CLEFT LIP AND PALATE – Dental and Orthodontic Considerations

As pediatric dentists we see patients with a variety of health and developmental anomalies. We often support craniofacial teams at various hospitals in Houston as those teams treat patients born with a variety of facial abnormalities including cleft lip and palate, hemifacial microsomia, Crouzon Syndrome, Apert syndrome and Pierre Robin. Some of the treatments for these patients begin with Nasoalveolar Molding (NAM) working with patients born with cleft lip and palate as early as one week of age. In conjunction with the other specialists on the cleft and craniofacial team, we can manage the pediatric dental needs of patients born with craniofacial abnormalities from the time of birth up through adulthood.

A huge part of this effort is trusting the orthodontic teams we work with that treat many patients with an array of different misalignment of the teeth. The orthodontists in local hospitals as well as ones in private practices often treat kids with complex medical and dental needs. Cleft lip and palate can be one of those complex treatments. A cleft occurs when certain structures do not fuse together during fetal development. Clefts can involve only the lip or both the lip and the palate. A cleft lip presents as an opening of the lip on one side or both sides of the face and depending on how severe the cleft is, it may extend up into the nose. A cleft palate is an opening in the roof of the mouth, known as the palate. The average incidence of cleft lip and palate is 1:750 births.

Of the different variations of cleft lip and cleft palate, each individual cleft is treated in its own unique way both surgically and orthodontically. One of the main dental issues with having a cleft is the possibility of missing teeth in the area of the cleft. The common tooth to be missing in the region of the cleft is the lateral incisor. This orthodontic challenge can be overcome with the use of braces either closing the space or making room to replace that missing tooth with a future bridge or implant.

Another issue in patients with cleft lip and palate is that teeth could erupt (come into the mouth) in inappropriate locations. Teeth can be misaligned, rotated and even blocked out and unable to erupt. This can cause problems with brushing, and maintaining excellent oral hygiene becomes a challenge. Team approach between the craniofacial team and a pediatric dentist is extremely important in upholding excellent oral health in these patients. If you have any questions regarding treating dentally complex patients, please don’t hesitate to contact us.

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team

Sugar in a Bottle

Marketing companies are amazing at well… marketing. It’s no wonder that most families’ refrigerators are stocked with “healthy” juice, sodas, and Gatorades. As dentists we cringe at the site of eye level positioned and well-advertised liquid sugars on grocery store shelves. Labels show clearly that the amount of sugar packed in juice much exceeds daily recommended levels. A normal size adult should have no more than 25 g of sugar per day, which amounts to around 6 tsp. A glass of typical juice has between 35 and 60 grams of sugar. Sports drinks do not trail far behind with around 40 grams of sugar. Because of lack of true regulations on food labels, even juices that claim to be “100% natural fruit” often have sugar added, other juices mixed in for volume and flavor, or are stored in tanks for a long time, which makes it necessary to add preservatives containing sugar. All these drinks are also extremely acidic due to naturally occurring fruit acids as well as added preservatives such as citric acid. This makes their acidity close to battery acid. 

As health professionals and dentists, our worry is both on a large scale of body health, and on a small scale of teeth. We witness staggering BMI numbers that lead to problems such as diabetes, heart problems, social difficulties, and behavioral issues starting in childhood and culminating in solemn complications in adulthood. We see more and more kids with diabetes, kids who have difficulty exercising and keeping up with their peers, and kids with serious social tensions due to weight. Our role as health providers often puts us in a position where we must counsel and educate parents and families to reinforce information already discussed by their family physicians. 

However, as dentists we are concerned about teeth in particular. Acid in juices can cause erosion of enamel, the hardest structure in your body. Acid creates wear and damage that allows for sugar to easily fit in the microscopic holes on teeth. Worn enamel will demineralize making work of cavity- causing bacteria easy, especially with addition of large amount of sugar, which fuels them. We see rampant cavities in children as young as two years of age. Dental decay is number one reason for missing school hours in young children and is still the most prevalent chronic disease in both children and adults. Costs of dental decay are staggering as many young children end up with expensive treatment including hospitalizations for infections or treatment with IV sedation. Prevention of dental decay is not contained to limiting sweet drinks, but in the face of today’s epidemic, we want to educate our families early and thoroughly on all controllable variables. Eliminating sugary drinks is an easy step in overall personal health and in dental well-being of our patients. Please feel free to contact us with any particular questions. 

Dr. Lindhorst, Dr. Jadav and Smiles For Kids Pediatric Dental Team 


Jumping on a trampoline, skate boarding, gymnastics, playing hockey, baseball, or basketball are just some of the fun activities kids engage in every day. Although very different, all of these activities have one thing in common: the potential for trauma to the mouth, face, and jaw. Trauma may include fractured or avulsed teeth, broken jaws, laceration of the soft tissues, concussions, and many others. Any of these injuries could impact the way you smile, talk, and eat forever. This can all be easily prevented by wearing a properly fitted mouthguard.

Studies have shown that athletes are 60 times more likely to suffer harm to the teeth if they are not wearing a mouthguard. Mouthguards are recommended to be worn at all times during recreational activities and sports, including practices. We all know that convincing a child to do so will require a comfortable device that does not obstruct his or her ability to talk and excel in the sport of choice.

There are three types of mouthguards: ready-made or stock mouthguard, “boil and bite” mouthguard, and a custom-made mouthguard fabricated by your dentist. According to the American Dental Association, the mouthguard should fit properly, be durable, be easy to clean and not restrict speech or breathing. The best mouthguard is one that is custom-made to fit your mouth. These kinds of mouthguards are tailored to the individual’s mouth, they are gentle on the soft tissues like cheeks and gums, and can be adjusted by your dentist to ensure proper fit over time.

“What if I have braces? Can I wear a mouthguard?” Absolutely! A mouthguard will provide a cushion between your braces and your lips and cheeks. This will prevent damage to the braces but also protect the soft tissues of the mouth. Typically, mouthguards are made to fit on the upper teeth, but if you have appliances that prevent wearing a mouth guard on the top teeth, a custom-made mouthguard for the bottom teeth is possible. Talk to us about which mouthguard is best for you.

Protect your mouth and your smile. Wear a mouthguard!


All conversations about orthodontics these days include Invisalign. Of all the options we have to straighten teeth, it is the most esthetic and accepted treatment. The most common questions we get about the aligners are if they work, if they hurt, and what is the cost?

Invisalign does work! Invisalign is essentially a series of removable clear aligners (much like the bleaching trays) that are worn day and night to align the teeth.  They are almost invisible and allow patients to speak clearly and smile without visible braces. Since the aligners are removable, compliance is absolutely necessary to get a great result, so it takes a persistent patient for the success of Invisalign.  Since compliance is critical, the majority of our Invisalign patients are adults.  However, some teen patients have been excellent at wearing them as well. In addition, with new research and developments, we have been pushing the envelope of treating more difficult orthodontic cases with Invisalign where braces were traditionally the only option.  

So how does it work? Each aligner slightly moves the teeth and treatment consists of a series of aligners, each a little closer to the ideal bite, to progressively straighten teeth.  The more complicated the bite correction is to begin with, the more aligners and greater the length of treatment will be needed. Since the movement with each aligner is slight, the pressure and discomfort are minimal. Most patients adjust to wearing their new aligners very quickly as there are no brackets or wires to get used to.

The cost of Invisalign treatment depends on the length of treatment and number of aligners necessary.  It is however, close to the same price as adult braces.  It can be as few as five aligners for minor treatment.  Longer treatments last between six and twelve months, which is generally shorter than patients expect.  The treatment and cost will be customized to fit patient’s concerns and the orthodontists will work with patients to fulfill their best smiles on a budget.

We have seen that many patients, especially adults who do not desire to have metal braces, have put off orthodontic treatment because of questions about Invisalign.  Now that they have been answered, all the specifics of an individual’s needs can be answered during complimentary consultation.  The orthodontists we refer to are Board Certified and have extensive experience with Invisalign.

The road to straight teeth is easier and shorter than most patients expect.  The key is starting as soon as possible to enjoy a beautiful new smile for a lifetime!

Dr. Lindhorst, Dr. Jadav and Smiles For Kids Pediatric Dental Team