Congenital cardiac anomalies accounts for 80% of paediatric cardiovascular conditions.
Classification
Acyanotic defects with shunts such as atrial septal defect, ventricular septal defect and patent ductus arteriosus.
Acyanotic defects with obstruction such as pulmonary stenosis, congenital narrowing of aorta and aortic stenosis.
Cyanotic defects with shunts such as Fallot's tetralogy, transposition of great arteries and truncus arteriosus.
General clinical manifestations
Stress intolerance
Fatigue
Shortness of breath
Delayed growth
Feeding difficulty
Clubbing of fingers
Heart sounds (murmur, thrill, click) and difference in the heart rate
Pathognomonic intraoral features
Developmental defects involving enamel pertaining to decidous dentition
Dental caries
Cyanotic gingivitis
Delayed tooth eruption
Intrinsic tooth stain
Periodontal disease
Malocclusion
Crowding
Medical implications
Bacterial resistance
Bacterial endocarditis and
Profuse bleeding
Dental management
Elimination of oral infection thereby reducing the risk of bacterial endocarditis
Maintainance of good oral hygiene
Effective communication with paediatric cardiologist
Chlorhexidene mouthwash [1]
Determine INR
Stress reduction with the help of sedation or general anesthesia
Antibiotic prophylaxis (administration of amoxicillin single dose before 30 – 60 minutes of dental procedure)
Avoid adrenaline during administration of local anesthesia [2]
Routine regimene includes 50 mg/kg intraorally Amoxycillin. If allergic, then 20 mg/kg Clindamycin or 50 mg/kg Cephalexin or 15 mg /kg Clartithromycin /Azithromycin
Cardiac conditions which require antibiotic prophylaxis during dental procedures:
Previous endocarditis
Prosthetic heart valves
Congenital heart disease.
Antibiotic prophylaxis recommended dental procedures:
Extraction
Periodontal treatment
Root canal therapy
Placement of dental implant
Reimplantation of avulsed tooth
Placement of orthodontic bands
Oral prophylaxis
Antibiotic prophylaxis is not recommended for following conditions:
Clinical examination
Dental xrays
Placement of removable orthodontic appliances
Placement of prosthodontic appliances
Placement of orthodontic brackets
Adjustment of orthodontic appliances
Exfoliation of decidous tooth
Minor trauma pertaining to labial or buccal mucosa. [3]
Acknowledgements
Childs Trust Medical Research Foundation (CTMRF) Kanchi Kamakoti Childs Trust Hospital 12-A,Nageswara Road, Nungambakkam, Chennai – 600034, Tamilnadu, India Ph: 0091-44-42001800
Conflict of Interest
None.
References
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