Dental treatment implications Since congenital cardiac defects are the most commonly encountered malformation, and since improvements in treatment have meant that the number of patients with these conditions is growing, it is important for members of the dental healthcare team to understand the impact of these conditions on a patient’s oral health (Sethi et al., 2022). Creating and maintaining oral health for this patient population is critical in preventing complications in the management of the patient’s medical condition. It has been Infective endocarditis Infective endocarditis (IE), also called bacterial endocarditis , is an infection of the endocardial surface of the heart, which may include the heart valves, the mural endocardium, or a septal defect. This condition may occur where there is turbulent blood flow in and around areas of the heart that have received either congenital or acquired damage. The turbulent flow of blood causes platelet adhesion, fibrin deposition, and vegetative bacterial growth, leading to a bacterial infection of the endocardial surface. These vegetations can also form an embolism and travel throughout the bloodstream (Rezar et al., 2021). Pediatric patients with some unrepaired CHDs present a high risk for IE. Significant causative agents for IE include Streptococcus mutans, S. sanguis , and S. mitis , which are
demonstrated that pediatric patients with untreated cardiac anomalies have a higher incidence of neurodevelopmental impairment compared with their unaffected peers (Delgado et al., 2022). This fact, combined with the stress of medical and surgical treatment for their primary condition, can significantly increase the risk of developing caries and other oral health problems, resulting in a further decline in the patient’s quality of life (Sethi et al., 2022). common oral bacteria (Lockhart et al., 2023). Therefore, it is important for a patient who is identified with a CHD to seek early referral to an oral healthcare provider for treatment of caries and periodontal disease. Certain CHDs are associated with endocarditis more often than others. In 2021, based on strong evidence, the AHA revised the guidelines for the prophylaxis of infective endocarditis (Thornhill et al., 2022). (See Tables 1 and 2.) Only patients at the highest risk of developing IE are recommended for prophylaxis; these high-risk patients include people with a prosthetic heart valve, an unrepaired cyanotic CHD, a repaired CHD for which a prosthetic material or device was used, and patients who have already experienced IE.
Table 1: Guidelines for the Prophylaxis of Infective Endocarditis
Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Infective Endocarditis
Prophylaxis for these casrdiac patients is recommended for procedures marked with √. Manipulation of gingival tissue √ √ √ √
√ √ √
√ √ √
√ √
√ √
√ √
√ √
Manipulation of the periapical region of teeth
Perforation of the oral mucosa
Prophylaxis for these casrdiac patients is not needed for procedures marked with X. Routine anesthetic injections thorugh noninfected tissue X X X X
X
X
Taking dental radiographs
X
X
X
X
X
X
Placement of removable prosthodontic or orthodontic appliances Adjustment of orthodontic appliances or placement of orthodontic brackets
X
X
X
X
X
X
X
X
X
X
X
X
Shedding of primary teeth
X
X
X
X
X
X
Bleeding from trauma to the lips or oral mucosa
X
X
X
X
X
X
* Except for these conditions, antibiotic prophylaxis is no longer recommended for any other form of CHD. Note . Adapted from: Thornhill M, et al. Antibiotic prophylaxis against infective endocarditis before invasive dental procedures. J AM Coll Cardiol . 2022 Sep 13;80(11):1029-1041.
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