Dental Health

Good dental health is important for all children, but it is especially important for children with a cleft, as they can be especially vulnerable to tooth decay and other problems. From a dentist’s point of view, children with a cleft often have narrow crowded arches, and accessing the mouth and teeth can be difficult practically. The shape or position of their teeth may also make them harder to clean effectively, so parents have to be extra careful to establish good habits early on.

There is evidence that the major increase in tooth decay (sometimes called caries) in young children happens between the ages of 3.5 and 4.5 years, and in most cases this is entirely preventable.

If your child can grow up without much tooth decay, free of pain, and without needing fillings or extractions (tooth removal), it will help to keep the bone in which the teeth are embedded strong, and this makes orthodontic treatment easier later in their life. It also makes visits to the dentist much more pleasant, which can encourage them to get regular check-ups as adults!

The dental specialist with your Cleft Team will be able to advise you on how to help your child maintain good dental health. It’s likely that they will meet with you in your child’s first year of life. This is to help identify children with a higher risk of tooth decay, but also to make sure you’re well-equipped to care for your child’s teeth.

They may also advise your family dentist, who should be aware of any problems caused by your child’s cleft and what this may mean for their treatment. You should take your child to see your family dentist regularly, and they should be the one to provide most of your child’s treatment. However, in some cases where more specialist treatment is necessary, you may have to go back to your Cleft Team.

Maintaining Good Dental Health

Here are some general tips to help maintain good dental health in children:

• Try to make visits to the dentist fun and rewarding. If your child has had to spend lots of time in hospital or in clinics, they may see the dentist as an extension of this and be reluctant to go.
• You should start brushing your child’s teeth twice a day as soon as their first milk tooth comes through, and you should continue to help them every time they brush as most children won’t be able to brush their teeth effectively until they are nine or ten.
• Flossing isn’t really necessary until adult teeth start coming through.
• Fluoride helps prevent tooth decay, so toothpaste needs to have enough fluoride in it (around 1,350-1,500 parts per million (ppm) fluoride) to be effective. A lot of children’s toothpaste doesn’t have enough, so you may want to ask your dentist whether you should be using adult toothpaste on your child.
• The less time the teeth spend ‘under attack’ by bacteria the better, so stick to only three meals a day and avoid snacking between meals.
• If your child needs to eat between meals, stick to foods that don’t contain much sugar, and watch out for ‘hidden’ sugars in foods like tomato sauce, savoury biscuits and even dried fruit.
• Be extra careful with drinks that contain sugar, such as fizzy drinks or fruit juice. Sipping on a drink throughout the day (unless it is water) can cause tooth decay. Milk is a good thing for children to drink, but it does contain a natural sugar, and if it is regularly drunk at night time it can cause tooth decay.
• Chewing gum can help as it stimulates saliva flow which clears away damaging acids more quickly, but it must be sugar free gum, it must be started immediately after eating, and it must be chewed for around 15-20 minutes to be effective.
• Around the area of the cleft there may be teeth that have not formed all their enamel properly, or are at more awkward angles to reach with a toothbrush. These teeth may collect more plaque on their rougher surface. If the lip is tight because of a cleft lip repair, it can be harder to move it away from the teeth so they can be cleaned properly. Your dentist can show you how to clean this area, which may involve using a special little brush.

You can find more general helpful tips here

Some children will need extra fluoride to help prevent tooth decay. This may be in the form of a chewable tablet, or, for older children, a mouth rinse. Your dentist might recommend fluoride varnish, which is painted onto the surface of the tooth every six months to prevent decay. This works by strengthening tooth enamel so it is more resistant to decay.

If your child’s cleft affects their gum, it may mean some of their teeth grow through twisted or crooked around their cleft. This is normal, and with the right orthodontic and surgical treatment their adult teeth should be fine. An Alveolar Bone Graft operation when they are around 8-12 years old will help make sure their adult teeth have a solid base to erupt from, and orthodontic treatment such as braces or a retainer can help their teeth grow straighter.

Talk to your family dentist if you have any concerns, or, if you want another opinion, see if you can make an appointment with the dentist or dental surgeon with your Cleft Team.

If you don’t have a family dentist, or don’t think that your current dentist understands how to treat children with a cleft, your Cleft Team may be able to make a recommendation.

‘Dental Hygiene’ Q & A

CLAPA volunteer, Jo, asks Charlotte Iddon, the Oxfordshire Oral Health Improvement Manager at Community Dental Services (CDS), questions about oral health and dental hygiene sent in to us by members of the CLAPA community. They cover questions about different toothpastes and toothbrushes, flossing, decay, and lots more. A subtitled version of this video is coming soon!