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ROLE OF PROSTHODONTIST IN TREATMENT OF CLEFT LIP AND PALATE PATIENTS

Smita R Athavale*, Dilip S Deshpande**, Avinash K Deodhar
*Lecturer; **Consultant Prosthodontist and Implantologist; ***Consultant Plastic Surgeon; Dept of Prosthodontics, Nair Hospital Dental College, Mumbai.

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In this article, an effort has been made to highlight the importance of role of prosthodontist in treatment of cleft lip and palate patients. Prosthodontist should utilize his/her knowledge and skills for cleft lip and palate patients and help them to enter the mainstream of society. A team approach of various specialities working together, results in successful rehabilitation of such patients in all aspects.

INTRODUCTION

Ideally, aim of medical profession is, to provide a state of total health to the patient, which is not merely a treatment of the disease, but a physical and psychological well-being of the patient.

But, in this era of superspecialization, with the boon of advanced knowledge and modern technology, there is a bane of developing a tunnel vision to our fields.

It is a well established fact, that multidisciplinary approach is definitely the most ideal way of treating cleft lip and palate patients and prosthodontist is an important and integral part of this team.

DISCUSSION

HK Cooper, an eminent orthodontist, put forth his concept of Lancaster clinic in which, the best possible treatment from all the concerned specialities was available under one roof.

He had a team of consultants to give the patient, right treatment at the right time. (Table 1).

TABLE 1 Team of consultants

Obstetrician and Gynaecologist Paediatrician and Neonatologist Psychiatrist Prosthodontist Plastic Surgeon Orthodontist Speech therapist Medical social worker

It was HK Cooper who emphasized, on having dental speciality treatment, especially prosthodontic and orthodontic services, available in each plastic surgery unit in the hospitals and medical institutions.

In that, the prosthodontist is not the one who merely replaces teeth, but the one who has multiple responsibilities towards other medical specialities (Table 2).

Prosthodontist can help the plastic surgeons in providing treatment to cleft lip and palate patients as follows,

In pre surgical phase

1. By giving feeding plates to the neonates, born with cleft lip and/or palate, to improve their nourishment and growth.

TABLE 2

2. Providing palatal obturator to the patients prior to surgery.

In post surgical phase

1. Immediate post surgical prosthesis / obturator.
2. Palatal obturator.
3. Dental implants.
4. Ear, eye, nose and other facial prostheses.
5. Speech-aid prosthesis for better speech of cleft lip and palate patients.
6. Replacement of teeth for better esthetics, mastication and speech.

In case of cleft lip and palate patients, prosthodontic treatment plays an important role right from the time, the child is born, till such a time that the individual is totally rehabilitated and becomes a normal human being, in a state of total health.

Neonates born with cleft lip and palate

Immediately after following a careful investigation by a neonatologist and counseling of the parents by gynaecologist and psychiatrist, prosthodontist comes in picture. After obtaining an accurate impression of the defect, a feeding plate, palatal obturator is made. Due to this, an artificial separation is provided between the nasal and oral passages which prevents nasal regurgitation of milk and facilitates better feeding for the child. It also helps preventing recurrent upper respiratory tract infections due to the defect. Most of the children are successful in taking breast feed and others can be given top feed with help of the bottle or traditional wati and spoon. Remarkable weight gain and satisfactory growth is seen after feeding plate is given to the child.

Post surgical fistula

Sometimes after the surgery post surgical fistula occurs, due to which nasal regurgitation and defective development of speech persists. With a suitable impression procedure, model can be obtained and a palatal obturator can be made for the patient which controls nasal regurgitation and helps in better speech development.

Speech aid prosthesis

Sometimes patients with wide bilateral cleft lip and palate defects do not show satisfactory closure, even after undergoing multiple surgeries. Besides other complications, defective speech with hypernasality becomes a hindrance in proper growth of a child.

With careful impression procedure, details of posterior palatal region are obtained and a palatal obturator is fabricated with a speech bulb in soft palatal region.

Speech-aid prosthesis along with active speech therapy treatment satisfactorily improves speech of the patient and helps in psychologically rehabilitating the patient.

Palatal obturator with replacement of teeth

In majority of surgically treated cases, as growth continues, there is a severe maxillary arch collapse and some maxillary teeth fail to erupt or are extracted because of some reasons. Such patients suffer from lack of esthetics, phonetics and function (mastification). Replacement of teeth in such cases becomes crucial for such patients, for their physiological as well as psychological well being. This helps the patients to develop a better personality.

CONCLUSION

Prosthodontist plays a very important role in complete rehabilitation of cleft lip and palate patients. For successful rehabilitation of such patients, a team approach of concerned specialities with phasewise, unanimous and systematic treatment plan is essential. Aim of the team of consultants should be rehabilitation of the patient "as a whole" and not just success of individual speciality.

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