Odontology Section Meeting, March 1988

16/03/1988 in Royal College of Physicians of Ireland, 6, Kildare Street, Dublin 2

President : Prof. Ian Bermingham

On March 16th, 1988 the Odontological Section hosted a lecture given by Mr. P. Fleming, Registrar in paediatric dentistry, Royal Victoria Dental Hospital, Belfast. As in most other centres, the approach to treatment in Belfast is multidisciplinary. The schedule followed is usually thus: lip repair is done at 10 to 12 weeks of age. Palate repair is done at I0 months onwards. Both of these procedures are done by plastic surgeons. In Belfast, there is no tradition of presurgical alignment of the palatal segments by using oral plates with extra-oral whiskers and/or facial strapping. Speech therapy starts at two years. At 6 years of age, limited orthodontics in the form of minor tooth movements, of the erupting permanent teeth, may be undertaken. Bone grafting into the cleft palate may also be appropriate.

Active orthodontics begins at 12 years of age; the aim being to align the permanent teeth into the optimum occlusions. Mr. Fleming then concentrated on the dental role in the infant years. It consisted of: 1. Parent counselling This involves explanations as to proposed therapies, problem solving and general support. 2. The provision of an adequate feeding plate, to aid feeding prior to palatial repair. 3. Parent education in preventive dental care. This focuses on (a) oral hygiene in the infant and child, (b) diet advice, (c) flouride treatment and supplementation. Preservation of the natural dention is: extremely important. Having explained the Kernahan and Stark classification, and indicated the cases where it would be appropriate, Mr. Fleming then spent some time describing a modified¬†feeding plate, currently being made in the Royal Victoria. These feeding plates prevent leakage of fluids through the nose and ensure adequate nutrition for the infant prior to palatial repair. An impression is made of the infant’s maxilla and a model made. On that model is made a plate which is unusual, in that the surface in contact with the maxillary and nasal mucosa, is soft and displacable. This results in a good fit of the feeding plate, even with the slight growth which occurs in the first 3 months. The soft lining helps avoid the ulceration of the mucosa overlying the nasal septum and/or the anterior nasal spine which is commonly seen with rigid feeding plates. Parents are instructed in the insertion, removal and hygiene of these appliances. Parents often gain comfort and confidence while using these feeding aids, as the infant is retaining and swallowing his/her feed.