Good oral health is important for every child.

For children born with a cleft lip and/or palate, it is especially important.

Children with a cleft may be more likely to develop tooth decay or gum problems because:

• Teeth may be crowded or harder to reach.
• The shape of the mouth can make cleaning more difficult.
• Some teeth may develop differently.
• There may be an orthodontic appliance in place, such as a moulding plate (sometimes called PNAM).

Starting good oral care early can help protect your child’s teeth, reduce pain, and make future dental and orthodontic treatment easier.

Keeping your child’s teeth healthy can also help them feel more relaxed about dental visits as they grow up.

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Your cleft team and your regular dentist

Your child’s cleft team usually includes a dental specialist. They can:

• Give advice on caring for your child’s teeth.
• Help identify early signs of tooth decay.
• Support you in building a strong daily routine.
• Show you how to clean around the cleft area and any appliances safely.

They may also work with your regular dentist to make sure your child’s care is well coordinated.

If specialist treatment is needed, your dentist may refer your child back to the cleft team.

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How should I clean my child’s teeth?

You may find it easiest to stand or sit behind your child, gently supporting their chin so you can see and reach all the teeth.

• Start brushing as soon as the first teeth appear.
• Use a children’s toothbrush with a small head and soft bristles.
• Use a pea-sized smear of fluoride toothpaste.
• Brush gently in small circular movements.
• Clean all surfaces of the teeth and along the gumline.
• Don’t forget the backs of the teeth.

The cleft area may need extra cleaning using a small brush, such as an interspace brush. Your cleft or dental team can show you how to do this.

• Supervise brushing until your child is at least 7 years old.
• Brush last thing at night and at least one other time during the day.
• Spit out after brushing, but do not rinse with water – this helps fluoride protect the teeth.

Some children with a cleft may have an extra tooth in the palate (roof of the mouth). Make sure this tooth is cleaned carefully, as it can be easy to miss.

If your child has a moulding plate or other orthodontic appliance, follow your cleft team’s advice on how to clean it and when to remove it for cleaning.

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What toothpaste should I use?

• Under 3 years: Use a smear of toothpaste with at least 1,000ppm fluoride.
• Over 3 years: Use a pea-sized amount of toothpaste with 1,350–1,500ppm fluoride.

You can check the fluoride level on the toothpaste packaging.

If your dentist feels your child has a higher risk of tooth decay, they may recommend:

• A higher-fluoride toothpaste.
• Fluoride varnish is applied to the teeth every six months.

These help strengthen teeth and reduce the risk of decay.

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What toothbrush is best?

• Use a small-headed toothbrush with soft bristles.
• Choose a brush suitable for your child’s age.
• A power toothbrush designed for children can help:
• Make brushing more enjoyable.
• Ensure brushing lasts long enough.

Power brushes with small, rotating heads can be used from around 3 years old, if your child is comfortable with them.

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Your child’s diet

Sugar is one of the main causes of tooth decay. Try to reduce both how much sugar your child has and how often they have it.

• Aim for 3–4 regular meals a day.
• Avoid constant snacking.
• Keep sugary foods, drinks and fruit to mealtimes.

Saliva helps protect teeth between meals, but frequent sugar attacks make this harder.

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Tooth-friendly snack ideas

If snacks are needed between meals, try:

• Breadsticks.
• Rice cakes.
• Toast or crumpets.
• Raw vegetables.
• Cheese.
• Plain popcorn.
• Plain yoghurt.
• Nuts (if age-appropriate and no allergies).

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Helping your child feel confident

Children with cleft lip and/or palate may feel more anxious about dental visits.

Many have already experienced hospital appointments, treatments or surgery.

You can help by:

• Talking positively about dental visits.
• Letting your child know what will happen in simple words.
• Share any worries with your dental team.

Dental teams are used to caring for children with cleft and will work at your child’s pace.

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Summary

Every child is different. If you are unsure about brushing, toothpaste, diet or dental visits, speak to your dental team or cleft specialist.

Early support and simple daily habits can make a big difference to your child’s comfort, confidence and long-term oral health.