Children with heart conditions

(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)

CHILDREN with heart conditions are more at risk for endocarditis caused by oral bacteria, a new U.S. Centers for Disease Control and Prevention (CDC) study shows.

Little is known about the oral health of these children.

Endocarditis, usually caused by an infection, is a life-threatening inflammation of the inner lining of the heart chambers and valves (endocardium).  

The CDC study shows that from 2016 to 2019, only 83 of those aged 1–17 years with heart conditions received preventive dental care. Seventeen percent had symptoms of poor oral health during a 12-month period, and 10 percent had teeth in fair or poor condition.

Those with lower household incomes and intellectual and developmental disabilities had worse oral health.

Approximately 900,000 US children have heart conditions, such as congenital heart disease, says Karrie F. Downing of the Division of Birth Defects and Infant Disorders, CDC National Center on Birth Defects and Developmental Disabilities.

“These children might be at increased risk for life-threatening infective endocarditis from oral bacteria in the bloodstream,” says Ms. Downing, the lead researcher.

Preventive dental care such as check-ups, dental cleaning, radiographs, fluoride treatment, or sealant are important to maintain oral health is important.

The study compared oral health status and preventive dental care between children with heart conditions (2,928) and those without (116,826). The data were based from the 2016-2019 U.S. National Survey of Children’s Health (NSCH).

The NSCH is an annual parent-reported survey to evaluate health, well-being, and related factors among Americans aged 0 to17 years.

The study randomly selected one child from each household. In total, 2,928 children and adolescents with heart conditions (representing 1.4 million of the age group) and 116,826 children and adolescents without heart conditions (representing 6.4 million) were included.

The study found that children and adolescents with a heart condition, particularly those with intellectual disabilities, were more likely than those without a heart condition to have teeth in fair or poor condition.

Approximately one in six children with a heart condition had toothaches, bleeding gums, or decay, and approximately one in six had not received preventive dental care during the past 12 months.

Among children and adolescents with a heart condition, oral health was notably worse for those with intellectual or developmental disabilities, those living in poverty, and those without insurance.

Among children and adolescents who received preventive dental care, the majority received dental check-ups and dental cleanings, whereas application of sealant was least common. Overall, children and adolescents with a heart condition were more likely than were those without to receive preventive dental care.

Seventeen percent of children and adolescents with a heart condition had one or more indicators of poor oral health. Decayed teeth or cavities was the most prevalent indicator of poor oral health.

Preventive dental care was higher among children aged 6 years and above.

Those with a heart condition have low household income and intellectual or developmental disability.

Public health practitioners and health care providers can implement strategies such as parent and patient education and collaboration between pediatricians, dentists, and cardiologists to improve oral health and care among children with heart conditions, especially those with fewer resources and intellectual or developmental disabilities, says Ms. Downing.

The research team included Dr. Lorena Espinoza, a dentist, of the CDC National Center for Chronic Disease Prevention and Health Promotion; Dr. Matthew E. Oster of the Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia; and Sherry L. Farr, PhD, of CDC’s Division of Birth Defects and Infant Disorders.

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Dr. Joseph D. Lim is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; and Honorary Life Member of the Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.

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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com/PN