Does Dr. MacKenzie treat children with cleft lip and palate?
Yes. Dr. MacKenzie has been the orthodontist on the Cleft Lip and Palate Team at the Saint John Regional Hospital since 2019, and she regularly evaluates infants and young children.
Her specialty training at the University of Rochester included cleft lip and palate and craniofacial orthodontics, and as a senior resident she took part in the cleft and craniofacial clinic at Strong Memorial Hospital. As a mother of three, she understands what it means for a family to place that kind of trust in a specialist. Read more about Dr. MacKenzie and her research, teaching and hospital work.
What is the Cleft Lip and Palate Team?
It is a team at the Saint John Regional Hospital that evaluates and treats children with cleft lip and palate and other craniofacial conditions, from across Southern New Brunswick and beyond. Dr. MacKenzie is its orthodontist.
Alongside her, the team includes a plastic surgeon, an oral and maxillofacial surgeon, a pediatrician, an ENT specialist, an audiologist, a speech and language pathologist, a social worker and a nurse. Each looks after a different part of your child’s care, and the team coordinates that care. On complex cases, Dr. MacKenzie works together with the plastic surgeons and the oral and maxillofacial surgeons.
How can a cleft affect the teeth and jaws?
A cleft is an opening in the upper lip, the roof of the mouth (the palate) or both, that forms before birth. When it reaches the gum, the teeth near it can be missing, extra or out of position, and the upper jaw can be narrow or grow less than the lower jaw.
That can lead to crowded teeth, a crossbite or an underbite. How much care a child needs depends on where the cleft is and how the jaws grow.
When should a child with a cleft first see an orthodontist?
Well before age 7. The Canadian Association of Orthodontists recommends a first orthodontic evaluation by age 7 for every child, but a cleft or a craniofacial condition can call for a much earlier look.
If your pediatrician, family doctor or dentist has raised a concern, please do not wait for age 7. We are glad to see your child sooner, and the first visit is free. See Treatment for Children (ages 6 to 10) and Why Is My Child Seeing an Orthodontist If They Still Have Baby Teeth?.
What does orthodontic treatment for a cleft involve?
It usually comes in stages that follow your child’s growth, rather than one course of braces. Each stage is planned with the rest of the team.
In childhood, a narrow upper jaw is often widened with a palatal expander, and the front teeth may be lined up. Many children with a cleft in the gum have a bone graft placed there by the surgeon, usually before the adult canine tooth next to the cleft comes in, and orthodontic treatment helps prepare for it. Once the adult teeth are in, braces or clear aligners finish the alignment and the bite, and retainers hold the result. We offer three types of palatal expander, and Dr. MacKenzie recommends the appliance that suits your child.
Will my child need jaw surgery?
Some children with a cleft do, once they have finished growing, when the upper jaw stays small or set back compared with the lower jaw. Many do not, and whether it is needed becomes clearer as your child grows.
Jaw surgery, also called orthognathic surgery, is done by an oral and maxillofacial surgeon, and we provide the orthodontic treatment before and after it. In New Brunswick, the hospital procedures for jaw surgery are generally covered by Medicare. There are additional fees for the surgeon’s consultation and planning. Read Orthognathic Surgery.
Do we need a referral?
No. You can book a free consultation yourself, at any of our three clinics. If your child is already seen by the hospital team, tell us when you book.
If your child’s dentist would like to refer, they can call (506) 633-0555 or email info@sjortho.ca, and our Dentist Referrals page explains how. After the consultation, we send the referring dentist a letter with the diagnosis and the treatment plan.
How much does orthodontic care for a cleft cost?
Your first consultation is free, with no obligation. If treatment is needed, the fee depends on the plan, and we go through it with you, including your insurance, before anything starts.
We direct bill most major insurance providers and offer 0% interest monthly payment plans, and there is no tax on our payments. Dr. MacKenzie’s team has also donated free orthodontic care to children who could not otherwise afford treatment, through the Cleft Lip and Palate Team, Smiles4Canada and the Kiwanis Club of Saint John. See Cost, Insurance, and Financing.
Does your child have a cleft lip or palate, or has a doctor or dentist suggested an early orthodontic check? Book a free consultation in Saint John, Quispamsis or St. Stephen, or call us at (506) 633-0555.