The Practitioner's Perspective: Dental Care and Congenital Heart Defects
By: Michelle M. Kelman, DDS
Pediatric Dentist, Cedars-Sinai Medical Center, Department of Surgery, Dentistry, UCLA School of Dentistry, Pediatrics
“Go brush your teeth.”
It’s a phrase that most children feel they hear too often. There is so much to do at the start and then the end of the day that all too often, tooth brushing is overlooked. Studies have shown that children with congenital cardiac disease (CCD) have poor oral health compared with healthy children. As you may already know, children with congenital heart disease (CHD) are at risk for bacterial endocarditis, an infection of the tissue that lines the heart and blood vessels. It is important for your child’s health to keep the oral cavity healthy to prevent infection that may begin in the mouth.
Some important facts to consider:
Studies have shown that children with CCD suffer poor oral health, compared with heart healthy children. This is most likely related to a combination of abnormal dental formation associated with the cardiac condition and dental neglect.
Children with CCD are more likely to have abnormal tooth formation including developmental enamel defects such as weakness in enamel, are more prone to malocclusion that includes crowding of teeth, and are more prone to harmful gum disease, compared with heart healthy children.
The chronic intake of sweetened medications is associated with increased cavities in children with CCD.
Children with CHD are prone to develop infective endocarditis from bacteremia not only induced by dental procedures but also from chronic poor oral health. Untreated dental decay may develop quickly into pulp infections which are associated with bacteremia, endocarditis, and even brain abscesses in children with CCD.
In regards to dental treatment, severely affected children may have reduced tolerance to the stress induced by dental treatment. Complications of CCD such as hematological, respiratory and immunological problems, and drug interaction with chronic medications must all be considered for children with CCD.
Unfortunately, a significant number of children with CCD do not receive optimal professional dental care until the child already has a mouth full of cavities. The goal is to prevent this. Here are some oral health guidelines to follow:
Home Oral Care:
Start taking care of your children’s gums before the first tooth erupts. Wipe down the gums after every meal, especially after medications.
Help your children with their toothbrushing. Children under the age of eight do not have the manual dexterity skills to brush on their own.
Teeth should be brushed for two minutes at least twice a day. As most medications are very sugary, it is recommended that your child brushes after medication is given.
Flossing: Children’s Flossers are recommended because of their ease of use. Because of tooth crowding, food/ sugary medications get stuck in between the teeth. It’s essential to floss the teeth to get the food out from in between them and from the gum line.
Tooth Wipes: It is recommended that you carry tooth wipes with you for “on the go” situations. It is recommended to wipe your child’s teeth following medication.
Diet: Avoid excessive sugar intake and “sticky” foods such as hard candies & even food that you feel is "healthy" like raisins (still "sticky"!) As soothing as sticky candy may be, a scoop of sorbet is much better for the teeth than a jolly rancher.
Seek out a knowledgeable dentist:
Your child should be seen by a pediatric dentist by the age of one. Make sure the dentist you have chosen has experience treating children with CCD. Please arrange for your cardiologist to send over a complete medical history and recommendations for treatment prior to your child’s first visit. Most children with CCD do not need premedication with antibiotics. The pediatric dentist and your cardiologist are familiar with the latest guidelines and will determine if premedication is needed.
Your pediatric dentist will form a preventative treatment plan that may include more frequent cleanings.
Your dentist may prescribe topical fluoride therapy and fluoride supplementation.
As the molars develop in the mouth, your pediatric dentist may recommend sealant placement on all molars with deep grooves and fissures. This will help prevent the entrapment of food/ sugar in these grooves and thus assist in preventing the formation of cavities.
If your child already has cavities that need to be filled, your pediatric dentist will coordinate with your cardiologist a treatment plan that will place the least amount of stress on your child. This may include treatment under General Anesthesia with an anesthesiologist that specializes in high risk pediatric patients.
To conclude, the time to start taking care of your child’s teeth is before the first tooth erupts. Brushing and flossing properly at home, and having regular dental visits, from a very early age, is essential.
Michelle M. Kelman, DDS
Pediatric Dentist
Cedars-Sinai Medical Center
Department of Surgery, Dentistry
UCLA School of Dentistry, Pediatrics
For more information on the American Heart Association guidelines for antibiotics prior to dental care:
http://www.ada.org/2157.aspx#heart
http://www.ada.org/sections/professionalResources/pdfs/patient_75.pdf
A special note from Sisters by Heart:
In addition to February being Congenital Heart Defect Awareness Month, it is National Children's Dental Health Month. All information here is for the purpose of helping you care for your child with a Congenital Heart Defect (and your healthy heart children, too!) However, please consult with your dentist regarding personalized care and a treatment plan for your child. This is very good general advice, but does not take the place of seeing a dentist. If you are not currently implementing these practices in your child's oral hygiene, it is a great time to start. No need to panic if you have some room for improvement in your home care and also if you have not had your child see a dentist yet. You may get recommendations/referrals from your cardiologist, pediatrician, and/or your adult/general dentist. No matter the age of your child, it's a great time to seek out a dentist who can work well with your child, your cardiologist, and you! ~Sara Hale, Sisters by Heart Mom/DDS