DENTAL HYGIENIST 3
Etiology of cleft lip and palate
The factors which cause cleft lip and palate are multifactorial. They involve a major percentage,
genetics, teratogens and factors which are brought about by the environment. As stated above,
cleft lip and palate are composed majorly by the identification of genetic susceptibility as the
major cause. Studies involving monozygotic twins suggest that genetics factor accounts for about
40 – 60% of cases involving orofacial cleft. The process of identifying candidate genes is
complicated by the limited size of samples, heterogeneity and patterns which do not follow
Mendelian inheritance. Interferon regulatory factor 6 gene relates to non – syndromic cleft lip
and palate in many studies which has been shown to cause van der Woude syndrome, the
syndrome which is commonly known to cause cleft lip.3
Factors from the environment have undergone epidemiologic studies that have shown to cause
cleft lip. The studies that have been done is showing that smoking by the mother has been
increasing the developing a cleft lip and palate risks by 30% with the report of a dose-response
effect. Passive smokers on the other hand have not been shown to cause an increase in the risk.
Alcohol consumption by the mother is a controversial issue even though instances of binge
drinking may alleviate the risks.4 There is a link between the non – cardiac defects, pregestational
diabetes and gestational diabetes including the orofacial clefts. Meta-analysis recently done
showed that there is an increased risk of cleft lip and palate by 56% for maternal age of above 40
years as compared to ages between 20 and 29 years. Supplementation with folate in pregnancies
of early stages have been shown to reduce the risks by ¼ to ¾. The reduced risk is due to the
metabolism through which folate undergoes and its strong genetic component. Zinc deficiency
also causes cleft in animals and may cause an increased risk of cleft development in humans.
Pregnant women are advised to be taking multivitamins daily to reduce the risks of developing
clefts since multivitamins have potential benefits.5
Teratogens have been reported to cause clefts. These include retinoic acid, valproic acid, and
phenytoin. There are also risk factors that have been proposed including hyperthermia, chemical
exposures, supplementation oral hormone, stress, ionizing radiation, maternal infection and
obesity. All these factors play roles in the pathogenesis of clefts.6

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