Teeth at birth??

It is not uncommon for cleft babies to be born with one or some teeth already erupted. These are also usually supernumerary teeth, or “extra teeth.”

Let’s start with some definitions you may hear from your craniofacial team during an examination…

Natal Teeth: Teeth that are present at birth above the gumline

Neonatal Teeth: Teeth that erupt during the first month of life

You’re probably thinking this is odd.  It’s actually quite common in cleft babies to not only have natal or neonatal teeth, but also to have supernumerary teeth. Don’t worry, it’s not usually a whole mouth full of extra teeth…just one or a couple. About 10% of natal teeth are also supernumerary.¹ 

Usually, teeth erupt at about 6 months of age

Meaning, teeth present at birth is an unusual finding, but it does happen.

• Studies have found that natal/neonatal teeth are more common in bilateral cleft lip and palate babies. 
• The most common place for a natal tooth is on the upper jaw near the cleft site

Luckily, the presence of natal/neonatal teeth does not affect the baby teeth or permanent teeth.²

What is usually done when these teeth are present?

There are problems that can occur with natal/neonatal teeth:³

1. Risk of baby choking on loose natal/neonatal tooth
2. Discomfort during feeding
3. Interference with NAM appliance
4. Ulceration on tongue from tooth

If none of the above are occurring, and the tooth is not mobile, it can generally be left alone. If the tooth is in the cleft site and asymptomatic, it can stay until the lip surgery is performed. During that surgery, the surgeon can simply remove the tooth.

¹Tannure PN, Oliveira CA, Maia LC, Vieira AR, Granjeiro JM, Costa Mde C. Prevalence of dental anomalies in nonsyndromic individuals with cleft lip and palate: a systematic review and meta-analysis.
Cleft Palate Craniofac J. 2012 Mar; 49(2):194-200.
²Cabete HF, Gomide MR, Costa BEvaluation of primary dentition in cleft lip and palate children with and without natal/neonatal teeth.
Cleft Palate Craniofac J. 2000 Jul; 37(4):406-9.
³Kadam M, Kadam D, Bhandary S, Hukkeri RY. Natal and neonatal teeth among cleft lip and palate infants. Natl J Maxillofac Surg. 2013;4(1):73–76. doi:10.4103/0975-5950.117883.

To crown or not to crown?

After visiting the dentist, you may walk away with a large treatment plan for your cleft child, including stainless steel crowns.

You may be asking yourself, what are stainless steel crowns?

Stainless steel crowns, sometimes referred to as “caps” or “silver crowns,” are strong, durable, and cost-effective ways to protect baby teeth. Baby teeth are so important to protect because they serve as space-holders for permanent, adult teeth. If baby teeth are removed too soon, your child is at risk for permanent, adult teeth coming in at the wrong locations in the mouth.  This leads to an improper bite and tilting of teeth, which leads to improper function. 

They are usually indicated when your child has a high-cavity risk or a large cavity in the tooth. The reason a filling cannot just be done on these teeth is because of the size of the cavity. If a crown is being recommended by your dentist, that means a simple filling could potentially break just due to the size. A crown covers the entire tooth and protects the tooth structure underneath it.

What puts a child at a high-cavity risk?

To put it simply, having a cleft lip and/or palate already puts your child at a high-cavity risk.¹

• The reasons are not entirely clear, but much research shows that because of the tooth malformations and malpositioning of teeth that result from a cleft, the plaque buildup is much greater in cleft patients. Naturally, through chewing and saliva flow, plaque is wiped away from the teeth, but teeth in different positions because of the cleft may be more difficult to clean. 
• The nasal discharge from the opening in the palate also makes it difficult to keep teeth clean.
• Hypoplastic lesions, or weakened enamel, is more prevalent in cleft patients. If the enamel is weak, the child is more susceptible to cavities.²
• Lastly, it’s been found that cleft patients partake in a more sugary diet than non-cleft patients. 

OK, if I do the crown, what are my options?

There are 4 options for the type of crown to get. Which one to choose depends on esthetics, function, and finances.

Stainless Steel Crown

• Durable
• Strong
• Long lifespan
  
• Cost-effective
• Not suitable if child has metal allergies

Stainless Steel Crown with White Facing

• Has a tooth-color on the front of the crown
• More bulky to add white color
• Tend to chip over time

Composite Strip Crowns

• Entirely tooth-colored
• Takes longer to put on than a stainless steel crown
• Because it takes longer, sedation is recommended
• Over time, discolors
• Significantly weaker than stainless steel crowns

Zirconia Crowns

• Entirely tooth-colored
• Smooth and shiny
• Do not stain
• Extremely strong
• More expensive

Moving Forward

Just because your child has a cleft and is at higher risk for developing cavities does not mean all of the teeth should have crowns. Unless his/her dentist is recommending crowns, do not voluntarily get them. 

It does mean more care should be taken to prevent cavities from occurring, at least with the parts you can control. 

What this includes:³ 

1. Less sugary snacks
2. Always clean any appliances in the child’s mouth at least twice a day
3. Have regular dental examinations
4. Fluoride supplements in non-fluoridated areas
5. Practice good oral hygiene by brushing twice a day!

Thank you for reading! I hope this helps answers some questions and makes these crowns seem less scary. At the end of the day, they are good for your child and will help ensure proper positioning when those adult teeth do come in.

 

1. Britton, K.F.M., Welbury, R.R. Dental caries prevalence in children with cleft lip/palate aged between 6 months and 6 years in the West of Scotland. Eur Arch Paediatr Dent 11, 236–241 (2010). https://doi.org/10.1007/BF03262754

2. Shashni R, Goyal A, Gauba K, Utreja AK, Ray P, Jena AK. Comparison of risk indicators of dental caries in children with and without cleft lip and palate deformities. Contemp Clin Dent. 2015;6(1):58–62. doi:10.4103/0976-237X.149293

3. Preventing caries in cleft lip/palate. Br Dent J 202, 61 (2007) doi:10.1038/bdj.2007.59

 

Many people ask about when to see a dentist. You’ve done the NAM (or haven’t), and the baby doesn’t have any teeth yet. And when he or she does start having teeth come in, they are just baby teeth and eventually fall out. So a dentist appointment really isn’t necessary yet, right?

I think you know where I’m going with this.

OK, so when should we do the first dental visit?

All children should have their first dental visit as soon as the first tooth appears in the mouth OR before 1 year of age…whichever comes first.

And where?

Hopefully, your local Craniofacial Team can help direct you to a pediatric dentist who works with cleft children. The pediatric dentist is usually on the Craniofacial Team. However, the child’s doctor or nurse can give a recommendation as well.

What to prepare when you call:

It is good to have something rehearsed when you call so the pediatric dentist can be prepared for the visit. Choose a time for the appointment that works best for your child during the day. Have these things prepared to say:

• Calling to schedule your son’s/daughter’s first dental visit
• Mention:
  • The child has a cleft and what type
  • Any fears the child may have
  • What the dentist/assistant can do to make the child more comfortable
  • It may take longer to treat your child
• Can you bring a stuffed animal or favorite toy to the appointment?
• Is there a private area you can wait until you are seen by the dentist?

Now that the appointment is scheduled, you can prepare your child (and yourself).

Prior to the visit:

The best thing you can do is talk to your baby about the dentist in a positive way. Touch the baby’s mouth, playfully. Put your finger in the baby’s mouth and move it around while using an upbeat tone of voice.

1. Prepare a list of medications the child takes.
2. Have the child’s primary doctor’s name and address ready to give to the office.
3. Bring a folder of the child’s records of surgeries and medical visits.
4. Prepare a list of any questions you have about the baby’s mouth and teeth.

The day is here!

First Dental Visit:

This is an exciting time. You are creating a dental home for your child, which is so important because now you will have someone to call if a dental emergency occurs. 

Bring your paperwork you prepared! Arrive at least 15 minutes early.

Make sure you reiterate what will make the child comfortable when you check-in at the front desk. 

Most importantly, ASK QUESTIONS to the dentist like:

• Who to call if there is a dental emergency
• What you should be doing now to help care for the teeth
• How to clean the cleft area if debris gets stuck
• Is there an orthodontist you recommend who specializes in craniofacial patients?
• What kind of toothbrush should be used
• What toothpaste should be used
• Best snacks for healthy teeth
• General medications without added sugar
• What is normal and not normal in a cleft patient’s mouth

YOU DID GREAT!! And I’m sure your cleft baby did too.

Now, here is how you can care for the baby at home:

General Dental Care 

Stick to these guidelines, and your baby will have healthy teeth and gums for life:

• Brush twice a day with fluoride toothpaste
• Drink water with fluoride in it
• Avoid sugary snacks and foods (anything with ingredients ending in -ose)
• Try different toothpastes until your child likes one
• DO NOT chew on food and offer to baby, or share utensils, cups, or toothbrushes 
  • This passes your oral bacteria to your baby, which can cause tooth decay
• Clean the pacifier with only water
• If the baby knocks a tooth out, put tooth in milk to bring to the dentist
• Take precautionary measures to avoid injury to face
• Be sure to have sealants done on permanent teeth to avoid dental decay

The dentist is so important! 🦷

You can be a huge advocate for your child by bringing him or her to the dentist regularly and by following the guidelines above.

AND your child will be more comfortable with oral healthcare as he or she gets older. Remember, oral health affects the body’s health. Caring for your child’s teeth contributes to a healthy body.

Keep up the great work! You are an awesome parent!!

Can I breastfeed my cleft baby?

This is a common question with new moms. After all, we know that breastfeeding has many benefits both for the mother and the baby, including but not limited to:

• protects against allergies
• easier on the baby’s stomach than formula
• reduces risk of viruses and bacterial infections
• reduces risk of ovarian and breast cancer in moms
• more rapid uterine healing for mom
• bonding with baby

Breastfeeding exclusively is recommended for the baby’s first 6 months of life. Breastfeeding is HARD, whether the baby has a cleft or not. So it’s important to realize that and not be quick to give up.

I just recently attended a Craniofacial Meeting where the presenter, a speech pathologist, discussed breastfeeding and bottle feeding cleft babies.

She mentioned how babies with a cleft lip only are usually able to breastfeed successfully. The only thing that needs to happen in order to do so is a seal. Babies, surprisingly, with a cleft lip are able to create a seal around the nipple, regardless of the cleft in the lip. 

The seal is created by the breast or mom’s finger.

A hissing sound Indicates the seal is not adequate.  At this point, it is important to reposition the baby to create the proper seal.

What about cleft palate babies?

This is a little more difficult. Sometimes, if the cleft palate is smaller, the breast may be able to cover the palate. In many situations though, a bottle is needed to for this task. The reason is because it is difficult for the baby to create a suction.

Feeding your baby expressed breast milk will still offer the many benefits of breastfeeding, including reduced middle ear infections, which are common in cleft babies!

Bottles for cleft babies

There are many options out there for bottle feeding your cleft baby, but the most successful ones are as follows:

• SpecialNeeds Feeder by Medela

• Dr. Brown’s Specialty Feeding System with a one-way valve

Special Needs Feeder by Medela

This is nice because you can control the flow rate just by squeezing on the bottle. This is important because since the baby cannot suck by himself, you can help express the milk for the baby.

There are 3 different flows for this bottle. The valve is sensitive to the baby’s feeding, even with the weakest amount of sucking, and completely closes when the baby pauses sucking. 

It is so important to get help from a Cleft Nurse Specialist regarding bottle feeding. The nurses in the hospital do not use this bottle every day, so it’s best to receive training from those who are experts with these bottles.

Dr. Brown’s Specialty Feeding System with a One-way Valve

This bottle looks exactly like the normal Dr. Brown’s bottles, but it has a valve that is inserted into the bottle. The valve works the same way as the Medela bottle, where it helps the infant with self-regulation during the feedings. 

The only difficulty with this bottle is that there are many parts, so it may be hard at first to assemble all the pieces. 

The difference between this bottle and the Medela is that you do not squeeze the milk into the baby’s mouth. The bottle releases the bolus of milk without a squeezing mechanism, so it helps with self-regulation.

Watch this video for a tutorial.

My Story

I don’t know much about how I was fed as a baby, but I know there were only 2 people who were able to successfully feed me: my mom and grandma.

My mom would constantly tell me stories about how they had to feed me from a cup. I’m not sure if these specialty bottles were as prevalent when I was young, but I was not fed from a bottle. 

They would use a medicine cup and fill it with formula and slowly drip it into my mouth. This seems very tedious and difficult! I’m glad these bottles are a resource for families now. 

As always, please feel free to comment or reach out to me about a topic you’d like more information on. Thank you for reading!