Cleft palate and cleft lip is a prevalent birth defect all over the world. Being a dental professional, it is important for us to understand and implement the best care possible to those who are affected with this defect. This paper will cover the topic on what a certified dental assistant needs to know concerning this oral surgery. The definition of cleft palate and lip, x-rays, proper infection control, and what is expected of the dental assistant will all be discussed.
Cleft palate and lip defects happen in the womb before birth around the 6th to 11th week of gestation.https://www.nidcr.nih.gov/health-info/cleft-lip-palate/more-info During this time period, the right and left cleft do not fully form together with tissue causing a cleft palate or lip. In some cases, the defect can affect both the palate and lip. If a child is born with this defect, it can affect their eating, breathing, ears, and teeth, as well as speech problems later in life (Mouth Healthy). The CDC estimates 7,090 infants are born with cleft palate or lip in the US alone (National Institute of Dental and Craniofacial).
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The cause of this defect could be due to gene syndromes, the parent’s genes, and environmental factors during early gestation. If the cleft palate or lip is big enough to be visible during an ultrasound, it can be detected as soon as the first ultrasound takes place. Some more minor cases may be diagnosed after birth or later in life. Once a child is diagnosed with cleft palate or lip, they are most likely referred to a professional who specializes in oral surgery (National Institute of Dental and Craniofacial). The oral surgeon will have completed an additional 4-6 years of dental requirements as well as pass a standardized exam. (BB ch.56)
The professional for the oral surgery will take various dental radiographs of the patient. The dental radiographs will help determine bone loss, any abnormalities, and can aid in surgical planning. The type of radiograph most commonly taken is a panoramic and typical dental radiographs. The radiographs taken can also help the family more understand the reconstruction and why it needs to be done (Abramson, et al. 2015). The severity of the defect and the oral surgery will be discussed with the parents of the patient with the surgeon. Depending on medical needs and timing, there may be more than one surgery taking place (Children's Hospital 2014). The patient's medical history and consent forms will be completed, as well as discussion of cost and type of anesthesia.
Once the healthy patient has reached the appropriate age for the surgery around 3 to 6 months, they will be scheduled for the oral surgery in a hospital-based region. It is a huge responsibility for the dental assistant to make sure everything is up to infection control standards for the safety of the patient and dental team. The dental assistant needs to be properly educated on the infection preventative measures that will be taken in an oral surgery.
Proper infection control should be done no matter the patient and all staff should practice standard care. Things such as personal protective equipment, hand hygiene, and aseptic techniques need to be implemented. Personal protective equipment implies a proper fitting mask, fitting gloves that may be sterile, protective eyewear or shield, and protective clothing such as a lab jacket or surgical gown. Personal protective equipment is used for the safety of both staff and patients (Miller 2018). Hand hygiene is done when personnel arrive at the office, when contaminated and before assisting in a procedure. Antimicrobial surgical scrub product needs to be used with a soft sterile brush or sponge on the skin, nails and forearms for 2-6 minutes with many scrub and rinse cycles, rinsing with hands up, letting the water drip from elbows. Once washing is done, dry with a sterile towel and insert hands into sterile gloves with the help of a gloved assistant (Miller 2018). Aseptic techniques such as minimization of touching surfaces are used, as well as barriers in the operation room. Disposable items are heavily utilized in the dental surgery field to insure no cross contamination and should be used whenever possible (Miller 2018).
The expectations of a dental assistant for cleft palate and lip operation is quite extensive. Before the procedure takes place, all paperwork needs to be looked at. The dental assistant needs to have all records and radiographs organized for the surgeon to review, including information from the patient's physician. The assistant will then gather signed consent forms and make sure it is filled out correctly and has all signatures needed from the guardian for the surgery. Finally, contact the parents and give them preoperative instruction reminders and answers and questions they have (Bird Ch. 56).
The next thing that needs to be done is make sure all surgical instruments needed are sterilized in a mannerly time before the operation. Then the operative room needs to be prepared with all barriers on clinical surfaces. The sterile surgical cassettes will be placed on the proper barrier and left sealed until use. Have any pain control methods ready that the surgeon will need to use, although it will most likely be anesthesia administered by an anesthesiologist. The surgeon will have a list of postoperative instructions for the parents of the patient after they leave the hospital. A cleft palate or lip surgery can be extensive, so they could be in the hospital a week or more. The time they are in the hospital you can have a printout of the instructions, and answer any questions they have (Bird Ch. 56).
Before the surgery, medical history and reports must be updated correctly, and the guardian will be asked if they ate or drank anything after midnight. Vital signs will be taken and charted, and if there are any irregular vital signs the surgeon will be notified. Finally, any motoring equipment will be set up, and radiographs and other scans will be on the monitor for the surgeon (Bird Ch. 56).
During the surgery, the assistant must be focused and maintain asepsis. Helping to monitor vital signs will be one of the assistant’s duties. The passing and retrieval of instruments and having apprehension of what the surgeon will want next will make the operation run smoothly. Retraction of any tissue needed by the surgeon, as well as suction of saliva will be done by the assistant (Bird Ch. 56).
Lastly, at the end of the surgery the assistant will be with the patient till they have begun recovery and is conscious. Although the patient will be in recovery in the hospital for a week to four weeks, make any post-operative appointments needed with the parents of the patient (Bird Ch.56).
The last thing in this paper that will be discussed is the emotional toll that comes with cleft palate or lip, and how a dental assistant can make a positive impact on the family. Parents and the patient with the defect go through many obstacles through the diagnosis and treatment plan. They also deal with other problems such the child's speech, hearing, and physiological issues (Health talk). One thing that can impact this family is the attitude of the assistant. Being caring, empathetic, and patience. Resources can be extremely helpful for the family and patient if the surgeon has references for the family. Resources that may be helpful are speech therapy, psychological therapy, as well as orthodontic treatment and many more. A good attitude, team, and surgeon are all aspects the family needs. A dental assistant has the power to help turn a bad situation into a better one with the attitude that is portrayed with situations like cleft palate and lip.
Work Cited
- Abramson, Zachary R., et al. “Radiology of Cleft Lip and Palate: Imaging for the Prenatal Period and throughout Life.” RadioGraphics, 12 Nov. 2015, pubs.rsna.org/doi/full/10.1148/rg.2015150050.
- Bird, Doni L.. Robinson, Debbie S. Modern Dental Assisting. Saunders, 2020.
- Children's Hospital. “Cleft Lip and Palate Repair Surgery.” Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia, 5 May 2014, www.chop.edu/treatments/surgical-repair-cleft-lip-and-palate#.
- “Cleft Lip and Cleft Palate.” Mouth Healthy TM, www.mouthhealthy.org/en/az-topics/c/cleft-lip-palate.
- “Cleft Lip and Palate.” Speech, Language and Hearing with a Cleft, healthtalk.org/cleft-lip-and-palate/speech-language-and-hearing-with-a-cleft.
- “Cleft Lip and Palate Diagnosis, Causes, Treatment.” National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services, www.nidcr.nih.gov/health-info/cleft-lip-palate/more-info.
- Miller, Chris H. Infection Control and Management of Hazardous Materials for the Dental Team. Elsevier, 2018.
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