Publications

The Ontario Cleft Lip and Palate/
Craniofacial Dental Program

One in every 700 infants in Ontario is born with a cleft of the lip and/or palate or other craniofacial difference. These conditions can be corrected through surgery, specialized dental treatment and speech therapy.

To assist families of children and young adults who must cope with the expense of specialized dental treatment, the Ministry of Health provides funding forThe Ontario Cleft Lip and Palate/Craniofacial Dental Program, managed by The Provincial Council for Maternal and Child Health. This program provides financial assistance for the specialized dental needs of affected individuals.

Why is a multi-disciplinary approach used?

Individuals affected with a cleft lip and/or palate or craniofacial condition may be faced with significant dental concerns affecting the tooth and bone structure in addition to feeding difficulties, middle ear problems and speech and language issues. As a result, management of treatment is best facilitated in a multi-disciplinary team setting.

Rehabilitation for these conditions requires the expertise of a team of medical, dental and other specialists. The complex nature of these conditions and the impact of growth and development on treatment outcomes may necessitate a number of rehabilitation services between birth and when growth stops in adulthood.

The team may include the following professionals:

• Audiologist
• Ear, Nose and Throat (ENT) Surgeon
• Oral and Maxillofacial Surgeon
• Orthodontist
• Paediatric Dentist
• Plastic Surgeon
• Prosthodontist
• Psychologist
• Social Worker
• Speech and Language Pathologist

Who is eligible for funding?

For children and young adults who have a cleft lip and/or palate or other craniofacial difference, to be eligible for funding, they must be:

1. A resident of Ontario in possession of a valid OHIP number, and
2. Diagnosed as having a cleft lip and/or palate, a craniofacial difference or other severe dental anomaly, and
3.  Have sufficient residual craniofacial growth necessary to achieve the maximum potential benefit from a single course of treatment.

How does someone get assessed for eligibility?

To determine eligibility for financial assistance through the program, an individual must contact, or be referred to, one of the designated centres for a screening assessment.

An individual's eligibility for registration with the program is determined by the Dental Director and the assessment team at each designated centre.

Once an individual is registered with a designated centre, the multi-disciplinary team works with the patient and/or family to coordinate a treatment plan. In some cases, the treating dentist may be based in the community. The team will meet with the patient regularly to manage and assess the progress of treatment and make appropriate recommendations.

Patients must be seen by the multi-disciplinary team at designated intervals during their treatment so that progress can be monitored.

What does the program cover?

The Ontario Cleft Lip and Palate/Craniofacial Dental Program covers up to 75% of the pre-approved dental specialist treatment costs not covered by private dental insurance.
These costs may include:

• Dental infant orthopaedics
• Orthodontic treatment
• Some restorative dentistry
• Dental prosthetics
• Dental implants and oral surgery not funded by OHIP

Eligible patients are entitled to one course of treatment and it is anticipated most treatment will be completed by 22 years of age.
The program will NOT cover the cost of regular dental check-ups, some procedures that are not deemed eligible and long-term follow-up care.

How does the program work?

• Procedures need to be completed in Ontario by a certified dental specialist.
• A treatment plan and fee estimate must be forwarded to and approved by, the Dental Director of a designated centre prior to the initiation of any dental treatment.
• Use of private dental insurance must always precede any funding through the Cleft Lip and Palate/Craniofacial Dental Program.
• The program will reimburse up to 75% of dental treatment costs remaining after private dental insurance.
• If there is no private insurance in place, the program will reimburse up to 75% of the approved estimate.
• If the patient has coverage provided by Healthy Smiles Ontario (HSO), the Cleft Lip and Palate/Craniofacial Dental Program will reimburse up to 75% of the approved estimate with the remaining amount to be paid by HSO, for procedures covered by both programs.
• If the patient has coverage provided by The First Nation and Inuit Health Branch - Non-Insured Health Benefits Program (NIHB), the Cleft Lip and Palate/Craniofacial Dental Program will reimburse up to 75% of the approved estimate. The remaining amount can be submitted for coverage consideration to NIHB. NIHB coverage is limited to NIHB eligible services only and is governed by NIHB policy criteria which can be found in the NIHB Dental Benefits Guide.
  
• For patients registered with diagnoses other than Cleft Lip and Palate and/or Craniofacial conditions, the program will cover up to 75% of the approved estimates to a lifetime maximum of $40,000.
• All requests for reimbursement (e.g. orthodontic bills) must be sent to The Hospital for Sick Children, the designated provincial paymaster for the program. Patients are provided with acceptance packages that contain up-to-date information for the paymaster and the funding centre where the patient is registered.

Where are the designated centres?

Hamilton

McMaster Children's Hospital (HHS)
Cleft Lip and Palate/Craniofacial Dental Program
905-521-2100, ext. 77069

Kingston

Kingston Health Sciences Centre
Cleft Lip and Palate/Craniofacial Dental Program
613-544-3400, ext. 3623

London

TVCC
Cleft Lip and Palate/Craniofacial Dental Program
519-685-8700, ext. 54086

Ottawa

Children's Hospital of Eastern Ontario
Cleft Lip and Palate/Craniofacial Dental Program
613-737-7600, ext. 3009

Toronto

The Hospital for Sick Children
Cleft Lip and Palate/Craniofacial Dental Program
416-813-5882

Holland Bloorview Kids Rehabilitation Hospital (HBKRH)
Cleft Lip and Palate/Craniofacial Dental Program
416-425-6220, ext. 3466

HBKRH also offers an annual assessment in Thunder Bay, Sault Ste. Marie, Sudbury and Timmins.
Please call HBKRH for more information.

Windsor

John McGivney Children's Centre
Cleft Lip and Palate/Craniofacial Dental Program
519-252-7281