Title	Dentists Treating Cleft Lip and/or Palate Patients Will Need to Consider Anatomical Variations when Delivering Local Anesthetic
Clinical Question	In cleft lip and palate patients, will altered anesthetic techniques be more effective than standard techniques in achieving adequate pain control?
Clinical Bottom Line	Low evidence to support minor alterations needed that include first anesthetize away from cleft and then at cleft margins. But similarities include the use of topical anesthetic and the guidance for slow injection.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 22437689 Trindade-Suedam/2012 2 patients with cleft palate and lip Case Report Key results This article discussed the innervation of the cleft area and reported on the management of two patients. The authors made the following recommendations: 1. Topical anesthetic. 2. Puncture away from cleft area first (i.e. PM area). 3. Slow administration of local anesthetic. 4. Infiltrate local anesthetic at cleft margins. 11318002 da Silva Dalben/2000 Cleft lip and palate patients Narrative Review Key results This article discussed the anatomical features of cleft lip and palate patients and frequently used dental anesthetic techniques. Recommendations: 1. Dry mucosa. 2. Topical anesthetic. 3. Initial infiltration along long axis of dental tooth. 4. Local anesthesia of the adjacent segment may be needed; therefore change needle direction at initial puncture site towards pre-maxilla, crossing cleft towards other side.
Evidence Search	Search (((cleft lip and palate)) AND local anesthetic) AND dental treatment
Comments on The Evidence	Validity: Limited articles with low level of evidence have been published to support modifications to anesthetic techniques on cleft lip and palate. For example, da Silva Dalben/2000 only cited three other articles on this topic. Therefore, more studies are needed in order to provide quality evidence that can support best clinical practices for the cleft lip and palate population. Perspective: Personally, I did not think of any technique changes needed for cleft lip and palate patient that would need operative/extraction/etc. It is important to be confidant when treating patients and having gained this knowledge, I will be better prepared to treat a cleft lip and palate patient in the future.
Applicability	Effective local anesthetic technique is imperative to the success of any procedure, especially in the pediatric population - pain can alter how a patient will tolerate the rest of the procedure. Patients and parents expect to be anesthetized properly.
Specialty	(General Dentistry) (Pediatric Dentistry)
Keywords	cleft lip, cleft palate, local anesthesia
ID#	3331
Date of submission	09/13/2018
E-mail	wheelers1@livemail.uthscsa.edu
Author	Sarah Wheeler, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Maria-Jose Cervantes Mendez, DDS MS
Faculty mentor e-mail	CervantesMen@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available