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Growing Up with CLA: Dental Health and Long-Term Outlook

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The long-term outlook for a child with Cleft Lip and Alveolus (CLA) is excellent. While they may need specialized dental care for missing teeth, an alveolar bone graft, or secondary rhinoplasty in their teens, most go on to live healthy, active lives with high psychosocial well-being.

Key Takeaways

  • • Children with CLA frequently experience dental anomalies near the cleft site, such as missing or extra teeth, which can be successfully treated with orthodontics or implants.
  • • Excellent oral hygiene is critical for the success of the Secondary Alveolar Bone Graft (SABG), typically performed between ages 8 and 12.
  • • Secondary rhinoplasty to correct nasal asymmetry and improve breathing is usually delayed until facial growth is complete around age 14 to 16.
  • • Children with CLA generally report a high quality of life and excellent long-term emotional well-being.

As your child grows, the focus of their care shifts from early feeding and initial repairs to supporting healthy dental development and facial symmetry [1][2]. While the teenage years may bring new milestones, such as final braces or a potential secondary nose surgery, the long-term outlook for a child with Cleft Lip and Alveolus (CLA) is excellent [3][1]. Most children go on to live healthy, active lives with smiles they are proud of [3].

Dental Development and Anomalies

Because the cleft occurs in the exact spot where the upper teeth develop, it is very common for children with CLA to have dental anomalies in that area [4].

  • Missing Teeth (Hypodontia): The most common issue is a missing upper lateral incisor (the tooth next to the front teeth) [4][5]. In some studies, over 70% of children with a cleft in the gumline are missing at least one tooth near the cleft site [6]. Please do not worry if this happens. Routine dental implants, dental bridges, or orthodontic space closure (using braces to move the teeth together) in late adolescence are highly successful, standard solutions that create a seamless, complete smile.
  • Extra Teeth (Supernumerary): Conversely, some children may grow an extra tooth in the cleft area [7]. These are usually easily removed by a pediatric dentist to make room for the permanent teeth to grow in properly [8].
  • Enamel Defects: Teeth near the cleft may sometimes have thinner or weaker enamel, making them more prone to cavities [9].

The Critical Role of Oral Hygiene

As your child approaches the stage for a Secondary Alveolar Bone Graft (SABG), usually between ages 8 and 12, oral hygiene becomes the single most important factor for success [10][11].

  • Graft Success: The bone graft needs healthy, germ-free gum tissue to heal properly. High levels of plaque or gum inflammation (gingivitis) are leading causes of graft failure or resorption [11][12].
  • Specialized Care: Because the cleft area may have unique contours or “notches,” it can be harder to clean with a standard toothbrush. Your cleft team’s dental hygienist may recommend specialized tools, such as small interdental brushes or water flossers, to keep the area pristine [10].

Nasal Symmetry and Secondary Rhinoplasty

As the face grows and matures during puberty, the nose may develop some asymmetry, especially if the initial cleft was “complete” [13][14].

  • Why it happens: The cartilage of the nose on the cleft side may be slightly flatter or tilted [15].
  • Secondary Rhinoplasty: This is a surgery performed to improve both the appearance and the function of the nose (such as breathing) [13][3].
  • Timing: While “intermediate” procedures can be done earlier, “definitive” rhinoplasty is usually deferred until the child has finished growing, typically around age 14 to 16 [16][17].

Long-Term Quality of Life

Research shows that children with CLA typically report a high quality of life, often scoring better on functional and emotional well-being tests than children with more complex cleft types [18].

  • Psychosocial Growth: While it is normal for adolescents to become more aware of their appearance, most children with CLA adapt well and experience the same social milestones as their peers [19].
  • Support: Your cleft team includes professionals, such as psychologists or social workers, who can help your child navigate any self-esteem or social concerns that may arise during the school years [20].

By staying consistent with dental check-ups and maintaining excellent oral hygiene, you are providing your child with the best possible foundation for a healthy and confident future [10].

Frequently Asked Questions

Will my child with a cleft lip and alveolus be missing teeth?
It is very common for children with a cleft lip and alveolus to have dental anomalies, most frequently a missing upper lateral incisor near the cleft site. Orthodontic treatments, dental bridges, or implants can successfully create a complete smile in late adolescence.
Why is oral hygiene so important before an alveolar bone graft?
The bone graft requires healthy, infection-free gum tissue to heal properly. High levels of plaque or gum inflammation are the leading causes of graft failure, making rigorous brushing and flossing essential before the procedure.
When is secondary rhinoplasty typically performed for children with CLA?
While minor procedures can be done earlier, a definitive secondary rhinoplasty to improve nasal appearance and breathing is usually deferred until the child has finished growing. This typically occurs around age 14 to 16.
Do children with CLA have a good long-term quality of life?
Yes, research shows that children with cleft lip and alveolus typically report a high quality of life and adapt well socially. They often score high on emotional well-being tests and reach the same social milestones as their peers.

Questions for Your Doctor

  • • Which specific adult teeth are missing or extra near the cleft site, and how will this affect our orthodontic plan?
  • • Is my child's current oral hygiene routine good enough to ensure the success of the upcoming bone graft?
  • • At what age do you typically consider a 'definitive' secondary rhinoplasty for children with CLA?
  • • Are there any signs of nasal obstruction or septal deviation that we should be monitoring as my child grows?
  • • Can you recommend a pediatric dentist who has specific experience working with children who have alveolar clefts?

Questions for You

  • • How do I feel about my appearance, and is there anything about my smile or nose I would like to change as I get older?
  • • Am I being consistent with brushing and flossing around the cleft area, even if it feels a little different or sensitive?
  • • What are my goals for my final orthodontic and surgical results as I approach my teenage years?

Want personalized information?

Type your question below to get evidence-based answers tailored to your situation.

References

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    Plastic and reconstructive surgery 2025; (155(4)):746e-757e doi:10.1097/PRS.0000000000011622.

    PMID: 38991117
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    Orthodontic burden of care for patients with a cleft lip and/or palate.

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    Journal of orthodontics 2019; (46(1)):63-67 doi:10.1177/1465312518823010.

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    Patient Satisfaction Level of the Functional and Aesthetic Outcome of Secondary Rhinoplasty in Patients With Secondary Deformity of the Nose After Lip Repair in Hospital Kuala Lumpur and Hospital Pakar Universiti Sains Malaysia.

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    Annals of plastic surgery 2025; (95(3)):273-278 doi:10.1097/SAP.0000000000004496.

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    Prevalence of tooth agenesis and supernumerary teeth related to different Thai cleft lip and cleft palate populations.

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    Secondary Dentition Characteristics in Children With Nonsyndromic Unilateral Cleft Lip and Palate: A Retrospective Study.

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    Characterization of enamel developmental defects in patients with orofacial clefts and their relationship to surgical procedures.

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    PMID: 37955725
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    Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2025; (109()):40-49 doi:10.1016/j.bjps.2025.07.040.

    PMID: 40795484
  11. 11

    Predictive factors for secondary alveolar bone graft failure in patients with cleft alveolus.

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    Orthodontics & craniofacial research 2022; (25(4)):585-591 doi:10.1111/ocr.12573.

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    Outcome after secondary alveolar bone grafting among patients with cleft lip and palate at 16 years of age: a retrospective study.

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  14. 14

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    Importance of Stem Cell Transplantation in Cleft Lip and Palate Surgical Treatment Protocol.

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  19. 19

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  20. 20

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This page provides general information about the long-term outlook and dental care for Cleft Lip and Alveolus. Always consult your child's cleft team for personalized medical, dental, and surgical advice.

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