**2.3 Early mixed dentition**

It is not uncommon for patients to develop a crossbite as the incisors start to erupt. If it is associated with displacement of the lower jaw, tooth wear /fremitus of the opposing dentition than an orthodontist can fabricate a simple upper removable appliance to procline the upper incisors and push them out of an anterior crossbite. Alternatively, a sectional fixed appliance can be used. Care must be taken to ensure that incisors positioned close to the cleft site are not moved out of the alveolar bone as there is typically very thin bone covering these teeth on the cleft side.

If a dental cross bite is not related to a mandibular shift, it is advisable not to perform any palatal expansion at this early stage due to:


Patients should be seen on a regular basis, usually on a 6 monthly basis to monitor dental development, continue to motivate the family, reinforce oral hygiene and dietary advice and generate a good relationship and rapport with the patient and family. Orthodontic dental records including radiographs, photos and study models should be taken regularly after the eruption of the upper permanent incisors to detect teeth that may be positioned in the cleft area and to ascertain whether there is congenital absence of the lateral incisor.
