The development of a malocclusion in adulthood can present as a diagnostic and management challenge to an orthodontist. It is prudent to identify the aetiology of changes to the occlusion which will influence the management plan. Uncommon causes include acromegaly. Orthodontists are in a good position to identify certain underlying disorders based on a patient’s presenting malocclusion that may otherwise go unnoticed and undiagnosed until other systemic signs and symptoms present themselves at the latter stages of the condition. This case report highlights possible aetiological factors of a developing malocclusion in adulthood and presents the clinical manifestations and joint orthodontic–surgical management of a patient with a developing skeletal III base attributed to acromegaly.

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Introduction It is well recognised that cleft lip and/or palate carries an increased risk of developing dental caries. This article describes a service evaluation that was undertaken at the South Thames cleft service to analyse whether the five-year-old cohort of patients attending the clinic were following preventative advice as well as whether they were registered with a general dental practitioner and attending for regular recall. Methods A total of 96 patients were assessed. Data from a 24-month period were collected retrospectively using a data collection sheet. Results The vast majority (92%) of the patients included in this service evaluation were registered with a general dentist. Despite this, 40% had a decayed/missing/filled teeth score of >0, only 73% were having fluoride varnish applied regularly and 79% were using toothpaste containing the recommended fluoride content. More than half (57%) of the patients had developmental defects of enamel. Conclusions There needs to be increased emphasis on following national prevention guidelines given that this group of patients is known to be at a higher risk of dental caries. Parents and carers must be made aware of the requirement for shared care between general dental practitioners and secondary care.