Cleft Lip and Cleft Palate Waterloo
Cleft lip and cleft palate are two common but markedly different birth defects that affect about one in every 700 newborns. These developmental deformities occur in the first trimester of a woman’s pregnancy; cleft lip in week seven, and cleft palate in week nine. Cleft lip and cleft palate occur simultaneously in about half of all cases, and separately in approximately a quarter of all cases.
A cleft lip is essentially a separation of the two sides of the lip. In many cases, this separation will include the bone and gum of the upper jaw. A cleft palate occurs when the sides of the palate fail to “fuse” as the fetus is developing, which results in an opening in the roof of the mouth.
The cleft deformities are categorized according to their location in the mouth and the size of the defect.
Unilateral Incomplete: A cleft on only one side of the mouth that does not extend as far as the nostril.
Unilateral Complete: A cleft on only one side of the mouth that extends into the corresponding nostril.
Bilateral Complete: Larger clefts affecting both sides of the mouth which each extend as far as the nostril.
Microform Cleft: A mild case of cleft lip which may simply form a bump on the lip, or a small scar line extending toward the nostril.
Reasons for Cleft Lip and Cleft Palate Correction
Cleft lip and cleft palate are highly treatable deformities, though it may take a whole team of different specialists to fully treat the condition. The prognosis for sufferers who receive corrective treatment is excellent; medically, physically, dentally, and emotionally. There are however, a series of risks for those who do not receive corrective treatment:
- Speech – Children born with either cleft deformity are likely to experience speech problems unless treatment is sought. Speech problems are detrimental to a child’s social and emotional development.
- Feeding – Babies with a cleft palate or a complete cleft lip have problems drinking milk. The gap means that liquids can pass from the mouth to the nasal cavity. This can be dangerous unless the child is fed sitting upright.
- Hearing Loss & Frequent Ear Infections – A cleft palate can cause the eustachian tubes (connecting the throat to the ear) to be incorrectly positioned. The fluid build up which results from this poor positioning can lead to painful middle ear infections. Severe and prolonged ear infections can lead to complete hearing loss.
- Dental Issues – Abnormalities in the upper jaw, gum, or arch can cause teeth to become impacted (unable to erupt) or absent completely. The shape of the mouth might not permit proper brushing which can lead to periodontal disease and tooth decay.
What Does Cleft Lip and Cleft Palate Treatment Involve?
Initially, surgeons will work to close the cleft openings in the first six months of the child’s life. Unfortunately, this does not cure the dental problems that occur as a result of cleft lip and cleft palate defects. The dentist will perform a thorough examination of the teeth surrounding the deformity. Panoramic x-rays will generally be taken to allow the dentist to determine the best course of treatment.
The dentist may implant teeth to fill resulting gaps, and/or place braces on the teeth in order to correctly align the upper arch. These treatments will restore functionality to the jaw and improve the aesthetic appearance of the smile. Dental restoration work can generally be performed under local anesthetic and will not require an overnight stay.
If your child was born with any cleft deformity, we strongly encourage you to contact our Waterloo dental office to schedule a consultation.
Our pediatric dentistry in Waterloo at Trillium Dental Centre focuses on supporting children with conditions like cleft lip and palate, helping guide healthy dental development as they grow.
What to Expect From Cleft Lip and Palate Care
Cleft lip and cleft palate are among the most common birth differences, affecting roughly one in 700 newborns. Care for a child born with a cleft involves a team — pediatrician, plastic surgeon, ear/nose/throat specialist, speech therapist, orthodontist, oral and maxillofacial surgeon, and general dentist — working together across many years. The role of dental and oral surgery care begins early and continues into late adolescence or adulthood.
A baby born with a cleft is typically seen by a cleft team within the first few days of life. Surgery to repair the cleft lip is done around three to six months of age; cleft palate repair follows around nine to eighteen months. Throughout childhood, follow-up appointments monitor speech, hearing, dental development, and facial growth. Additional procedures may be needed at specific stages: alveolar bone grafting (placing bone in the gum line) around age seven to nine, orthodontic treatment in the early teens, and sometimes corrective jaw surgery in the late teens after growth is complete.
Dental and oral surgery care at Trillium fits into this broader team framework. We coordinate with your child's other care providers, monitor dental development, manage any specific issues with teeth in or near the cleft area, and prepare for the orthodontic and surgical phases of treatment. Adults with previously treated clefts receive ongoing dental care just like any other patient.
Common Dental and Oral Concerns With Clefts
Children and adults with clefts often face specific dental considerations that benefit from focused care. Issues we monitor and treat include:
- Missing, extra, or malformed teeth near the cleft site, especially the lateral incisor on the affected side
- Delayed or unusual eruption patterns of permanent teeth
- Increased risk of dental caries in the cleft area where home cleaning is more difficult
- Crowding and bite issues that often need orthodontic treatment in the teen years
- The need for alveolar bone grafting before orthodontics can move teeth into the cleft area
- Speech and hearing follow-up coordinated with the cleft team specialists
- Eustachian tube dysfunction with hearing implications during childhood
- Self-image and confidence considerations that may benefit from psychological or counselling support during the teen years
- Adult restorative needs for cleft-area teeth that may require implants, bridges, or other replacement
Care plans are individualized — every cleft is different, and the timing of various procedures is set by the team based on each child's growth and development. We work in close coordination with the lead cleft team your family is connected to.
Long-Term Outlook and Follow-Up Care
With modern team-based care, outcomes for children born with clefts are very good. Most reach adulthood with normal speech, hearing, dental function, and facial appearance, though the path to that outcome involves multiple procedures and many years of follow-up. Patience and consistency through the early years pay off in the teen and adult years.
Adult patients who were treated as children for clefts continue to need dental follow-up. The cleft area may have weaker periodontal tissue around the affected teeth, replacement teeth (bridges, implants) may need maintenance, and orthodontic retainers protect long-term tooth position. Regular cleaning visits, careful home care of the cleft area, and prompt attention to any new symptoms keep the long-term result stable.
Pregnancy in adult patients with clefts deserves a conversation with the cleft team because of the slightly higher chance of a child also being born with a cleft. Genetic counselling can clarify risk and options. We can help connect you with the right specialists if this conversation becomes relevant.
Cost and Insurance Coverage
Most surgical care for clefts (lip repair, palate repair, alveolar bone grafting, jaw surgery) is covered by provincial health insurance because the procedures are medically necessary. Dental care that falls within standard dental services (exams, cleanings, fillings, restorative work) is billed under dental plans, including CDCP for eligible patients and private insurance.
Trillium follows the current Ontario Dental Association Suggested Fee Guide for dental services, and we submit insurance claims directly where the plan allows. For orthodontic treatment and major restorative work, we run pre-determinations with your insurer so coverage and out-of-pocket portions are clear before treatment starts.
Frequently Asked Questions
Will my child need many procedures?
Most children born with clefts have multiple procedures across childhood and into the teen years — typically three to six major procedures by age 18, plus follow-up dental and orthodontic care. The timing is spread out so growth and development happen at the natural pace, and each procedure builds on the result of the previous one.
When does dental work start?
Routine dental care begins at the same age as for any child — around the first birthday or when first teeth come in. Specific cleft-area dental work like alveolar bone grafting typically happens around age seven to nine, in coordination with the cleft team and orthodontist.
Will my child need orthodontics?
Most children with clefts benefit from orthodontic treatment in the teen years to correct crowding and bite issues. This is usually planned in coordination with the cleft team and may include preparatory work before bone grafting and continued treatment after.
Are dental implants an option for a missing tooth in the cleft area?
Often yes, in adulthood after all growth is complete and after alveolar bone grafting has provided enough bone to support an implant. The decision depends on the specific anatomy and tissue quality. Other options include bridges and partial dentures.
How do you coordinate with our cleft team?
We communicate directly with the cleft team's coordinator and your child's other providers, share x-rays and treatment notes, and align our scheduling with their treatment plan. The goal is one coordinated care plan, not several separate ones.
Will my child have speech problems?
Speech outcomes are generally very good with early and consistent care from the cleft team's speech-language pathologist. Some children need additional speech therapy beyond the team's standard support. Hearing issues from middle-ear concerns are also monitored and treated as needed.