An investigation of the oral status and reported oral care of children with heart and heart-lung transplants

Oral health-related quality of life and oral manifestations of Syrian children with congenital heart disease: a case-control study

BACKGROUND

There was an immense need for studies evaluating the oral health status of Syrian children with congenital heart disease (CHD) and its impact on their quality of life. No contemporary data are available. The objective of this study was to investigate oral manifestations and oral health-related quality of life (OHRQoL) of children with CHD and compare them with healthy controls aged 4-12 years.

METHODS

A case-control study was undertaken. A total of 200 patients with CHD and 100 healthy children belonging to the same patient's family were included. Decayed, missed, and filled permanent teeth index (DMFT) and decayed, missed, and filled primary teeth index (dmft), Oral Hygiene Index (OHI), Papillary Marginal Gingivitis Index (PMGI), and dental abnormalities were recorded. The Arabic version of the Child Oral Health-Related Quality of Life Questionnaire (COHRQoL, 36-item) which was divided into 4 different domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, Social Well-Being) were studied. Chi-square test and independent- t-test were used to perform statistical analysis.

RESULTS

CHD patients experienced more periodontitis, dental caries, poor oral health, and enamel defects. The dmft mean was significantly higher in CHD patients than in healthy children (5.245 vs. 2.660, P < 0.05). No significant difference was found between patients and controls in the DMFT Mean (P = 0.731). There was a significant difference between CHD patients and healthy children in the mean of the OHI (5.954 vs. 1.871, P < 0.05), and PMGI (1.689 vs. 1.170, P < 0.05). CHD patients have significantly higher enamel opacities (8% vs. 2%) and hypocalcification (10.5% vs. 2%) than controls. Also, the 4 COHRQoL domains, showed significant differences between CHD children and controls.

CONCLUSIONS

Evidence about the oral health and COHRQoL of children with CHD was provided. Further preventive measures are still required to improve the health and quality of life of this vulnerable group of children.

Oral health status and dental anomalies among children with congenital heart disease in contemporary times

AIMS

The aim of the study was to assess the oral health, hygiene status, and prevalence of dental anomalies in children suffering from congenital heart disease (CHD).

MATERIAL AND METHODS

The study was conducted on 300 children, aged 2-16 years, diagnosed with CHD.

RESULTS

Overall, the oral health status of the children with CHD was found to be poor in this study. The prevalence of caries was found to be 56.7%. It was significantly higher in children with acyanotic CHD compared to cyanotic CHD. Mean DMFT was 0.6 ± 1.6. Mean Debris index was 0.8 ± 0.9. Mean calculus index was 0.3 ± 0.6. The prevalence of dental anomalies was 9%. Most common anomaly was enamel opacities/hypoplasia (8.0%) followed by hypodonita (0.7%) and fusion (0.3%). The mean dmft score and Calculus Index were found to be significantly higher in cyanotic CHD group compared to acyanotic CHD group. Prevalence of caries, Debris Index, Calculus Index, and Oral Health Index were found to be increasing with increasing age (> 5 vs. < 5 years).

CONCLUSION

Overall, the oral health status of the children with CHD was found to be poor in this study.

Evaluation of the Effectiveness of an Interdisciplinary Preventive Oral Hygiene Program for Children with Congenital Heart Disease

It is recognized that children with congenital heart disease (CHD) are predisposed to having poorer oral health. Therefore, the purpose of this study was to evaluate the effectiveness of an interdisciplinary preventive oral hygiene program (POHP) for children with CHD. The aim was the reduction of the incidence of dental caries, as well as improvement of oral hygiene. The total number of participants in this study was 107 children with CHD aged between two to six years. At baseline, these children were compared to a healthy control group (HCG) of 101 children of similar age from five preschools in Giessen, Germany. All examinations were carried out before the introduction of a standardized POHP. The Quigley/Hein Plaque- (QHI), Silness/Loe Gingival- (GI) and Gingival Hyperplasia Index (GHI) were determined. Starting with baseline, the described procedures were repeated in the CHD group during two follow-ups after three and six months. In the first examination, compared to controls, CHD children showed a significantly (p < 0.05) poorer oral hygiene (QHI: 2.6; GI: 0.3; GHI: 0.2). All oral hygiene parameters (QHI, GI, GHI) of the CHD group improved significantly over the whole period of the preventive program (p < 0.05). These results demonstrated an improvement in CHD children involved in a standardized POHP. The data with regard to the general health of these risk patients, including prevention of endocarditis, demonstrate the necessity of an interdisciplinary approach between pediatric cardiologists, pediatricians and dentists.

Oral health complications after a heart transplant: a review

Background Heart transplants have become a successful treatment for some cardiovascular diseases. To prevent rejection of the transplanted heart, patients have to take immunosuppressive medication.Aims The aims of this study were to identify and review oral health complications after heart transplantation.Methods The electronic database PubMed was searched for relevant articles. The search yielded 332 papers, of which 24 matched the criteria for this review.Results Gingival hyperplasia was observed in 8.3-67% of the patients. Heart transplant patients who received professional periodontal treatment starting six months after transplantation showed significantly better scores on the Gingival Index (GI) and gingival hyperplasia. In comparison to a control group, heart transplant patients did not differ significantly in the DMF(T) index. The incidence of fungal infection in patients receiving a heart transplant varied between 10% and 25%. Heart transplant patients had a 4.3 times higher chance of developing oral cancer.Conclusion Patients who underwent a heart transplant and subsequently used immunosuppressive medicines appear to have a higher risk of gingival hyperplasia, periodontal conditions, the presence of Candida species and oral malignancies, in comparison to healthy individuals. The association between heart transplants and dental caries was unclear. It is recommended that heart transplant patients receive frequent oral examination and professional dental cleaning.

Dental Caries and Gingival Evaluation in Children with Congenital Heart Disease

Background

Dental health is one of the most important health burdens of children health. The association between dental health and endocarditis has been already demonstrated, but there is controversy about different frequency of dental caries, periodontitis, and saliva microorganism in comparison to healthy population and children with congenital heart diseases (CHDs). In this study, we evaluated these differences.

Methods

Seventy-six healthy children and 68 CHD patients were enrolled in the present case-control study. Dental decay, periodontitis, oral microorganisms, serum calcium, phosphorus, and frequency of carbohydrate and protein consumption of all participants were evaluated by standards method.

Results

CHD patients experienced more periodontitis, but the difference was not significant (0.12 vs. 0.09, P = 0.2). In healthy children, the mean saliva colony counts of Streptococcus mutans were more significant (50639 ± 3324 vs. 35285 ± 27226, P = 0.03), which was diminished by adjusting the carbohydrate consumption. The mean colony count of Lactobacilli in children with CHD was nonsignificant higher than healthy children (P = 0.3).

Conclusions

Pediatric patients with CHD experience insignificantly higher dental decay, periodontitis, and saliva Lactobacilli colony counts. The frequency of decayed tooth and gingival diseases in healthy children is high, and hence, more dental care attention in our health system is needed for healthy children.

Estimation of salivary nitric oxide levels in children with congenital heart diseases

Introduction:

Oral health problems, especially dental caries are known to be common in children with severe heart disease, especially at early ages. The role of nitric oxide (NO) in protection against oral diseases owing to its strong antimicrobial action has been a topic of interest.

Objective:

The current study was carried out to estimate the NO levels in the salivary samples of children diagnosed with congenital heart diseases (CHDs) and to determine whether salivary NO can serve as a potential biomarker for the evaluation of dental caries-risk.

Methodology:

This prospective study was performed on 50 children suffering from CHDs who reported to the department of pediatrics and the levels were compared with those of 50 healthy caries-free children. NO levels in the collected salivary levels were determined spectrophotometrically using the Griess reaction method.

Results:

Subjects between the age group of 6 and 12 years had maximum decayed teeth (20.95%). The mean NO level in children in study group (60.63) was decreased in comparison to the control group (132.40), which was statistically significant (P value of 0.001). The mean age of the subjects in the study group was 7.24 and the salivary NO levels decreased with age, which was statistically significant.

Conclusion:

Children are suffering from medically compromising conditions such as CHDs are at a higher risk for dental caries and decreased salivary NO levels in these patients may prove as a critical indicator of the same. Saliva can be further utilized as an important biomarker for the determination of the relationship between salivary NO levels and development of dental caries.

Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients

OBJECTIVE

Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at risk of several diseases, principally attributable to immunosuppression. This global overview of SOT/HSCT-associated orofacial diseases is aimed at providing a practical instrument for the oral healthcare management of SOT/HSCT recipients.

METHODS

Literature search was made through MEDLINE. The associations between orofacial diseases and SOT/HSCT were assessed using observational studies and case series and were classified into 'association', 'no association', and 'unclear association'.

RESULTS

Lip/oral cancers, drug-induced gingival overgrowth (DIGO), infections, including hairy leukoplakia and, less frequently, post-transplantation lymphoproliferative disorders (PTLDs) and oral lichenoid lesions of graft-versus-host disease (GVHD), were associated with SOT. Lip/oral cancers, GVHD, mucositis, DIGO, infections and, less frequently, PTLDs were associated with HSCT. Associations of orofacial granulomatosis-like lesions and oral mucosa-associated lymphoid tissue-type lymphoma with SOT, and of pyogenic granuloma and hairy leukoplakia with HSCT were unclear. Periodontal disease and dental caries were not associated with SOT/HSCT. For none of the local treatments was there a strong evidence of effectiveness.

CONCLUSIONS

Solid organ transplant/HSCT recipients are at risk of orofacial diseases. Adequate management of these patients alleviates local symptoms responsible for impaired eating, helps prevent systemic and lethal complications, and helps where dental healthcare has been neglected.

Caries-, Candida- and Candida antigen/antibody frequency in children after heart transplantation and children with congenital heart disease

The aim of this study was to determine the incidence of oral/intestinal Candida colonization and Candida-antigen/antibody in immunosuppressed children after HTx (group III, n = 31), in children with CHD (group II, n = 24) and in children with healthy hearts (comparison group, group I, n = 23) aged 2-16 yr according to their dental status between 2004 and 2007. Candida species in saliva, dental plaque, carious lesions and stool were detected with Sabouraud-/CHROMagar and Auxacolor system. Candida-specific-antigen/antibody assays were used for serological diagnosis. Dental status was determined on the basis of the DMF/dmf(T/t)-index. We found significant group differences in fecal Candida colonization (p = 0.027). In relation to dental status, oral Candida colonization increased within group III from 28.5% [DMF/dmf(T/t) = 0] to 66.7% [DMF/dmf(T/t) > or = 1] up to 100.0% [D/d(T/t) > or = 1], similar in groups I and II. Candida-mannan-antigen was determined to be positive in 16.1% (HTx), 5.5% (CHD) and 13.0% (comparison group). We show correlation between oral Candida colonization and (carious) dental status. We assume that high oral Candida and their descending/resorption through the gastrointestinal tract may lead to serologic Candida accumulation or rather candidiasis. Therefore, healthy oral cavity (especially before/after HTx) is an important precondition to prevent Candida infections.

Oral health status of children with congenital heart disease and the awareness, attitude and knowledge of their parents

The oral health status of children with congenital heart diseases and the parental awareness on maintaining good oral health and attitude towards preventive dental health measures were evaluated. A total of 170 children between the age group of 1-16 yrs belonging to both genders, with the history of congenital heart disease from Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram and Narayana Hrudayalaya Institute of Medical Sciences, Bangalore were examined. Oral lesions and caries experience were recorded using modified WHO oral health assessment form. Oral hygiene of the children with congenital heart disease was found to be poor with tongue coating (50.6%), plaque (41.8%), calculus (35.3%), and caries (42.4%). Parental awareness on the importance of maintaining good oral hygiene, preventive dentistry, medicinal decay and its systemic effects has been found to be very poor. Dentistry should give priority to patients whose general health may be put at risk by poor dental health. Closer cooperation between Pediatrician, Pediatric Cardiologists and Pediatric Dentists could help improve dental care for these children.

The impact of oral health on the quality of life of young patients with congenital cardiac disease

The purposes of our study were, first, to determine the prevalence of dental caries in young patients with congenital cardiac disease, second, to determine the effect of oral health in their quality of life, third, to examine parental knowledge about associations between oral health and cardiac health, and fourth, to examine parental perceptions regarding access to dental care. A standardized questionnaire was given to a convenience sample of parents of 43 children with cardiac disease and 43 healthy controls from 12 to 71 months of age. In every patient, we performed a dental examination. Descriptive statistics, the two-tailed t-test, and Fisher's exact test were used for statistical analysis. Of the children with cardiac disease, 17% had caries, compared to 13% of the control group. Almost half of those with cardiac disease had never seen a dentist, compared to 35% of the control subjects. Of the parents of those with cardiac disease, one-fifth did not know whether oral health was important for the heart, compared to one-tenth of controls. Insurance and access to care were not barriers to obtain dental treatment. Statistically significant differences were, first, parents of children with congenitally malformed hearts felt more guilt about their child's oral health than control parents (p = 0.026), second, they were more upset about the dental problems and/or treatments of their children (p = 0.012), and third, they thought that dental problems and/or dental treatment made their children more irritable (p = 0.012). Our findings indicate that it is of paramount importance that cardiologists and their associated staff educate patients and families about oral health and other issues associated with congenital cardiac disease.

A study on oral health of children with cardiac diseases in mashhad, iran in 2004

BACKGROUND AND AIMS

Preventing oral disease is the most desirable way of ensuring good dental health for children with heart disease. Dental and gingival infections in patients with cardiac problems may lead to infective endocarditis. The aim of this study was to evaluate oral and dental health status in children with heart disease referred to a cardiac center compared with the control group.

MATERIALS AND METHODS

In this descriptive cross-sectional study, case group consisting of 100 patients 2-12 years old with heart disease were examined for oral and dental status in Pediatric Cardiac Center in Mashhad, Iran, in 2004. Fifty healthy children with the same age as the case group referring to the Department of Pedodontics, Mashhad Faculty of Dentistry served as the control group. For each patient, dental and medical history, dmft, DMFT, debris index, tooth brushing status as well as parental knowledge of infective endocarditis and their economic status was registered on a questionnaire. Statistical analysis was performed using Kruskal-Wallis, chi-square and t-tests.

RESULTS

There were no significant differences between case and control groups in dmft (3.92 ± 3.99 and 3.54 ± 3.33, respectively), DMFT (3.7 ± 4 and 1.47 ± 1.72, respectively) and their components. Tooth brushing status and debris index were significantly worse in the study group (P = 0.001 and P = 0.008, respectively). 35% of parents were aware of the importance of good oral health in cardiac children although none of them knew about infective endocarditis. Most of the parents in study group had low (30%) to medium (53%) economic status.

CONCLUSION

In this study, the children with cardiac disease did not have a good oral and dental health status. Developing strategies toward preventive dental care of children with cardiac problems and informing their parents is suggested.

Necessity of surgical dental foci treatment prior to organ transplantation and heart valve replacement

Diagnosis and surgical treatment of septic foci (e.g., apical or marginal and profound periodontitis, cysts, unrestorable teeth, or abscesses) in patients awaiting organ transplants and heart valve replacement (HVR) have become a recommended, yet controversial standard procedure. This study aims to evaluate the numerical extent of the required oral surgical procedures removing septic foci in these patients. Data of 204 patients (115 males/89 females) of the Department of Oral- and Maxillofacial Surgery with an average age of 58 years were evaluated in terms of necessary oral surgical procedures before HVR or kidney (K), heart (H), or liver (L) transplant (T) and were compared with data from patients not undergoing transplantation or HVR, who were referred for other reasons such as oral surgery. The number of tooth extractions or apicoectomies per patient averaged two to five for each of the four patient groups (KT, 0-7 affected teeth; HT, 0-5; LT, 1-5; and HVR, 1-10). Treatment of periodontitis was necessary in 64% of patients. A total of 70% of patients required oral surgical procedures before HT, LT, and HVR, while 84% needed before KT. Removal of oral septic foci is necessary to avoid jeopardizing the success of transplantations. With regard to the surprisingly high need for surgical treatment in this patient population, assessment of these patients by the appropriate specialist and continuation with a follow-up program is still highly recommended.

Concomitant oral findings in children after cardiac transplant

Heart transplantations have been performed in the Centre for Paediatric Heart Surgery at the Justus Liebig University in Giessen (Germany) since 1988. For further consultation and therapy, some affected children subsequently present at the Polyclinic for Paediatric Dentistry. In all these cases problematic oral findings were diagnosed. It was the aim of this study to describe the different findings and to create a concept for avoiding them in the future. Altogether, 10 children with cardiac transplants (three girls, seven boys) were examined and, where necessary, treated. At the time they first presented, they were between 23 and 119 months old (average = 72.2) and had all been operated on (organ transplant) in the first 6 months of life. Each child showed evidence of gingival hyperplasia in the area of the front teeth, which was because of ongoing immunosuppression. In three patients, reactive mucosal caps avoided the age-related penetration of a permanent incisor in the upper jaw. In addition, the primary teeth of six children were affected by caries; in two of these cases, the damage was because of the nursing-bottle syndrome. The results show that any infant with cardiac transplant has to be subjected to careful dental examination and offered comprehensive medical care in cooperation with the competent centre for child cardiac surgery. Furthermore, the parents of such children should be informed prior to transplantation about the possibility of subsequent findings and how these findings can be either avoided or, if necessary, adequately treated.