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Oral Health for Children with Orofacial Clefts FDI GUIDELINES.pptx
- 1. Changing the World One Smile at a Time ORAL HEALTH IN COMPREHENSIVE CLEFT CARE 3rd Annual International Congress for Cleft Lip, Palate and Craniofacial Deformity 2022 Dr. Mónica Domínguez Director, Global Oral Health Programs Smile Train
- 3. WHAT CAUSES CLEFT? Between 30%-50% of clefts are related to genetic factors. Multifactorial
- 4. EMBRIOLOGY
- 6. L= Lip A= Alveolus H= Hard Palate S= Soft Palate Incomplete= lower case No Cleft = _ LAHSAL clasification Understand the complexity, implications and treatment needs
- 10. ORAL HEALTH CONSIDERATIONS IN CLEFT LIP AND PALATE •Shape - Structure •Number & size Position •Pshysiology
- 11. DENTAL SHAPE & STRUCTURE - Irregular Surface - Enamel hypoplasia - Pit and fissures SHAPE & STRUCTURE
- 12. NUMBER & SIZE - Microdontia - Supernumerary - Agenesia - Hipodontia - SHAPE & STRUCTURE
- 13. POSITION - Croocked - Crawed - Inside the cleft - In the palate
- 14. PHYSIOLOGY - Deviated septum - Oral breather - Maxillary hypoplasia Tongue position - Maxillo- mandibular Discrepancy - Labial incompetency
- 15. More prone to develop oral diseases and malocclusion RISK FACTORS
- 16. BURDEN OF CARE
- 17. POOR ORAL HEALTH Affects: Surgery Speech Nutrition Orthopedic/ Orthodontics Psychosocial development Well being
- 18. SMILE TRAIN – FDI GUIDELINES www.smiletrain.org/medical-professionals/oral-health
- 19. PROVIDING DENTAL CLEFT CARE EDUCATION SAG PREVENTION SDF ART
- 21. MASSIVE OPEN ONLINE COURSE www.smiletrain.org/medical-professionals/oral-health#
- 26. Thank You
Editor's Notes
- Hello everyone i am Dr Monica Dominguez and I am the Director of the global oral Health programs at Smile Train. I want to thank the for this kind inivatation, i am very honored and happy to be here at this wonderful fórum to share about Smile Train´s work on oral Health for children with orofacial celft
- Orofacial Cleft is a birth condition, a very commun birth condition since it is present in 1 out of 700 new borns, although we know there is variability in different parts of the world due to ethnic and geographic variation in birth prevalence The cause of this birth condition is multifactorial, there are genetic and epigenetic factors involved, which makes it more difficult to prevent resulting in this high incidence.
- Embryologically the structures of the face and oral cavity are formed during the 4th and 12th week of pregnancy, there are 5 processes that form the face, in normal conditions, these 5 groups of cells grow to the front and to the midline to meet with each other and fuse giving form to the different structures of the face, the same thing happens in the mouth, the primary palate, secondary palatal shelves and the nasal septum grow until they meet and fuse, giving place to the alveolar ridge, hard and soft palate. When this process is interrupted and the different structures do not fuse properly it leaves a gap between which we know as cleft.
- a cleft can be as simple as a notch in the lip, to affect and include the nose, lip, gum ,alveolar bone, hard palate and soft palate. It can affect just one side or can be bilateral, it can be incomplete or complete, it can be an isolated soft palate, or a combination of some of these presentations. The complexity of the treatment will be directly proportional to the structures affected by the cleft. For example, the interventions needed for the incomplete cleft lip will be totally different from the needs to the isolated cleft palate. Every case is unique and needs and individualized treatment.
- The cleft can affect different structures and have different presentations. There are many proposed classifications based on embryology, anatomy, surgical approach, etc. But the most known and used is the LASHSAL
- But in general, the implications for cleft patients include complications with feeding (breast or bottle) given to the communication between the oral and the nasal cavity, which makes sucking more difficult and ta high risk of choking. That communication between the nose and the mouth allows the bacterias from both cavities to combine and since ther is also a connection to the ear, the ear can also be affected resulting in recurrent ear infections that can lead to hearing loss.That hearing loss directly affects the Speech development since we all learn to speak by listening and repeating. When the palate is affected by te Cleft, the muscles that helps us pronounce specific sounds of phonemas, get affected as well, interfering in the Speech and language development. Cleft patients can also develop maloclussions and other oral health conditions. There are many myths arounf Cleft lip pand palate all these believes keeps the caregivers and patients from seeking care, that is the case of this older patient that given the believes from her comunity, she lived her whole life with an open Cleft until her baby twins were born with the same condition as her.
- Comprehensive Cleft care includes different áreas and specialties such as …
- Proper comprehensive Cleft care requieres a lot of commitment from the families. Many families find this overwhelmning and FIND THEMSELVES IN THE NEED TO FOCUS THEIR ATTENTION, TIME AND RESOURCES… PRIORITAZING ONLY WHAT THEY CONSIDER important and URGENT LEAVING aside other áreas of care and most of the times ORAL HEALTH is NEGLECTED.
- Poor oral Health affects other áreas of the comprehensive Cleft care. A palate surgery performed in a patient with multiple cavities has a higer risk of porsurgical complications, infections and even dehiscence. , a patient that has lost his teeth due to caries has bigger challenges developin Speech since Some phonemas require the front teeth to be pronounce. The same with orthopedic and orthodontic treatment that requiere the teeth to hold the devices. Poor oral Health affects the psycosocial development and in general the wellbeing of the patient.
- Smile Train and FDI joined forces and with the Support of GSK developed guidelines for the oral Health treatment for Cleft patients, followed by this guidelines, educational resources were developed for oral Health professionals that does not necesarily are familiar with clefts and for non oral Health professionals, because everyone in the team can have a role to improve oral Health in Cleft patients.
- And the most important piece in this puzzle to work for a preventative culture, with the help of the toothy tigers we have available resources for parents and caregivers to promote oral higiene, feeding habits and regular monitoring to mantain Good oral health
- I invite you to visit our websites where you can have free Access to all this resources. There is a lot of work to do with Cleft patients in this regards and we all can be part of the change.
- Thank you for your time and attention, i am happy to answer any questions.