CLEFT PALATE

Virola, Maria Soledad T.DMD2D

CLEFT PALATE (cheiloschisis) is a condition in which the two palates of the skull that form the hard palate are not completely joined. The soft palate in these cases are cleft as well.

CLEFT PALATE

• Between the 6th and 12th weeks of fetal gestation,the left and right sides of the face and facial skeleton fuse in the midddle. When they do fail to do so, the result is a craniofacial cleft.

• Cleft palate without cleft lip occurs more in females (57%) than males (43%).

• It is possible that facial clefts are caused by a disorder in the migration of neural crest cells.

• Another theory is that facial clefts are caused by failure of the fusion process and failure of inwards growth of the mesoderm.

CLEFT PALATE

UNILATERAL / BILATERAL COMPLETE CLEFT PALATE• Extends through both the hard and soft palates, into the nasal cavity• Includes a gap in the jaw

INCOMPLETE CLEFT PALATE• May occur as a hole in the roof of the mouth.• Usually, it only includes the SOFT PALATE

CLASSIFICATION

CLEFT PALATE

MAY APPEAR AS: • A split in the roof of the palate that can affect both sided of the face• A split in the roof of the face that doesn’t affect the appearance of the face.

SIGNS AND SYMPTOMS

Difficulty in swallowing Nasal Speaking voice Recurring ear infections Change in Nose shape Poorly aligned teeth

PROBLEMS ASSOCIATED WITH OROFACIAL CLEFT:• Failure to gain weight• Feeding problems• Flow of milk through nasal passage during feeding• Poor growth• Speech difficulties

GENETIC CLASSIFICATION

CLEFT PALATE is classified under MULTIFACTORIAL BIRTH DEFECT.

MULTIFACTORIAL BIRTH DEFECT = Genetic Factor + Environmental Factor

Common Examples of Multi factorial Birth Defects are:• Cleft lip/and palate• Club foot• Congenital Heart Defects• Neural Tube Defects (Spina Bifida)

GENETIC FACTORS •IRF6 Gene on chromosome 1• MAFB gene on chromosome 20• ABCA4 on chromosome 1• a region on chromosome 8

ENVIRONMENTAL FACTORS• Maternal smoking• Maternal alcohol abuse• Maternal diet and vitamin intake• Medications take during pregnancy• Exposure to viruses in chemicals of fetus• Women with diabetes diagnosed before pregnancy

DENTAL CORRELATION• Dental Procedures on patient with cleft palate usually has no difference with those patient with normal conditions.• Proper and adequate care should be observed by the dentists.• A team approach is required during difficult dental procedures such as SURGERY.

A Partial List of Oral Problems in Children with Cleft Lip & Palate•Feeding Problems •Missing teeth- 50% •Supernumerary Teeth- 20% •Dystrophic (hypoplastic) teeth- 30% •Disturbances of tooth eruption •Ectopic tooth eruption •Malocclusion- 100% •Dental caries and gingivitis