is usually done before a baby’s first birthday, and palate repair usually happens before 18 months. Later, many children need a bone graft to fill the gap in the gum area near the cleft, which our practice notes is often done around age 8 or 9.
Orthodontic care is woven through these stages. Children with cleft palate commonly go through two phases of orthodontic treatment.
Phase 1
The first phase often focuses on expanding a narrow upper jaw and relieving severe crowding. This can help prepare the area for a bone graft and create a better foundation for incoming permanent teeth. Our page on early orthodontic care explains how our office approaches this first phase for growing children.
Phase 2
Once the permanent teeth have come in, the second phase aligns the teeth and corrects the bite, usually with braces. When the upper and lower jaws differ significantly in size or position, jaw surgery may be coordinated with an oral surgeon while braces are in place.
Related Dentofacial Conditions
Some children have craniofacial differences beyond a cleft, including conditions such as hemifacial microsomia, Treacher Collins syndrome, and Pierre Robin sequence. These can also affect jaw growth and tooth alignment. Dentofacial deformity treatment in these cases typically involves the same kind of coordinated, staged care, with orthodontics addressing the teeth and bite as growth continues.
What Families Can Expect at Our Office
At Backus Smiles, Dr. Backus works closely with oral and plastic surgeons to address the dental problems that arise as a child with a cleft grows. Our practice describes her training in cleft lip and palate and other craniofacial conditions, which began during her orthodontic residency and has continued throughout her time in private practice.
A first visit typically includes a review of your child’s history and prior surgeries, an exam, and diagnostic records. From there, we discuss where your child is in the overall treatment timeline, what orthodontic steps may come next, and how we will coordinate with the rest of the care team. Our cleft and dentofacial treatment page describes our services in more detail.
Coverage for Cleft-Related Orthodontics
Orthodontic care for children with a cleft may qualify for coverage that routine braces do not. In Alabama, Medicaid provides medically necessary orthodontic services for eligible children, and those services must be requested through a multidisciplinary clinic, such as those administered by Alabama Children’s Rehabilitation Service, and approved in advance. Private plans vary, so it helps to check your benefits early. Our guide to insurance and financing explains how orthodontic benefits typically work.
Take the Next Step
Every child’s cleft and treatment path is different, and an in-person evaluation is the way to learn what orthodontic care may be needed and when. Families across the region can learn more about cleft lip orthodontics with a Birmingham orthodontist who works alongside cleft care teams. The first visit at Backus Smiles is complimentary. Call (659) 734-1740 or contact our office to schedule.