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Good oral hygiene is critical to maintaining healthy teeth, and gums, preventing bad breath and reducing the risk of other oral health-associated conditions. In India, cleft lip and palate is the most common birth difference impacting the growth and development of a child. Children with clefts are also uniquely susceptible to poor oral health and are commonly affected by missing, extra, or malformed teeth and facial structures. Even children who receive cleft surgery are at an increased risk for caries, periodontal disease, and other oral health and well-being challenges as they grow and develop.
Nearly 35,000 children are born with cleft lip and palate in India. The most familiar oral health concern in patients with cleft lip and palate is dental caries. There is a higher susceptibility to caries compared with the population group without clefts. This could be further accentuated as toothbrushing, which is tedious due to the lack of flexibility of the surgically corrected lip, the cleft structure, and the patient's anxiety about brushing around the cleft area could be a cause of poor dental health.
This is often due to a lack of awareness of the cause & the scarcity of guidance that the parents receive on nutrition and oral hygiene. The unaffordability of expensive dental treatments and the lack of accessibility to nearby dental facilities stimulates & worsens the scope of timely dental care. Common dental anomalies associated with a cleft are supernumerary tooth, congenitally missing tooth, delayed tooth development, morphological anomalies in both deciduous and permanent dentition, delayed eruption of permanent maxillary incisors, microdontia, and abnormal tooth number. However, the approach to oral care for people with clefts may vary depending on a person's age and stage of development. Infants, children, teenagers, adults, and seniors all have unique dental needs that require specific care and attention.
Comprehensive Cleft Care with focused dental & orthodontic care is needed critically. In the newborn, presurgical infant orthopaedics is performed. For the age group of 8-11 years- the orthodontic preparation, a mixed dentition analysis is done for secondary alveolar bone graft
and maxillary protraction. And, in permanent dentition- comprehensive orthodontics & pre and post-orthognathic surgical orthodontics are done.
For comprehensive cleft lip and palate treatment, healthy dentition is essential to orthodontics, which improves surgical and patient outcomes. Therefore, it is imperative to integrate preventative oral health care with primary treatment of cleft lip, early detection of caries, and prompt intervention to avoid related problems. Hence, there is a subsequent need to provide ongoing and proactive guidance regarding regular brushing, use of fluoridated toothpaste, and restriction of dietary free sugar intake.
The best prevention and early treatment of oral disease should be less expensive and less burdensome for patients, providers, and the healthcare system. Charities like Smile Train have been endlessly working towards providing free cleft care and have constantly boosted
their awareness through- Oral Health through Prevention program, known as Smile Train Oral Health through Prevention (STOP) program. STOP program is designed to support Smile Train medical partners to help future generations of CLP (Cleft Lip Patients) experience minimal
oral disease in their children and lead a healthy and higher quality of life.
There is further a need to spread awareness regarding oral health in children with clefts to ensure prevention and provide early care. In order to sustain a healthy smile and healthier life, oral health matters and should not be neglected.
(This article is authored by Dr Puneet Batra, Senior Orthodontist & Smile Train Partner Doctor)
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