The Ontario Cleft Lip and Palate/Craniofacial Dental Program

This program, outlined below DOES cover people with an ectodermal dysplasia syndrome even if they do not have a cleft lip or palate.

You must have a diagnosis first, through your dentist and a genetic test. Even if the genetics come back inconclusive for the type of ectodermal dysplasia you have, a doctor, dentist or both can give an official diagnosis based on their professional opinion. While all the processes, etc. below seem complex, it is actually your dentist who will apply on your (or your child’s behalf) and will submit the required paperwork while guiding you through the process. In CEDSA’s experience, the process was quite easy once the diagnosis was made, and a letter confirming the patient had been approved was sent within weeks of the dentist submitting the application. When you see your dentist for ectodermal dysplasia-related treatments, just like with a dental plan, the coverage from The Ontario Cleft Lip and Palate/ Craniofacial Dental Program is applied right there in the dentist office and you pay the difference – you don’t have to submit forms.

This program doesn’t cover regular dental coverage like cleanings, check-ups, fillings, etc. which is traditionally covered by a benefit plan, Ontario Works, Ontario Disability Act or other resources. The Healthy Smiles Program is also available for children under the age of 17 who don’t have coverage for regular dental care and are in financial need. Click here to read more.

One in every 700 infants in Ontario is born with a cleft of the lip and/or palate or other craniofacial anomaly. 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 treatment, the Ministry of Health and Long-Term Care established The Ontario Cleft Lip and Palate/ Craniofacial Dental Program. This program provides financial assistance for the specialized dental needs of affected individuals.

A multi-disciplinary approach to treatment:

The individual with a cleft lip and/or palate or craniofacial syndrome 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.

Rehabilitation services for these conditions require the expertise of a multi-disciplinary 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 adulthood.

The assessment 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 assessment?

To be eligible for funding an individual 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 anomaly or other severe dental dysfunction, and
3. Registered in the program before their 18th birthday.

How does someone apply for an assessment?

To determine eligibility for financial assistance through this 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 Paediatric Dental Director and the assessment team at each designated clinic.

Once an individual is registered with a designated centre, the multi-disciplinary team works with the individual to coordinate a treatment plan. The team will meet with the client regularly to manage and assess the progress of treatment and make recommendations.

Patients must be seen at designated intervals during their treatment by the multi-disciplinary team to monitor the progress of their treatment.

What is covered?

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

  • Dental orthopaedic
  • Orthodontic treatment
  • Some restorative dentistry
  • Dental prosthetics
  • Dental implants and oral surgery not funded under OHIP

Patients are entitled to one course of treatment and will be discharged from the program upon completion of treatment. The Cleft Lip and Palate/Craniofacial Dental Program does not cover the cost of routine dentistry and long-term follow-up care.

How does the program work?

  • Some procedures may need to be completed by a certified dental specialist in Ontario.
  • A treatment plan and fee estimate must be forwarded to and approved by the Paediatric Dental Director of a designated clinic prior to the start of any dental treatment.
  • The program will reimburse up to 75% of dental treatment costs remaining after private dental insurance.
  • Use of private dental insurance and coverage provided by The First Nation and Inuit Health Branch must always precede any funding through the Cleft Lip and Palate/Craniofacial Dental Program.
  • A funding limit applies to non-orthodontic treatment for patients registered with diagnoses other that Cleft Lip and Palate and/or Craniofacial syndromes.
  • If there is no private insurance in place, the program will reimburse up to 75% of the approved estimate.
  • All requests for reimbursement (e.g. orthodontic bills) must be sent to The Hospital for Sick Children, the designated provincial paymaster for the program.

Where are the designated centres located?

HAMILTON
McMaster Children’s Hospital
Regional Cleft Lip and Palate Team
1-905-521-2100 ext. 77210

KINGSTON
Hotel Dieu Hospital,
Cleft Lip and Palate Clinic
1-613-544-3400 ext. 3624

LONDON
Thames Valley Children’s Centre
Cleft Lip and Palate/Craniofacial Clinic
1-519-685-8700, ext. 54086

OTTAWA
Children’s Hospital of Eastern Ontario
Cleft Lip and Palate/Craniofacial Dental Program
1-613-737-2357

TORONTO
Bloorview Kids Rehab*
Cleft Lip and Palate/Craniofacial
Dental Program
1-425-6220, ext. 3466

*Bloorview Kids Rehab also offers an annual assessment in Peterborough, Thunder Bay, Sault Ste. Marie, Sudbury and Timmins. Please call for additional information.
The Hospital for Sick Children
Cleft Lip and Palate/Craniofacial Dental Program
1-416-813-5882

WINDSOR
John McGivney Children’s Centre
Maxillofacial-Speech Clinic
1-519-252-7281
Referenced from the Ontario Ministry of Health and Long-Term Care; [revised January 2009]. [1 screen]. Available from: http://www.health.gov.on.ca/english/public/pub/child/cleft.html