Signs and symptoms
Individuals with jaw abnormalities have both functional and aesthetic impairment.Misalignment of teeth creates difficulties in head and neck functions related to chewing, swallowing, breathing, speech articulation and lip closure/posture.Affected individuals may also experience TMJ pain and dysfunction, which negatively affect the quality of life.A proportion of affected individuals also have psychological problems. Diagnosis
Diagnosis of a jaw deformity is a structured process, linking the undertaking of a history, physical examination of the patient, and appraisal of diagnostic studies. This process may involve more than a single discipline of Dentistry – in addition to orthodontic and surgical needs, some patients may also require periodontal, endodontic, complex restorative, and prosthetic considerations.It involves the chief presenting complaint of the patient, which allows the clinician to understand the patients perception of the problem – what they think the problem is and what they would like corrected. The patient may find eating difficult or may have problems with speech or the appearance of the teeth or face. However, patients may be hesitant to discuss dissatisfaction with their appearance because they may feel that it is more acceptable to present a functional problem to the clinician. For this reason it is important to reassure patients that their aesthetic problems and the effects of these are perfectly valid concerns. In children, psychological development can be affected due to teasing if they have abnormal appearance of teeth or face. Correction of the abnormality can be extremely beneficial to the patient.
The formation of secondary palate starts with the growing of tissues vertically and mesially forming the right and left lateral palatal shelves. On the week 8, the tongue will be withdrawn downwards and the right and left lateral palatal shelves will be rapidly elevated, flipped into a horizontal orientation and fuse together from the front to the back two. The right and left lateral palatal shelves contact or fuse with each other at the midline to form the secondary palate two.A lot of growth factors are actively involved in the signalling to the tissues during craniofacial development. These growth factors function to control the cells proliferation, survival and apoptosis. Some of the growth factors that can be implicated in the facial development resulting in craniofacial defect are BMP, FGF, Shh, Wnt and endothelins. One of the environmental factors that has been identified in mice study to have link to cleft lip is teratogen which can interfere the molecular signalling between the growth factors. However, the exact mechanism is still not clear. Another environmental factors that has been actively involved in studies to prevent cleft lip and palate occurrences is the intake of folic acid during pregnancy. 0.4 mg folic acid intake per day has been shown to reduce one third risk of cleft lip (with or without cleft palate) in babies. However, it seems had no apparent effect on the risk of cleft palate alone.