A Smile Made Possible: Treating Children with Cleft Lip and Palate

Cleft lip and palate is a congenital facial deformity that develops while a baby is still in the womb. It significantly impacts a child’s development and daily life, from feeding and speaking to self-confidence as they grow. Thanks to advances in medical imaging, 3D and 4D ultrasound scans now allow early diagnosis and treatment planning while the baby is still in utero.

Causes of Cleft Lip and Palate

• Genetics: A family history of cleft lip and/or palate increases the risk.
• Environmental Factors: Especially during the first trimester, such as infections, alcohol consumption, smoking, vitamin or nutritional deficiencies, and side effects from certain medications or chemicals.

Treatment Steps for Cleft Lip and Palate

The earlier and more continuous the treatment, the better the outcome. Children should ideally receive care from birth through late adolescence. Treatment varies by age and addresses abnormalities that may affect several areas—nose, lips, palate, alveolar ridge, speech, and hearing—requiring a multidisciplinary team of specialists.

From Birth to 3 Months

Babies with cleft palate often have difficulty sucking. Dentist will create an obturator (a prosthetic palate) to assist with feeding. Babies may also have a flattened nose on the cleft side. NAM (Naso Alveolar Molding) device can reshape lips, gums, and nose before surgery. Lip strapping is also used to bring the lip segments closer and reduce gum protrusion.

3–6 Months (or when baby weighs over 5 kg)

Plastic surgeon performs lip surgery to close the cleft in the lip. This closes the gap and aligns the lips into a more natural position. After lip surgery, a nasal stent may be used to maintain the nostril shape, which may regress slightly after lip surgery.

6 Months to 1 Year

As baby teeth begin to erupt,  Dentist will guide parents on cleaning them. Palate repair is done before speech development starts, preventing nasal regurgitation when eating and unclear speech. Speech therapy is recommended, along with ENT evaluation for hearing issues.

Around 8–9 Years Old

By age 6, permanent teeth start to come in. At 8–9 years old, children have a mixed dentition (baby and adult teeth). Most cleft palate patients develop malocclusions, such as anterior or posterior crossbites, supernumerary, missing, or malformed front teeth. A removable orthodontic device (active plate with screw) is used to expand the upper jaw and align the teeth. This may reduce the need for surgery later. If there’s a gap in the alveolar ridge, bone grafting will be performed, followed by  orthodontics treatment.

12 Years and Older

At this stage, all permanent teeth have typically erupted. Dentists may use fixed appliances (braces) or clear aligners to align teeth on upper and lower jaw. If any teeth are missing, orthodontists may close the gaps or prepare the area for prosthesis.

18–20 Years Old

Severe jaw relation problem and abnormal bite are treated with a combination of orthodontics and jaw surgery—either moving the upper jaw forward, the lower jaw backward, or both. After surgery, further orthodontic work fine-tunes the bite. Cosmetic corrections like rhinoplasty or scar revision can also be done during this stage or later.

Can Cleft Lip and Palate Be Prevented?

While it’s not 100% preventable, the risk can be significantly reduced:

• Take folic acid as recommended by your doctor.
• Avoid smoking and alcohol during pregnancy.
• Consult a doctor before taking any medications while pregnant.
• Maintain good health: eat a balanced diet, get enough rest, and keep a healthy weight.
• If there’s a family history, consult a specialist for pre-pregnancy planning.

 

If cleft lip or palate is detected during pregnancy, consult a specialist to begin planning care early. At Bumrungrad Hospital’s Dental Center, a team of expert dentists work closely with pediatricians, plastic surgeons, ENT specialists, speech therapists, and mental health professionals. This multidisciplinary approach ensures accurate diagnosis, comprehensive treatment planning, and continuous care through each life stage—delivering the safest and most effective outcomes possible.

Prepared by Dr. Piyathida Chittanandha, D.D.S.