Does a Cleft Lip Cause Missing or Extra Teeth?

Yes, it is very common for children with a cleft lip and alveolus to have missing, extra, or misshapen teeth. Because the cleft passes directly through the alveolus (the bony ridge of the gum where teeth form and develop), it disrupts the normal growth of tooth buds in that specific area ^[1][2].

These dental variations typically happen directly adjacent to the cleft site, particularly affecting the upper lateral incisors (the teeth located right next to the two front teeth) ^[3][4].

Common Dental Differences

Depending on the severity of the cleft, your child may experience one or more of the following:

• Missing Teeth (Hypodontia): This is the most common dental issue in the permanent (adult) teeth ^[1][5]. The tooth bud simply may not form in the area of the cleft. Research shows that as the size of the cleft increases, the likelihood of a missing permanent tooth also increases ^[5].
• Extra Teeth (Supernumerary Teeth): Sometimes the cleft causes the developing tooth bud to split, resulting in an extra tooth. This is most frequently seen in the primary (baby) teeth ^[1][5].
• Malformed or Small Teeth (Microdontia): The teeth that do grow near the cleft—whether they are baby teeth or adult teeth—are often smaller than normal or irregularly shaped ^[4][6].
• Crooked Eruption: Both baby and adult teeth near the cleft may come in sideways, twisted, or out of alignment because they lack the proper bone support to guide them naturally into place.

How These Issues Are Managed

While these dental issues are expected, managing them is a marathon, not a sprint. A specialized cleft team—which includes a pediatric dentist, an orthodontist, and an oral surgeon—will coordinate your child’s care from infancy through young adulthood ^[7].

The treatment journey typically involves:

1. Early Monitoring and Hygiene: Your pediatric dentist will help you navigate daily care, as keeping the baby teeth healthy is critical. They can provide guidance on gentle brushing techniques around the delicate cleft gumline. As your child grows, the dentist will take baseline X-rays to see exactly which adult teeth are developing under the gums and which might be missing or extra.
2. Phase 1 Orthodontics: Before any bone grafts, your child’s orthodontist may use early braces or appliances to align the baby teeth and safely expand the roof of the mouth ^[8]. This prepares the oral cavity for surgery.
3. Bone Grafting: Usually between ages 8 and 11, before the permanent canine teeth erupt, surgeons perform an Alveolar Bone Graft ^[9][10]. This procedure places new bone—often safely taken from your child’s own hip (the iliac crest)—into the cleft gap in the gum ridge ^[11]. This provides a solid foundation for adult teeth to drop into and stabilizes the jaw ^[12].
4. Phase 2 Orthodontics (Braces): Once the permanent teeth begin coming in, your child will likely need full braces to straighten the adult teeth, align the jaw properly, and bring everything into its final functional position ^[8].
5. Tooth Replacement: If a permanent tooth is entirely missing, the orthodontist will hold the space open with a retainer or braces. Once your child is fully grown (usually late teens), the missing tooth can be permanently replaced with a dental implant or a dental bridge ^[12][7].

While managing cleft-related dental issues requires patience and years of coordinated appointments, rest assured that this established roadmap successfully helps children achieve healthy, functional, and complete smiles.