complicates and hinders treatment. The dentist thus has a vitally important part in
maintaining continuity of routine preventive and restorative care. It is well recognized
that patient compliance with long and complex treatments dwindles, and
unfortunately many patients with clefts, and their families, do not give routine
dentistry a high enough priority compared with other aspects of their treatment such
as surgery. An enthusiastic and supportive dental team must therefore play a central
part in the multidisciplinary management of clefts of the lip and palate.
14.11 SUMMARY
- All children from the age of 8 years should be screened for malocclusion.
- Unerupted maxillary canines should be palpated routinely on all children from the
age of 10 years until eruption. - A maxillary canine which is not palpable should be investigated.
- Significant variation from the normal sequence of eruption should be investigated,
e.g. upper lateral incisor erupting before upper central incisor. - Refer for orthodontic advice in good time and give as much background
information as possible. - Good oral hygiene and co-operation are essential for successful orthodontic
appliance treatment. - Consider orthodontic aspects when extractions in the mixed dentition are necessary.
- A space maintainer should be fitted immediately if a traumatized upper incisor is
lost. - Cross-bites with displacement may be treated in the mixed dentition.
- Treatment of increased overjet in the mixed dentition can become lengthy.
- Persistent digit-sucking habits usually resolve when appliance treatment is started.
14.12 FURTHER READING
Andreason, J. O. and Andreason, F. M. (1994). Textbook and color atlas of traumatic
injuries to the teeth, (3rd edn). Munksgaard, Copenhagen. (Comprehensive coverage
of the management of dental trauma, including the role of orthodontics.)
Houston, W. J. B., Stephens, C. D., and Tulley, W. J. (1992). A textbook of
orthodontics, (2nd edn). Wright, Oxford. (An excellent introductory textbook).
Isaacson, K. G., Reed, R. T., and Stephens, C. D. (1990). Functional orthodontic
appliances. Blackwell Scientific, Oxford. (A clear and thorough review of the role,
management and effects of functional appliances.)