Awareness of oral health in adults with congenital heart disease.

BACKGROUND: Poor oral health is known to be a risk factor for infective endocarditis (IE) and acquired cardiovascular disease. Many patients with congenital heart disease (CHD) are at risk for developing IE. Excellent oral health is deemed essential to prevent IE, a potentially life-threatening condition, and therefore is important in adults with congenital heart defects (ACHD). As data on oral heath in ACHD are scarce, the current study aims to assess the prevalence of caries among ACHD and the knowledge of patients about oral health as a risk factor for IE and cardiovascular disease. METHODS: A cross-sectional study included ACHD who subsequently presented at the German Heart Center Munich. The participants completed a questionnaire assessing oral health and risk awareness. Additionally, as an indicator of caries prevalence, a dentist documented the DMFT index (sum of decayed, missing and filled teeth). RESULTS: The median age of the 112 participants was 31.5 (range, 18-77) years. Forty-three patients (38%) were unaware of a correlation between oral health and heart disease. Twelve participants (11%) did not know about poor oral health being a risk factor for cardiovascular diseases. Less than half of the surveyed patients knew the term endocarditis. An additional twelve patients (11%) reported caveats against dental treatment because of their CHD. In twenty-three patients (21%), caries was found at the dentine level. The mean DMFT index, representing caries prevalence, was 7.91 (±6.54). There was no correlation between the Bethesda criteria of CHD and the DMFT index (P=0.69). The DMFT index was higher in patients at high risk for IE (P<0.01). However, this difference in the caries score was mainly due to more extracted and filled teeth in the high-risk patients for IE, whereas the number of decayed teeth did not differ significantly (P=0.09). CONCLUSIONS: The awareness of the importance of optimized oral health in ACHD needs to be improved.

Oral Health in Adults with Congenital Heart Disease.

Oral bacteria and odontogenic oral infections are responsible for a high portion of cases with infective endocarditis. Hence, oral health in patients with congenital heart disease (CHD) gains particular importance. This case-control study compared the oral health status in 112 adults with CHD and 168 healthy control subjects. In addition, the patient group was stratified according to the complexity of the heart defect and the recommendation for antibiotic prophylaxis during invasive dental procedures. Considering caries experience, a significantly lower mean DMFT (decayed missing filled teeth) score (7.91 ± 6.63 vs. 13.6 ± 8.15; p < 0.0001) was found in patients with CHD compared to healthy controls. Healthy controls had a higher average number of decayed teeth (0.33 ± 0.76 vs. 1.76 ± 2.61; p < 0.0001). In female subjects a significant lower relative amount of teeth with apical periodontitis was found among CHD patients (3.4% ± 0.9%) as compared to healthy controls (5.6% ± 1.9%) (p = 0.053). Regarding periodontal health, patients with CHD had lower rate of sulcus bleeding (0.32 ± 0.65 vs. 0.71 ± 0.60; p < 0.0001) and less alveolar bone loss than heart healthy individuals (% root length: multi rooted teeth: 8.97 ± 10.64 vs. 23.22 ± 20.70; p < 0.0001; single rooted teeth: 5.59 ± 6.25 vs. 17.30 ± 17.17; p = 0.003). On the contrary, CHD patients presented with higher amount of plaque in comparison to healthy controls (Quigley & Hein index: 2.22 ± 0.67 vs. 1.25 ± 0.72; p < 0.0001). Based on the current results, it can be concluded that adults with CHD have better oral health than heart healthy individuals.