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This one is about: Opinions on Obturators

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Opinions on Obturators
Dr Kirt Simmons DDS, PhD replies to a parents questions

>He reiterated that he thought that he would close Sam's soft palate between
>8-12 months...And of course our concern becomes his speech. I asked him 
>about obturators, since I have learned a lot about them here on line.

"Obturators" are named because they are meant to block off (obturate) holes - either in the palate or at the back of the throat, they typically are made for 2 reasons - to block off the palate cleft for feeding - these are usually made very shortly after birth and maintained until the palate surgery is done, they are sometimes called 'feeding' obturators - since the children are not capable of talking at this age they have no effect on speech.  WHEN one is capable of speech (typically around 1 year old and beyond - this is why the palate surgery is done at this age - to allow normal development of speech) but still has 'holes' and cannot isolate the nose from the oral cavity (mouth) then an obturator, sometimes called a 'speech' obturator or appliance, can be made to assist in speech.

Now: Pros and Cons

Pros of 'feeding' obturators - feeding is easier, tends to keep food out of the nasal cavity, MAY decrease ear infections (controversial)

Cons of 'feeding' obturators - requires impressions (which ARE dangerous- if anyone inhales, or swallows, the impression material before it sets it can set, or turn rubbery, in the windpipe, lung, throat, etc. and be very difficult to remove QUICKLY - which in the case of an airway blockage could be fatal) of generally uncooperative conscious infants or the infant to be put to sleep (which also carries certain risks), expense, can irritate tissues, can restrict growth of the jaws, can result in dependence on the appliance which often must be removed for some period of time (usually 1-2 weeks) prior to surgery - resulting in feeding difficulties just prior to surgery - not good since you generally want babies gaining weight, or at least not losing, prior to surgery.

Pros of 'speech' obturators - CAN (but they don't always) improve speech, cheaper (relative to surgery), can be replaced/adjusted with growth, etc.

Cons of 'speech' obturators - much of same as 'feeding' - impressions, irritation, possible jaw growth restriction, can be lost, not "permanent" like surgery, added expense (if surgery done later anyway)

>I would like to hear your opinions on obturators.  
>1.When would be an optimum time to start wearing one.  

Not until he is speaking- after the soft palate surgery.

>2. How often do they have to change it?  Considering baby has gone from 5#
>14oz at birth to 14# at 4 months and growing fast.

Whenever it stops fitting- they can be 'relined' or modified sometimes without making a whole new one, may need to be done every couple of months.

>3.  Does it really help their speech?

It CAN, depends on the child and the specific problem - need to take this up with the speech therapist/pathologist.
>4. Does it stay in like a retainer, but hooked to his gum?  

Retainers are 'hooked', actually 'clasped' or held to the teeth by wires which bend over the teeth and kind of clamp them, you can't really clamp the gums - so these stay in like grandpa's dentures - by suction with the gums - 
in fact the need for denture adhesives is common.

>5. Is it uncomfortable? 

Can be initially, depends on the child.

>6.  Is the process of taking impressions dangerous?  

YES - see above.

Kirt Simmons DDS, PhD

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