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Article: Volume 41 Number 1 Page 20 - January/February 2014

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  Dent Update 2014; 41: 20-26

Orthodontics:  The Long and Winding Road Part 2. The CLP Patient’s Journey, 0–21 Years

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Abstract: Patients with a cleft lip and palate (CLP) deformity require the highest standard of care that the NHS can provide and this requires multidisciplinary care from teams located in regional cleft centres. Care of these cases is from birth to adulthood and requires several phases of intervention, corresponding to the stages of facial and dental development. Management ideally starts pre-natally, following the initial diagnosis, and occasionally pre-surgical appliances are prescribed. The lip is ideally repaired within three months, followed by palate closure between 12 and 18 months. Careful monitoring is required in the first few years and ENT referral, where necessary, will diagnose middle ear infection, which commonly affects CLP patients. Speech therapy is an integral part of the ongoing care. Excellent oral hygiene is essential and preventive dietary advice must be given and regularly reinforced. Orthodontic expansion is often needed at 9 years of age in preparation for a bone graft and, once the permanent dentition erupts, definitive orthodontic treatment will be required. Maxillary forward growth may have been constrained by scarring from previous surgery, so orthognathic correction may be required on growth completion. Final orthodontic alignment and high quality restorative care will allow the patients to have a pleasing aesthetic result. CLP patients and their families will need continuing support from medical and dental consultants, specialist nurses, health visitors, speech and language specialists and, perhaps, psychologists. The first article in this series of two outlined the principles of care for the CLP patient and this second part illustrates this with a case report, documenting one patient’s journey from birth to 21 years of age.

Clinical relevance: A successful outcome for CLP patients requires a sound dentition. The general dental practitioner role is vital to establish and maintain excellent oral hygiene, a healthy diet and good routine preventive and restorative care. Understanding the total needs of CLP patients can help the dentist to provide high quality care as part of the multidisciplinary management.

Author notes: Paul Jonathan Sandler, BDS(Hons), PhD, MSc, FDS RCPS, MOrth RCS, Consultant Orthodontist, Chesterfield Royal Hospital, Calow, Chesterfield S44 5BL, Alison Murray, BDS, MSc, FDS RCPS, MOrth RCS, Consultant Orthodontist, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, Robert Orr, BDS, MB ChB, FDS RCS, Consultant Maxillofacial Surgeon, Chesterfield Royal Hospital, Calow, Chesterfield S44 5BL and Arun K Madahar, BDS, MFDS RCS(Edin), SHO, Department of Oral and Maxillofacial Surgery, QMC Campus, Nottingham University Hospitals Trust, Derby Road, Nottingham NG7 2UH, UK.

Objective: To follow the case of a cleft lip and palate patient from birth to adulthood.