Caring for your child's teeth after cleft repair

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 after toothbrushing
  • Not brushing twice a day with fluoride toothpaste
  • Bottle feeding for a prolonged time, especially overnight
  • Not visiting the dentist for regular check-ups and a fluoride varnish application at least twice a year
  • A dry mouth

Can decay be prevented?


  • Brush teeth twice a day with a fluoride toothpaste
  • Reduce the amount and frequency of sugars in the diet
  • Ask your dentist about fluoride varnish. This is like 'super strength' toothpaste
  • Your child may benefit from plastic coatings on the back adult teeth

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.

Brushing my child's teeth

  • Encourage your child to spit the toothpaste and don't rinse with water after brushing
  • Supervise your child's tooth brushing until at least seven years of age
  • Spend extra time brushing teeth in the cleft area. Crowded teeth are more likely to collect plaque
  • Use a small head tooth brush or ask your dentist for a specialist brush if access is limited

Make it fun

  • Use a colourful soft toothbrush and encourage your child to help with brushing
  • Use a brushing app to help your child brush for two minutes

Brush twice a day

  • Morning and evening

Fluoride toothpaste

  • Fluoride helps prevent decay
    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 toothpaste with 1000ppm fluoride.
  • Over 3 years: Use a pea-sized amount of toothpaste with 1350ppm to 1500ppm fluoride.

Diet and teeth

  • Stop bottle feeding by 18 months.
  • Avoid giving the bottle overnight.
  • Only put plain milk or water in the bottle.
  • Avoid adding sugar to weaning foods.
  • Give sugar free snacks (breadsticks, crackers, rice cakes and cheese).
  • Avoid sugary snacks (cakes, biscuits, chocolates and sweets). Limit to special occasions.
  • Sugar free squash has hidden sugars.
  • Only drink plain water or milk between meals.
  • Dilute pure fruit juices with water as the acids in fruit juice may damage teeth.
  • Avoid fizzy drinks (regular and diet) including fizzy flavoured water, as these can damage teeth.
  • Only give water after tooth brushing before bed.

What about sugars in medications?

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.

Six steps to healthy teeth

  1. Avoid sugary snacks and drinks between meals
  2. Avoid giving a bottle overnight – if this is not possible, fill the bottle with water only
  3. Brush teeth twice a day with fluoride toothpaste
  4. Supervise your child's brushing until 7 years old and encourage spitting without rinsing
  5. Register your child with a dentist for regular check ups
  6. Ask for sugar-free medicines if possible

And remember...

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.

Compiled by:
The Cleft Team (Maxillofacial and Dental Department) in collaboration with the Child and Family Information Group.
Last review date:
November 2016