Recent studies put the incidence of cleft lip and cleft palate at one in every 500 births in the Philippines. This is a much higher incidence than the United States and other developed countries. Further, we treat impoverished patients that would be unable to afford surgery if they had to pay.
Children born with cleft lip/palate have an immediate disadvantage when it comes to feeding and getting proper nutrition. This results in not being able to suck as an infant, and/or properly hold food in the mouth which leads to malnutrition, and many other health problems related to poor nutrition. The hole in the roof of the mouth creates a continuous passage from the mouth into the nasal cavity. This often causes constant upper respiratory tract and sinus infections throughout life.
The cleft lip/palate repair is our central focus; however, there is more that is done to restore the children’s oral health. The complete lack of dental care which is seen in the patient population presents a myriad of problems for the treatment team. The common patient presents with Rampant Gross Caries, usually accompanied by multiple acute and chronic abscesses along with multiple mispositioned and missing teeth, many which present problems in the Cleft Lip/Palate surgical areas. Teeth that are badly decayed, that may compromise healing at the surgical site, are extracted by our mission dentists.
Each patient is given a complete pre-surgery written documented oral examination to first thoroughly evaluate the overall oral condition and then concentration on the areas that are to be repaired by Cleft Lip /Palate surgery.
The fact that these patients are completely sedated presents a unique opportunity for the Dental Team to treat these problems that would possibly compromise the surgery. Multiple extractions in the anterior maxillary are accomplished with ease and are often seen with both acute and chronic swellings and draining fistulas. Rotated and mispositioned teeth in the area are also commonly removed as it is a reality that no orthodontic treatment will be available to these patients, and teeth that might be retained under ideal circumstances are removed. In addition any acute situations in other areas of the oral cavity are treated if possible.
Given the time constraints and the limit of physical space, this approach has been successfully adopted in the treating of these patients by proceeding with treatment as necessary to alleviate any acute problems and concentrate on issues that might compromise the outcome of the surgery.
If a palatal cleft is too large to safely close, or other complications prohibit a safe surgical closure, then we offer the patient an alternative that will prevent food from passing into their nasal/sinus cavities and causing inflammation and infection. An obturator is fabricated by one of our volunteer dentists who works with a local dental lab to create the device.