DENTAL NEEDS OF CLEFT AFLFLlCTED INDIVIDUALS
Dentists will have. cleft-afflicted patients in their practice because of the relatively large number of people so affected. These patients should not pose any great problems, because their dental needs do not differ dramatically
from those of other individuals. However, because of the presence of the cleft, either corrected or uncorrected, these individuals have a few special needs of which the dentist should be cognizant.
I ted patients require, it behooves the dentist to be \ ‘3fl’ of the overall treatment plan formulated by the lert team. for the patient’s management. Awareness of ,i plan precludes the performance of any irreversible
or costly procedures on teeth that may be charted for ~xtraction in the futufe. For instance, placing a bridge to replace a’ congenitally missing lateral incisor before alveolar bone grafting and orthodontic therapy is
unwise. Similarly, extracting supernumerary teeth that may be temporarily retained to maintain alveolar bone support ‘is also disadvantageous. All fixed bridgework should be delayed until after the orthodontic, orthognathic, and alveolar grafting procedures have been completed:
Only then will the dentist be able to determine accurately the exact space and .ndge form .available for pontics. Furthermore, until the· two halves of. he maxillaryarch have been’ united with bone grafts, the halves will move independently and bridgework spanning the cleft margin may become loose. Therefore the dentist must communicate’ freely with the other professionals who are managing the patient’s other cleft problems,
and coordinat on of services is of paramount importance.Teeth adjacent to the cleft margins not only may be malformed or absent but also may have poor periodontal . support because of lack of bone and their position in the
cleft’ margin. This situation predisposes them to peripdontitis and early loss-If not kept in an optimal state of health. Because teeth are frequently malaligned and rotated, oral hygienic measures may be more difficult
these individuals may need more frequent prophylaxis and special oral hygienic instructions with careful reinforcement. Otherwise, rampant caries with premature loss may 4) . This is a special tragedy in the acleftafflicted individual, because he or she may have fewer teeth to serve vital functions (e.g., retaining orthodontic, orthopedic, or speech appliances).