1. Management Of Cleft Lip And Palate Group 4 Nur Fatin, Masyitah, Amalina, Syafiqah, Hanif

2. A multidisciplinary team approach Involving:  Surgeon  Paediatrician/paediatric dentist  Orthodontist  Speech pathologist  Psychologist  Cleft coordinator  Genetic counselor  Audiologist  CLAPAM

3. Dental Team: 1.Orthodontist – Concern on the alignment of teeth 2.Paediatric dentist – Concern on the well being of deciduous and permanent teeth and gingiva 3.Prosthodontist – Replace missing teeth 4.Oral and maxillofacial surgeon – Carry out the surgery procedure

4. Paediatric Dental Care 1.Infant-toddler 2.Primary dentition 3.Mixed dentition 4.Young permanent dentition

5. STAGEMANAGEMENT Infant-toddler-Prenatal oral health counseling for parents -Monitor dental and oral environment, fluoride status, oral habits, OH, diet -Infant oral evaluation:  arch form, displacement of arch segment, presence of natal or neonatal teeth Primary dentition-GOAL: prevention and caries control -Review 3-4x/year -Topical fluoride -Restorative care Mixed dentition-Prevention against caries, temporary replacement of missing teeth -Eruption of permanent lat. Incisors and maxillary molars-retarded -Ectopic eruption into cleft defect -Parental role-active supervision -ABG (9-11 years old)  allow canine eruption -Pre grafting orthodontics -Closure of fistula

6. STAGEMANAGEMENT Permanent dentition- Care for malformed teeth and replacing missing teeth -Continuous caries prevention: fluorides, OH, fissure sealants, diet management -Periodontal disease- cleft lip and palate patient predispose to periodontal destruction of teeth adjacent to cleft  referral to periodontist -Presurgical orthodontics -Orthognathic surgery (>17 years old)  Premaxilla osteotomy  Le Fort I maxillary advancement osteotomy  +/- mandibular setback (BSSO)

7. Orthodontics Management Aims of treatment: Improved appearances Improved speech Improved self image Functional and stable occlusion

8. ORTHODONTISTS Neonatal (0-6month) Parental councelling Feeding plates Rarely pre-surgical orthopeadic Primary dentition (6months- 6years old) Monitor progress OHI-Reinforce dental awareness Mixed dentition (6-12 years old) Correction of minor malocclusion, malalignment of labial segment Arch expansion for ABG Permanent dentition (>11 years old) Definitive orthodontic treatment Orthodontic preparation for orthognathic surgery (>17 years old)

9. Feeding plate

10. Alveolar bone graft

11. Thank you