One in every 600 to 700 children in Ontario is born with a cleft of the lip and/or palate. This notch or separation in the lip or palate can mar appearance and affect both tooth and bone structure. Because of its effect on physical appearance, it can be stressful for both the child and his or her family. Clefts may be caused by heredity, nutritional deficiencies, infection or various drugs. The problem occurs about the seventh to ninth week of pregnancy, when the unborn baby's face is developing. Through surgery, specialized oral health treatment and speech therapy, the problem can be corrected eventually. However, these treatments can be very expensive. To help families of children and young adults who must cope with this expense, the Ministry of Health and Long-Term Care has established the Cleft Lip and Palate Program. Through this program, the ministry will provide 75 per cent of the cost of dental treatment by a certified specialist who is associated with correcting the cleft lip and/or palate. The Program also covers 75 per cent of treatment costs of severe acquired (non-genetic) dental dysfunction for patients up to 22 years of age.
Who is Eligible for the Program?
Anyone who is:
- under 22 years of age as of Jan. 1, 1990;
- diagnosed as having a cleft lip and/or palate or other severe congenital or acquired dental dysfunction;
- registered with a designated clinic;
- assessed by a multi-disciplinary team;
- a cleft lip and/or palate patient beyond 22 years of age, as of Jan. 1, 1990, who did not receive appropriate treatment during childhood.
How Does Someone Apply for the Program?
To apply for the program, a patient must register with a designated clinic. The dental treatment does not have to be done at the clinic, but the patient must be registered to receive a payment because the clinic processes the claims.
Where are the Designated Clinics?
Hamilton
Chedoke McMaster Hospitals - 905-521-2100
Kingston
Hotel Dieu Hospital - (613) 544-3310
London
Thames Valley Children's Treatment Centre - (519) 685-8680
Ottawa
Children's Hospital of Eastern Ontario - (613) 737-7600
Peterborough
Five Counties Children's Treatment Centre (Assessment Clinic) - (705) 748-2221
Toronto
The Hospital for Sick Children - 416-598-6018
Hugh MacMillan Rehabilitation Centre - 416-425-6220
Windsor
Children's Rehabilitation Centre of Essex County - (519) 252-7281
Hugh MacMillan Rehabilitation Centre also offers an annual assessment clinic in each of the following locations : Thunder Bay, Sault Ste. Marie, Sudbury and Timmins.
Interested patients or their families should contact the Easter Seal Society district nurse in their area for further details.
What is the Purpose of the Multi-Disciplinary Assessment?
A patient's eligibility for the program will be determined by the assessment team at each designated clinic on a case-by-case basis. The assessment team is made up of a speech pathologist, an audiologist, an ear, nose and throat surgeon, an orthodontist, a paediatric dentist, a plastic surgeon, a psychologist and a social worker.
What will the Cleft Lip and Palate Program Cover?
It will cover the following dental services :
- prosthetics;
- orthodontics;
- dental orthopedics;
- dental consultations;
- infant orthopedics;
- feeding therapy supervision;
- preventive dentistry - including endodontics (root canal) and periodontics (gum disease);
- restorative dentistry (to maintain the integrity of the dental arches).
How Does the Program Work?
- The clinic will need an estimate of total treatment costs.
- If the treatment is being done by a dentist, working within a designated clinic, the dentist will provide an estimate of the cost of the treatment plan (using a Certified Specialist in Orthodontics Standard Information Form).
- The dentist will also advise the patient or patient's family of the total cost and the 25 per cent that will be paid by the family or patient.
- If the work is being done by a dentist who is not at a designated clinic, the dentist must provide an estimate of the cost of the treatment plan (using a Certified Specialist in Orthodontics Standard Information Form).
- The estimate must be submitted - by either the dentist or the patient - to a designated clinic for approval. Again, the patient or patient's family must be informed of the total cost and the 25 per cent that they are responsible for paying.
- Any increase to the estimate must be explained by the dentist and authorized by the clinic before payment will be made.
- If the treatment costs less than $200 over a six-month period, pre-authorization is not required. How are payments handled?
- Designated clinics will have a budget to cover 75 per cent of the treatment costs. If the treatment is done within the clinic, the clinic is responsible for collecting the 25 per cent share from the patient or family.
- If the work is done by a dentist outside the clinic, the dentist can either:
- Bill the clinic directly. The clinic will pay the dentist 75 per cent of the bill, and the dentist will collect the remaining 25 per cent directly from the patient or family, or
- Bill the patient directly. The patient or family will pay the dentist in full. The clinic will reimburse the family for 75 per cent of the cost.
- Bills must be submitted on an Ontario Dental Association Standard Dental Claim Form.
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