The terms bite or occlusion define the position of the patient’s teeth when bringing the dental arches into contact.

In this sense, the desirable relationship between the arches is for the upper teeth to circumscribe them, covering the lower teeth to a lesser degree. This relationship is called normal occlusion.

What is cleft palate?

A cleft palate is a congenital abnormality characterized by a cleft in the hard palate and palatine veil.

The Velophthalatine cleft may occur in isolation or may be associated with other skull malformations, in particular cheiloschisis (‘rabbit lip’ – the child is born with a cleft upper lip, but the nose and alveolar ridge are also affected; ‘wolf’s mouth’ – in addition to the lip, the palatine vault and oral cavity are cleft, so that the roof of the mouth communicates with the nose).

Cleft lip and palate are the most common craniofacial congenital malformations.

The Cheilopalatoschisis (“wolf’s mouth”) significantly affects the body’s functionality, causing feeding problems and delay in the development of facial morphology and language.

Cleft lip and palate

The development of the jaws and oral and facial soft structures takes place as early as intrauterine life.

Any defect that occurs during this period can lead to changes that affect both the physiognomy and functionality of oral structures.

Most of the time, developmental defects are visible from birth and treatment will be carried out when the child is old enough for the intervention to take place.

Cleft lip, cleft palate or both, also popularly known as rabbit lip or wolf’s mouth, are malformations that are present at birth but can be detected in the womb.

They are characterized by disruption of continuity in the structures they affect and may occur in the following sites:

• Upper lip – may be only superficially affected and then the cleft has more of a fissure character or may affect both the red lip and muscle structures and the lip is completely split.

• In the latter situation, the mouth is no longer sealed and the oral gum structures can be seen.

• Alveolar process – the bone where the buds of the temporary and permanent teeth develop is affected, so dental abnormalities are possible as a result.

These take the form of destruction of the buds with lack of eruption in the arches, dental inclusions or gaps.

Hard palate and soft palate – also known as the roof of the mouth, if these structures are affected there may be communication with the nasal cavity and food may leak from the nose.

Most of the time, if the clefts deeply affect the oral structures, the child will have problems feeding.

This is because the baby feeds from the mother’s breast, sucking mainly through the lips.

If this sucking is not done, milk is no longer expressed through the mother’s breast and the baby will not feed properly.

Also, if the cleft palate is cleft, it is possible that the milk will reach the nasal passages. In either case, the baby will be deprived of nutrients.

Determinants

Factors that can lead to clefts include:

• Infectious agents – viruses such as rubella can trigger clefts.

• Ionizing radiation and medicines – it is therefore advisable that during pregnancy, the mother is exposed to as little radiation as possible and takes medicines only under the strict supervision of a doctor, to ensure proper development of the fetus during intrauterine life.

• Drugs and steroid hormones

• Deficiencies – lack of certain vitamins and other essential developmental constituents can lead to clefts.

The diagnosis of cleft lip or palate can also be established prenatally when ultrasound examinations are carried out.

If the diagnosis is positive, the surgeon should be contacted in order to work together to ensure that the child develops and grows as normally as possible.

Interventions are carried out in childhood and the child’s progress will be monitored by the surgeon until the age of 14.

Effects on the oral cavity and associated complications

Reverse occlusion can be painful when chewing and can also interfere with speaking. Left untreated, it prevents the harmonious development of the jaw and mandible bones.

Over time, severe TMJ problems occur, with the patient unable to open the mouth to normal values.

The gums are also affected, become inflamed and recede, the end result being premature tooth loss.

The bones, having a different rate of development and an unnatural position, will make chewing difficult. The same effect is caused by tooth wear. Teeth lose hard substance and become abraded precisely because of poor alignment.

How do we treat palatoschisis malocclusion?

These deficiencies can be corrected after surgical, orthodontic and prosthetic treatment.

The most common therapeutic procedure is orthodontic treatment with braces and a piece applied to the palate of the oral cavity, designed to guide and increase the width of the jawbone.

Braces can be made of metal, ceramic or sapphire, the latter two being aesthetic.

For cases of palatal malocclusion, in which the results of orthodontic treatment are unsatisfactory, the dentist may indicate prosthetic treatments such as those shown in the images opposite.

In the below case of a teenage patient, only three teeth were restored to correct the defect.