ORAL HEALTH OF CHILDREN WITH CONGENITAL CARDIOVASCULAR DISEASE

child-with-stethoscope.jpg

Cardiovascular diseases are the leading cause of death from congenital malformations. The 3 most common congenital cardiovascular diseases are, ventricular septal defect, aortic valve stenosis and coarctation of the aorta. Children with congenital cardiovascular diseases are less likely to receive quality dental care and more likely to have poorer oral health.

Many studies have noted a link between periodontal and cardiovascular diseases; some have suggested that periodontal disease is an independent risk factor for coronary disease. Children with congenital cardiovascular diseases must receive special dental care because of their susceptibility to infective endocarditis associated with dental and periodontal infections. Nosrati et al from Indiana University evaluated the gingival condition of children with congenital cardiovascular diseases to determine whether an association exists between congenital cardiovascular diseases and gingivitis and periodontal disease.
A group of 25 children aged 7 to 13 years old with congenital cardiovascular disease (6 with ventricular septal defect; 14 with aortic valve stenosis; 5 with coarctaion of the aorta, n = 5) was recruited from a pediatric cardiology department at a children’s hospital; an age- matched control group included 25 systemically healthy children. Parents completed a questionnaire about their children’s past and present systemic health status and dental health history.

Because periodontal probing may cause bacteremia and is therefore contraindicated in patients with congenital cardiovascular disease, modified techniques were used to measure the presence of gingivitis and dental plaque. Levels of recession were also measured.

pasted image 0.png

The children with congenital cardiovascular disease had significantly higher scores on the modified gingival index (GI) and the modified plaque index (PI) and higher levels of recession than did the control group (Figure 1). No differences were detected among the 3 subgroups defined by type of congenital cardiovascular disease. While 20% of the children with congenital cardiovascular disease had ≥1 site with recession >0, none of the control children had any sites showing recession. The study also showed that these 25 patients and their parents had received encouragement from their pediatrician, pediatric cardiologist and parents’ dentist to arrange dental visits for the children, and the children had more recent visits to the dentist than did the control group. Nevertheless, children with congenital cardiovascular disease showed a greater incidence of periodontal disease, perhaps due to less-than-adequate oral hygiene habits. These children need to receive regular dental check-ups on a more frequent basis than do their systemically healthy peers.

Nosrati E, Eckert GJ, Kowolik MJ, et al. Gingival evaluation of the pediatric cardiac patients. Pediatr Dent 2013;35:456-62.



Stephen Wall