This page explains about how to care for your child's teeth after a cleft repair at Great Ormond Street Hospital (GOSH).
Failure to maintain good mouth hygiene will lead to unhealthy gums, tooth decay, pain and infection. A decayed tooth will require a filling or it may need to be extracted.
When plaque mixes with sugar (from the food we eat), it produces acid. This causes decay, or ‘holes’ in the teeth. Plaque is a white sticky layer of bacteria which coats the teeth.
What makes decay more likely?
- Frequent daily sugar intake (food, drinks or medicines).
- Having sugary food, drinks or medicines last thing at night.
- Not brushing twice a day with fluoride toothpaste.
- Bottle feeding for a prolonged time, especially overnight.
- Not visiting the dentist for regular check-ups.
- A dry mouth.
Can decay be prevented?
- Brush the teeth twice a day with fluoride toothpaste.
- Reduce the frequency of sugar in the diet.
When should I start brushing my child’s teeth?
As soon as the first baby tooth appears.
Teeth can appear abnormal in the area of the cleft. They may not be ‘straight’ and they may be a different size or shape. You may also notice missing teeth or extra teeth in this area.
Brushing should be supervised until your child is around seven years old.
Spend extra time brushing the teeth in the cleft area. Crowded teeth are more likely to collect plaque.
Make it fun
- Use a colourful toothbrush and encourage your child to help with brushing.
Brush twice a day
- Fluoride helps prevent decay.
- Toothpaste is available for different age groups.
- Look at the information on the toothpaste tube for the fluoride concentration. This is usually written as “ppm” which means “parts per million.”
- Under 3 years: Use a small smear of paste with 1000ppm fluoride.
- 3 to 6 years: Use a pea-sized amount of paste with 1000ppm fluoride.
- Over 6 years: Use a pea-sized amount of paste with 1450ppm fluoride.
Diet and teeth
- Avoid sugary snacks (cake, biscuits and sweets) between meals.
- Avoid sugary food or drink last thing before bed.
- Sugar-free snacks include: bread, cheese, milk and water.
- Most fruit juices contain sugar.
- Fizzy drinks (regular and diet) can damage teeth. Limit these to special occasions.
- Milk and water are the only drinks to put in your baby’s bottle.
What about sugars in medications?
There are some sugar-free medicines available. Ask your doctor if there is a sugarfree alternative.
If there is not a sugar-free option:
- Clean the teeth, or give your child a drink of water after swallowing the medicine. This will dilute the sugar on the teeth.
- Ask your dentist for advice about fluoride mouthrinse.
Six steps to healthy teeth
- Avoid sugary snacks and drinks between meals.
- Avoid giving a bottle overnight (if this is not possible, the bottle should be filled with water only).
- A bottle during the day should only contain water or milk.
- Brush the teeth thoroughly, at least twice a day (morning and night).
- Use fluoride toothpaste (do not rinse with water after brushing).
- Register your child with a dentist for regular checkups (your dentist will advise you on the frequency).
It is normal for teeth to look different in the area of the cleft. It is important to keep the teeth clean and decay-free. Your orthodontist will assess the position of your child’s teeth and treat them when the time is right.
Last reviewed by Great Ormond Street Hospital: July 2011
Ref: 2011F1066 July 2011
Compiled by the Cleft Team (Maxillofacial and Dental Department) in collaboration with the Child and Family Information Group. Information in this leaflet has been based on advice from the Department of Health: www.pcc.nhs.uk/delivering-better-oral-health-preventive-toolkit
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.