Dental Hygienist Case Study 2022

Running head: DENTAL HYGIENIST 1
Dental Hygienist
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DENTAL HYGIENIST 2
Introduction
The condition involving Cleft lip or palate is a congenital defect which is common to the human
species and is usually recognized and identified at birth. Clefts are easily recognized at birth
since it involves the deformation of the normal structure of the face. There are a lot of
implications that are significantly posed to the affected individuals which include the following:
social, medical, psychological and financial implications. These implications may increase and
negatively affect families who are involved with this defect. Genetics and environmental factors
play important roles in the complex etiology of the clefts. Processes involving the development
of the clefts are brought up by several risk factors which include maternal smoking, maternal age
and deficiency of folic acid.1 Cleft lip or palate is among the major problems encountered in
public health due to the morbidity it is associated with in life, the complex etiology it poses, and
the highly involving commitments that are required during the process of extensive
multidisciplinary intervention. For a total of 1000 births which are alive, clefts affect about 1.5
with 250000 cases which are new per year in the whole world and 1 in 600 to 700 births in the
USA. This occurrence comes with very many variations which are tremendous withing different
ethnic groups and geographic areas. Clefts are debilitating since they are involved with serious
health problems like bleeding, speech, psychological impairments and hearing defects. These
defects help in the understanding of the development of the course of this defect and the
optimization of treatment options. Treatment options include those of supplementation with folic
acid and the optimal or early surgical procedures. Two categories are put in place for lip cleft
types, complete and incomplete depending on the degree of occurrence.2

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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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Associated problems
Clefts come with several problems and other anomalies as compared to the normal people. These
include the dental anomalies which describe the variations in the number of teeth and their
positions, reduced dimensions of the teeth which are mostly present near the area which has been
affected by the cleft, morphology and structure. There is also a prevalence of discoloration of the
enamel especially in children having clefts which usually causes trauma at the time of surgery.
There are also instances of hypodontia as well as root development of the tooth which is delayed.
Distribution of dental deformities and anomalies have presented at different proportions
according to studies that have been done. The studies have shown that there is an occurrence of
agenesis, microdontia, ectopic eruption, rotation, impaction, retained teeth, shape anomaly, short
or blunt root, pulp stone, and enamel hypoplasia among others occurring with a cleft of the lip or
palate.7
Other complications and problems of clefts involve early mortalities in the life’s first few days
for affected patients hence congenital anomalies. These problems also involve major
complications for the repair of the primary lip, pneumonia, and postoperative hemorrhage. There
are minor complications and problems which are associated with clefts, these include otitis
media, mild infection in the upper respiratory, diarrhea, partial suture line separation, bleeding,
wound dehiscence and infection, feeding difficulty, respiratory arrest and compromise.8
Surgical management of cleft lip and palate
Surgical management of cleft lip and palate involves the use of complex procedures that require
well-trained personnel to carry out the procedure. Surgical management involving the cleft lips
are usually done at the age of up to 3 months, a term known as cheiloplasty while surgical
management involving cleft palate is typically done at the age of around 12 months. 10 to 20
percent of surgical management of newly born infants may be needed to undergo through the
secondary physical management.9
Children and adolescents undergoing surgical intervention on cleft lip or palate requires that
there should be the involvement of both dental and orthodontic cleft care which is needed in the
monitor of the growth of the face and dental eruption. These processes help in the timing and
planning of procedures used during surgery. The grating of the alveolar bone usually involves

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this approach. Orthodontic treatment is also a framework involved in reconstructive surgery
together with the correction of debilitated occlusal abnormalities. For effective intervention of
midface and reconstructive advancements, appropriate orthodontic care must be adopted to avoid
the jeopardy of the outcomes. The use of surgical interventions in the management of cleft lip or
palate helps in the repair of facial deformities manly together with great improvements in speech,
hearing, feeding and breathing problems.10
Conclusion
The occurrences of cleft lip and palate conditions bring with it a lot of problems and deformities
that negatively impacts a large proportion of the society globally. This involves burdens such as
those of physical morbidity, emotional distress, social dysfunction, and expenses in health care
for the affected individuals in the society. This defect arises from genetic or environmental
perspective and/or exposure to teratogens. It causes dysfunction of the oral sphincter, difficulties
in speech among other anomalies like dental deformities. Surgical techniques have been put in
place to help achieve the objectives of restoration of the normal capacity of feeding, speech
development and esthetics of the face during the early ages of infants.

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References
1. Sinno H, Tahiri Y, Thibaudeau S, Izadpanah A, Christodoulou G, Lin SJ, Gilardino M.
Cleft lip and palate: an objective measure outcome study. Plastic and reconstructive
surgery. 2012 Aug 1;130(2):408-14.
2. Crockett DJ, Goudy SL. Cleft lip and palate. Facial Plastic Surgery Clinics. 2014 Nov
1;22(4):573-86.
3. Farronato G, Cannalire P, Martinelli G, Tubertini I, Giannini L, Galbiati G, Maspero C.
Cleft lip and/or palate. Minerva Stomatol. 2014 Apr;63(4):111-26.
4. Bezerra JF, Oliveira GH, Soares CD, Cardoso ML, Ururahy MA, Neto FP, Lima‐Neto
LG, Luchessi AD, Silbiger VN, Fajardo CM, de Oliveira SR. Genetic and non‐genetic
factors that increase the risk of non‐syndromic cleft lip and/or palate development. Oral
diseases. 2015 Apr;21(3):393-9.
5. Allam E, Windsor L, Stone C. Cleft lip and palate: etiology, epidemiology, preventive
and intervention strategies. Anat Physiol. 2014;4(3):1-6.
6. Miller SF, Weinberg SM, Nidey NL, Defay DK, Marazita ML, Wehby GL, Moreno
Uribe LM. Exploratory genotype-phenotype correlations of facial form and asymmetry in
unaffected relatives of children with non‐syndromic cleft lip and/or palate. Journal of
anatomy. 2014 Jun;224(6):688-709.
7. Stock NM, Feragen KB, Rumsey N. Adults’ narratives of growing up with a cleft lip
and/or palate: factors associated with psychological adjustment. The Cleft Palate-
Craniofacial Journal. 2016 Mar;53(2):222-39.
8. Noorollahian M, Nematy M, Dolatian A, Ghesmati H, Akhlaghi S, Khademi GR. Cleft
lip and palate and related factors: A 10 years study in university hospitalized patients at
Mashhad—Iran. African journal of pediatric surgery: AJPS. 2015 Oct;12(4):286.
9. Sitzman TJ. Cleft Lip and Palate: Current Surgical Management, An Issue of Clinics in
Plastic Surgery, E-Book. Elsevier Health Sciences; 2014 Mar 18.
10. Hupp JR, Tucker MR, Ellis E. Contemporary Oral and Maxillofacial Surgery E-Book.
Elsevier Health Sciences; 2018 Sep 27.