Impact of Dental Anomalies on Function and Aesthetics in Cleft Lip and Palate Patients

Abstract

Background: Cleft lip and palate (CL/P) are among the most prevalent congenital craniofacial deformities, often accompanied by a wide spectrum of dental anomalies including hypodontia, supernumerary teeth, peg-shaped incisors, enamel hypoplasia, and malocclusion that significantly impair oral function and esthetics. These dental irregularities not only compromise mastication, speech articulation, and occlusal stability but also exert a profound psychosocial burden on affected individuals, particularly during formative years. Objective: This review aims to synthesize current evidence on the functional, esthetic, and psychosocial impacts of dental anomalies in CL/P patients, highlighting the interrelationship between structural deformities, oral performance, and quality of life, and emphasizing the need for integrated, multidisciplinary management. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar databases to identify English-language studies published between 2010 and 2025. Search terms included “cleft lip and palate,” “dental anomalies,” “hypodontia,” “malocclusion,” “mastication,” “speech articulation,” and “psychosocial impact.” Original research articles, longitudinal studies, and clinical reviews examining functional, esthetic, or psychosocial outcomes in CL/P were included. Evidence was synthesized thematically without meta-analysis due to study heterogeneity. Results: Empirical findings demonstrate that 70–90% of CL/P patients present with one or more dental anomalies, most frequently maxillary lateral incisor agenesis and enamel hypoplasia. These abnormalities are strongly associated with reduced occlusal force (up to 80–85% lower than controls), altered chewing kinematics, and compensatory temporalis muscle hyperactivity. Speech articulation is adversely affected by missing or malaligned anterior teeth, particularly in the production of sibilant and labiodental sounds (/s/, /f/, /v/). Long-term skeletal instability after maxillary advancement is commonly attributed to postoperative fibrosis and scar formation. Aesthetically, enamel defects and asymmetric anterior dentition disrupt smile harmony and facial balance, while psychological studies reveal markedly higher distress scores and social stigma leading to decreased self-esteem and academic performance. Conclusion: Dental anomalies in CL/P patients have multifactorial repercussions that extend beyond oral function to psychosocial well-being. Although surgical and orthodontic interventions improve form and function, complete normalization remains rare. Early detection, timely orthodontic and surgical coordination, dietary and speech therapy support, and continuous psychosocial counselling are essential to achieving sustainable rehabilitation. Integrating these domains within a long-term multidisciplinary framework is critical for optimizing functional recovery, facial esthetics, and quality of life.