Care of adolescents with cleft lip and palate: the role of the general dental practitioner.

Management of the adolescent with cleft lip and/or palate is ideally undertaken by a cleft palate team which has overseen care since birth, and which provides, in a paediatric hospital setting, the specialist medical, dental and ancillary care services necessary for optimal management. However, in some countries such a team is not available and individual dental practitioners and dental specialists have to undertake the necessary treatment. This is facilitated in Australia by the Federal Government's 'Cleft Lip and Palate Scheme', which subsidizes all medical and dental treatment related to the congenital defect up to 22 years of age. In such circumstances the general dental practitioner or paedodontist may need to assume an important coordinating role. The timing and integration of phases of general dental, minor oral surgical, orthodontic, periodontic and prosthetic treatment with plastic, ENT and maxillofacial surgery, speech therapy and audiology may become his responsibility. In addition, the provision of a high standard of preventive and general dental care for the cleft patient must be maintained. To carry out this coordinating role effectively, the general dentist must know his patient and family well; must understand the current concepts, objectives, treatment and investigatory techniques used in all aspects of cleft palate management; he should be aware of the genetics of the clefting conditions, medical problems which may commonly be associated with clefts and the cleft as one feature of a syndrome. Most importantly, he should be aware of the special social adjustment problems faced by many cleft adolescents in relation to their perceived 'different' facial appearance and speech.