Dental management of children with congenital cardiac conditions

Congenital cardiac anomalies accounts for 80% of paediatric cardiovascular conditions.

Classification

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

Source of Funding

None.

Conflict of Interest

None.