Treating a Cleft Palate From Infancy to Adulthood

Managing a cleft lip and a cleft palate can be a complex, lifelong endeavor.

While initial surgical interventions are vital, these conditions can continue to affect a person’s ability to eat, speak, hear, and present themselves to the world. Long-term restoration of the mouth’s form and function, as well as of the patient’s confidence, requires the work of many experts, including prosthodontists.

What is a prosthodontist? A prosthodontist is a dentist who specializes in using advanced materials and techniques to restore and replace missing or damaged teeth and other oral structures. Think of them as “architects of the smile.”

Dr. Nupur Patel of Penn Dental Family Practice (PDFP) is a maxillofacial prosthodontist. She is an assistant professor of clinical restorative dentistry at the University of Pennsylvania School of Dental Medicine, serves as division chief of prosthodontics, and directs the dental school’s Advanced Education Program in the specialty.

Dr. Patel answered some questions about the prosthodontists’ role in cleft lip and cleft palate treatment. Watch the interview, then read on for more information about what prosthodontics is and how it provides solutions that grow with patients.

What Is a Cleft Palate or a Cleft Lip?

Cleft lip and cleft palate are congenital craniofacial (skull and face) deformities disrupting the normal development of the upper lip, jaw, and palate (the roof of the mouth).

Clefts can vary from a small notch in the lip to a complete separation of the lip and both sides of the palate that extends into the nose. They do more than affect appearance. They can pose challenges to feeding, speech, hearing, breathing, and dental development.

Clefts can also have profound impacts on quality of life. Difficulty with eating and drinking can affect nutrition and growth. Speech impediments can hinder communication and social integration. Facial asymmetry can impact self-esteem, as well.

How Do Prosthodontists Help Patients With a Cleft Palate?

The rigorous additional education prosthodontists receive (at least three years beyond dental school), the diagnostic expertise they possess, and the precision with which they design and build custom restorations make them “long-term, essential members of an interdisciplinary team,” explains Dr. Patel, “involved at different stages of treatment.”

Infancy & Early Childhood: Nasoalevolar Molding and Future Planning

When patients are infants, prosthodontists can use specialized mouth appliances, such as nasoalveolar molding (NAM) devices, to gently reposition lip and nose tissue. This early, nonsurgical intervention can reduce the cleft’s severity, improve nasal symmetry, and potentially make subsequent surgical repair less complex.

“Prosthodontists can also provide appliances that can facilitate speech as well as swallowing,” says Dr. Patel, “and in some cases provide aesthetic enhancements, especially because some patients who have these clefts also have congenitally missing teeth. And when some of these teeth are missing, it impacts the patient’s self-confidence, especially while they’re growing.”

Even in these early stages, prosthodontists start envisioning patients’ future needs. They map out long-term treatment blueprints that account for evolving anatomy, the sequence of cleft palate surgeries, and the eventual restoration of teeth and facial structures.

Childhood & Adolescence: Orthodontics, Bone Grafts, and Speech Appliances

A cleft palate can lead to irregular tooth eruption and teeth that are missing altogether. The prosthodontist works with orthodontists to guide jaw growth and create space for future prosthetic rehabilitation.

During childhood or adolescence, alveolar bone grafting is often performed to repair the gap in the upper jaw. This grafting provides a stable foundation for erupting teeth and supports the nose. The prosthodontist ensures the grafted area is optimally prepared for dental implants or other future prosthetic replacements.

Speech development also continues to be a key area of focus during these years. For example, prosthodontists can make a speech bulb obturator for patients with an unrepaired or inadequately repaired palate. This specialized appliance fits into the mouth to help the patient articulate sounds more clearly.

Adulthood: Dental Implants and Custom Prostheses

“In adulthood,” says Dr. Patel, “many patients require either maintenance or replacement of some restorations they may have received during their growing period or during their youth.”

Prosthodontists plan and carry out this work. For instance, they can place dental implants that support fixed bridges or dentures to restore the mouth’s function and appearance.

Beyond dental implants, prosthodontists design and fabricate a range of custom prostheses. These can be as straightforward as crowns to restore damaged or misshapen teeth, or more complex appliances that replace missing parts of the mouth or facial structures.

How Does a Team Approach Help Patients Who Have Clefts?

From the patient’s earliest days, prosthodontists collaborate with oral surgeons, orthodontists, speech language pathologists, and other specialists to ensure coordination of care for a cleft lip or cleft palate.

“It’s very important for patients to seek institutions or environments where they can receive a multidisciplinary approach,” Dr. Patel stresses. She offers the example of prosthodontists working alongside speech and language pathologists to alter appliances so they better facilitate exercises that improve speech and swallowing.

“Each team member brings diverse expertise,” she notes. “The true strength comes from their collaborative approach and their ability to successfully work with each other in gaining the best possible outcome for the patient.”

PDFP Delivers Comprehensive, Lifelong Care for Clefts

In the U.S., between 6,000 and 8,000 babies are born each year with a cleft lip with or without a cleft palate.

When asked what advice she has for parents of these children, Dr. Patel says, “From the infancy stage, look for an environment that can provide a team-based approach . . . [because] prosthodontists can contribute to the care of their infant from the beginning.”

PDFP offers the full range of dental specialties under one roof. Our patients have streamlined access to the services they need, and our doctors can easily and effectively communicate and work with each other.

Dr. Patel and other prosthodontists at PDFP do much more than restore the facial aesthetics of patients with clefts. They restore critical oral functions and help build the foundation for the patient’s enduring confidence and quality of life.

To consult with the prosthodontic experts at PDFP, schedule your appointment online now or call us at 215-898-PDFP (7337).