Significant heterogeneity has previously been reported but with no consensus on the prevalence of dental anomalies in subjects with a cleft lip and palate (CLP), thus, the purpose of this study was to investigate the frequency of various dental anomalies in the upper dental arch in different cleft groups. Diagnostic records, i.e., panoramic, occlusal and periapical films, dental casts, and intra-oral photographs, of 122 subjects (mean age: 14 ± 5 years; 67 males and 55 females) were grouped as either unilateral left cleft lip and palate (ULCLP), unilateral right cleft lip and palate (URCLP), bilateral cleft lip and palate (BCLP), or cleft palate (CP). Prevalence rates of 15 different dental anomalies were calculated for each group. Wilcoxon's test was used to determine if there was a statistically significant difference in the number of missing teeth between the right and left sides, in each cleft group. Overall, 96.7 per cent of patients were found to have at least one dental anomaly. The most prevalent was agenesis in the anterior region on the cleft side (70.8–97.1 per cent). There was a statistically significant difference in the prevalence of agenesis by cleft and non-cleft sides but only in the ULCLP group (P < 0.001). Significantly higher rates of impaction were observed in the anterior and premolar regions in the CLP groups (2.9–29.2 per cent), with the highest rates in the anterior region on the cleft sides. A very high proportion of subjects were found to have at least one dental anomaly. Thus, the management of dental anomalies should be central to the treatment planning process of individuals with a cleft.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Occasionally orthodontic appliances or parts of orthodontic appliances have caused problems with either the airway or the gastrointestinal tract. The type of appliances that have caused problems and their clinical management are discussed. A case is described in which an upper removable appliance with inadequate retention became lodged in a patient's pharynx lacerating the palatine tonsils. Suggestions are made to try and avoid the problems that were encountered in this case and others reported in the literature in patients undergoing orthodontic treatment.