The Patient with a Cleft Lip and/or Palate Quiz

During which gestational weeks does the secondary palate typically form?

 

weeks 4-5

 

weeks 7-12

 

weeks 14-20

 

weeks 18-24

weeks 7-12

A cleft of the soft palate results from the failure of fusion between which embryonic structures?

 

Maxillary and mandibular processes

 

Nasal septum and median nasal process

 

Palatal shelves of the maxillary processes

 

Lateral nasal and medial nasal processes

Palatal shelves of the maxillary processes

-fail to fuse at the midline

Which of the following is the most common type of cleft?

 

isolated cleft lip

 

cleft lip with cleft palate

 

isolated cleft palate

 

submucous cleft only

cleft lip with cleft palate

-especially in males

A major concern for oral health professionals when providing care to patients with cleft palate is:

 

High caries risk due to systemic fluoride deficiency

 

Inability to tolerate radiographic procedures

 

Communication between the oral and nasal cavities

 

Inability to tolerate ultrasonic instrumentation

Communication between the oral and nasal cavities

• An open communication between the oral and nasal cavities affects speech, feeding, and can lead to aspiration. Proper precautions must be taken during treatment

A patient with a repaired cleft palate is more likely to experience which of the following oral conditions?

 

Lichen planus

 

Malocclusion

 

Dentinal hypersensitivity

 

Geographic tongue

Malocclusion

• Due to the interruption in normal maxillofacial development, malocclusion is very common in cleft palate patients and often requires orthodontic intervention.

What is the ideal time frame for surgical closure of a cleft lip?

 

By 10 weeks of age

 

At 1 year of age

 

Before eruption of primary teeth

 

When speech develops

By 10 weeks of age

• The "Rule of 10s" is typically used: 10 weeks old, 10 pounds in weight, and 10 grams of hemoglobin for safe surgical closure of the lip.

Dental hygienists should exercise caution when performing which procedure on a patient with a cleft palate due to increased risk of trauma or aspiration?

 

Air polishing

 

Intraoral photography

 

Disclosing with tablets

 

Extraoral palpation

Air polishing

• Air polishing can be contraindicated due to the possibility of air or powder entering the nasal cavity through a residual or repaired opening.

Layla is a 6-year-old girl with a repaired unilateral cleft lip and palate. She has a speech prosthesis, wears an orthodontic appliance, and presents with plaque accumulation around brackets. Her mother reports difficulty brushing due to Layla’s limited cooperation and crowded dentition.

Which of the following factors contributes MOST to Layla’s caries risk?

 

orthodontic brackets

 

repaired cleft site

 

limited ability to maintain oral hygiene

 

her age

limited ability to maintain oral hygiene

• While orthodontic appliances and anatomy play a role, the most significant risk comes from poor plaque removal due to both physical barriers and limited cooperation.

Layla is a 6-year-old girl with a repaired unilateral cleft lip and palate. She has a speech prosthesis, wears an orthodontic appliance, and presents with plaque accumulation around brackets. Her mother reports difficulty brushing due to Layla’s limited cooperation and crowded dentition.

Which hygiene recommendation would be most appropriate for Layla?

 

Delay hygiene instruction until full cooperation develops

 

Suggest a powered toothbrush and parental assistance

 

Recommend disclosing tablets once a month

 

Use mouth rinse with alcohol for bacterial control

Suggest a powered toothbrush and parental assistance

Layla is a 6-year-old girl with a repaired unilateral cleft lip and palate. She has a speech prosthesis, wears an orthodontic appliance, and presents with plaque accumulation around brackets. Her mother reports difficulty brushing due to Layla’s limited cooperation and crowded dentition.

When scaling Layla’s teeth, the hygienist should avoid which of the following?

 

Using hand instruments near orthodontic appliances

 

Applying suction directly into the cleft area or near the prosthesis

 

Using a fluoride varnish

 

Assessing for malocclusion

Applying suction directly into the cleft area or near the prosthesis

Mr. Samuels is a 32-year-old patient with a history of cleft palate repair and multiple prior surgeries. He reports some difficulty speaking and eating. Intraoral exam reveals residual scarring in the palate and a fixed bridge replacing missing lateral incisors.

 Which of the following dental anomalies is commonly associated with cleft lip and/or palate?

 

Amelogenesis imperfecta

 

Hypercementosis

 

Congenitally missing maxillary lateral incisors

 

Macroglossia

Congenitally missing maxillary lateral incisors

Mr. Samuels is a 32-year-old patient with a history of cleft palate repair and multiple prior surgeries. He reports some difficulty speaking and eating. Intraoral exam reveals residual scarring in the palate and a fixed bridge replacing missing lateral incisors.

 What is the best approach when communicating with Mr. Samuels, who has mild speech difficulties?

 

Ask fewer questions to avoid frustration

 

Avoid eye contact to reduce pressure

 

Speak slowly, use visual aids, and allow extra time for responses

 

Have him write his responses instead

Speak slowly, use visual aids, and allow extra time for responses

Mina is a 14-year-old patient undergoing cleft team management, including orthodontic care and speech therapy. Her dental hygiene visits are complicated by food trapping in the cleft site and difficulty using floss due to an obturator appliance.

What oral hygiene aid might best help Mina clean around her obturator and cleft site?

 

water flosser

 

wooden interdental stick

 

disclosing solution

 

manual toothbrush with stiff bristles

water flosser

Mina is a 14-year-old patient undergoing cleft team management, including orthodontic care and speech therapy. Her dental hygiene visits are complicated by food trapping in the cleft site and difficulty using floss due to an obturator appliance.

Which professional collaboration is MOST essential in Mina’s case?

 

pharmacist

 

multidisciplinary cleft palate team

 

audiologist

 

dietitian

multidisciplinary cleft palate team

Mina is a 14-year-old patient undergoing cleft team management, including orthodontic care and speech therapy. Her dental hygiene visits are complicated by food trapping in the cleft site and difficulty using floss due to an obturator appliance.

What long-term dental hygiene concern may persist in cleft lip/palate patients despite surgical repair?

 

Halitosis

 

Periodontal disease in cleft-adjacent teeth

 

Dental fluorosis

 

Bruxism

Periodontal disease in cleft-adjacent teeth

• Teeth adjacent to the cleft site often have thin or malformed bone support, making them more prone to periodontal breakdown over time.