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Cardiac disease and children’s oral health

All children need a “dental home” for preventive advice and supervision. They need a place to go to in an emergency and somewhere to go for routine treatment. A dental home is where your child should feel comfortable and relaxed. Children have very varied dental needs depending on their age, ability to co-operate, dental health and also their medical health. Tooth decay can cause a number of problems to children’s general health. For children who already have health problems, dentistry can be more complicated. Early dental visits are important for all children but especially for those who are compromised in relation to dentistry due to medical reasons such as cardiac disease.

Dental decay can have effects on a child’s general health and wellbeing. The types of problems caused by decay can be divided into acute, meaning severe and short term versus chronic where they continue over a long period of months or years. Acute dental infection often leads to pain, swelling and suffering for children. A dental abscess can cause a child’s face to swell requiring antibiotics and sometimes hospital admission for general anaesthetic.

In Ireland about 500-600 children are born every year with a heart defect. Heart defects increase the risk of a condition called infective endocarditis which is a potentially fatal and very serious condition. To have a heart defect or what is sometimes called a “murmur” or “hole in the heart” can have important implications for dental care. Up to recently dentists would give these patients an antibiotic before treatment to prevent bacteria travelling from the mouth in the blood to the heart defect. Years of research has now shown that the antibiotics are no longer recommended but, it is thought that the long term effect of poor dental health is a greater threat to heart health. Dental infection carries a more serious health risk for these children than for the rest of the population. It is very important that children with heart problems avoid tooth decay. They require high quality, regular dental care.

Chronic or longer term dental infection has been shown to affect growth and physical development. It is not fully understood if it is because of the chronic inflammation or the effect of sleep loss that children’s growth is held back. When decay and infection is treated, the improvements in health and growth are measurable. There is very good quality research to support this. Children may often have decay and infection and not complain of symptoms. This highlights the need to have teeth checked for signs of dental disease on a regular basis.

Dental issues unique to children with cardiac problems include an increased risk of developmental defects in teeth (weak/soft teeth). This makes the teeth more vulnerable to decay. It also makes teeth less suitable for the use of regular white and silver fillings. Medical and dental anxiety result from frequent hospitalisations in infancy. This often means that these children may find dental visits more stressful than usual. Dietary risks arise from high calorific diets used to manage failure to thrive in children who find it difficult to gain weight. This is another reason who this patient group may present with more dental disease. Many Down Syndrome children have concurrent cardiac defects and have communication difficulties which can add to the difficulty involved in delivering high quality dental care.

Dental problems for healthy children are extremely common and can often require specialist care and services to treat them effectively. It is very important that vulnerable children who are medically compromised are protected from poor oral health. This starts with having a high quality dental home from a young age. Paediatric Dentists have advanced training and skills in the management of children with medical problems such as cardiac defects.

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