Introduction and Objective: This study aimed to report the case of an eight-year-old patient with cleft lip and palate associated with undiagnosed syndrome presenting high level of carious lesions, difficulty on oral hygiene, no collaborative behavior and cariogenic diet. Case report: The patient underwent outpatient treatment for dental extraction and Atraumatic Restorative Treatment. Later at the following-up appointment, the child presented new active white spots and fractured restorations. Then, dental treatment under general anesthesia for amalgam restorations was indicated. Conclusion: We conclude that dental care under general anesthesia was an alternative treatment for the reported child in this clinical case that had a high prevalence of caries, cariogenic diet, loss of lip elasticity due to corrective surgeries, difficult access for oral hygiene and caregiver's fear to toothbrush near to the cleft.