patients with CCD is generally caused by the development of supernumerary teeth. Due to malocclusion, articulation and mastication may be compromised. The skeletal relation- ship of the jaws is usually Class III occlusion due to the presence of a hypoplastic maxilla. Malocclusion is not only an esthetic problem but also has negative health effects, including airway obstructions, sleep apnea, immune deficiencies, gastric disturbance, and delayed developmental growth. Oral health professionals should refer patients with malocclusion to an orthodontist for evaluation.26 –29 Treatment The course of dental treatment is often determined by the patient’s age at time of diagno- sis.3 Combined treatment of surgery and orthodontics is effective for achieving almost complete permanent dentition and occlusal contact.30 Table 1 lists the four most common surgical-orthodontic approaches. The most significant difference between types is when treatment should be initiated.3,24,31 Interprofessional collaboration is essen- tial to support quality of life in patients with CCD because the disorder impacts the entire skeleton. Primary care providers might recommend a helmet if the cranial vault defect needs extra protection from blunt trauma. If bone density is below nor- mal, calcium and vitamin D supplements may be indicated.32 To address dental manifestations, ortho- dontists, oral surgeons, and prosthodontists may be included in treatment planning. Speech therapy may also be recommended due to possible changes in the oral maxillo- facial region. Ear, nose, and throat physi- cians may be needed to treat aggressive and reoccurring sinus and middle ear infec- tions.3,32 Oral health professionals should collaborate with patients’ other healthcare providers to create a specialized treatment plan that meets their specific oral and sys- temic health needs in a timely manner. Patient Management Several oral hygiene treatment modifications may be necessary for patients with CCD. Oral health professionals should be familiar with the signs of CCD to provide appropriate den- tal interventions and referrals to specialists as needed. Additionally, clinicians should edu- cate patients on dental anomalies associated with CCD and how to manage them. The process of care starts with assessing patients as soon as they enter the treatment area. Common physical characteristics are short stature, missing or malformed clavicles, SECTION 3 DIMENSIONS CE 30 Dimensions OF DENTAL HYGIENE • January/February 2024 dimensionsofdentalhygiene.com Belmont Business Media Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. July 1, 2023 to June 30, 2026 Provider ID# 317924 AGD Subject Code: 370 Belmont Business Media designates this activity for 2 credit hours of self- study continuing education units. This course is released January 2024 and expires February 2027. Belmont Business Media is an ADA CERP-recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at: ada.org/cerp. TABLE 1. Common Surgical-Orthodontic Approaches for Cleidocranial Dysplasia3, 24, 31 Approaches Description Age Unique Features 1. Toronto- Melbourne Stage 1: Extraction of primary incisors Extraction of primary canines and posterior teeth Stage 2: Surgical exposure of the permanent teeth, removal of supernumerary teeth, orthodontics 5 to 6 9 to 10 9 to 12 • Two timed surgical extractions • Removes overlying bone based on permanent teeth root development 2 .Belfast-Hamburg One surgical treatment in which all primary and supernumerary teeth are extracted under general anesthesia Permanent teeth are surgically exposed Orthodontics applied to facilitate eruption Unspecified • One surgical treatment • All primary and supernumerary teeth extracted despite root development 3. Jerusalem Surgery 1: Extract all anterior primary and supernumerary teeth, exposure of permanent incisors, and orthodontics applied to help erupt permanent incisors Surgery 2: Remove remaining primary and supernumerary teeth; all unerupted canines and premolars are surgically exposed and bracketed for guided tooth movement 10 to 12 13 • Two distinct surgeries 4. Bronx Phase 1: All supernumerary and primary teeth are extracted Phase 2: Unerupted teeth are exposed, and orthodontic brackets are placed on fully erupted molars Phase 3: LeFort I osteotomy is performed and dental implants are placed Unspecified • Three phases • Uses a removable overdenture, LeFort I osteotomy, and dental implants
