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Dental Care

Good dental hygiene is extremely important for children with single ventricle heart conditions. The reason it is even more important for these children is that they are at an increased risk of something called Endocarditis (a very serious infection of the inner lining of the heart), which is explained below. Always tell your dentist about your child's heart condition and any medications he or she takes, especially anticoagulants such as Warfarin or Aspirin.

What is Endocarditis?

We all have small bugs that live in our mouths and on our skin; they cause us no harm at all until we get a bad or broken tooth, or a skin injury which becomes infected. For most of us, this would mean a course of antibiotics and we would then be fine, but if you have congenital heart disease it can be more serious.

The bugs that infect our mouths can get into the blood stream and attach to the areas in the heart where surgery has been performed. The bugs then grow and cause the heart to become infected; this is called infective Endocarditis. If this should happen the only way to cure the infection is a four to six-week course of intravenous antibiotics or anti-fungal therapy. If it goes untreated your child would become sicker and sicker. Skin infections would need to be treated equally swiftly.

How should I look after my child's teeth?

Ask your dentist if you would like any extra advice about looking after your child's teeth. The ideas below should help, as the best approach is to try to prevent any infections from happening.

Dental Hygiene

• All heart patients should visit the dentist as often as is suggested by them. These routine check-ups should continue even when another specialist such as an orthodontist is involved.

• From the first signs of tooth growth children should brush their teeth twice a day, using an age-appropriate toothbrush. Children up to the age of eight may need adult help with brushing.

• Use a small smear of a fluoride toothpaste. Ask your dentist whether fluoride supplements (eg drops) or a high fluoride toothpaste would be beneficial for your child in the area where you live.

• Special sealants called fissure sealants can sometimes be applied to the biting surfaces of the back adult teeth (six-year molars onwards). Your dentist will advise whether this is suitable for your child. It can help keep them clean and free from decay, but it is not a subsititute for following good dental hygience advice.

Diet

• Snacks should be healthy: cheese, milk and raw vegetables. Children with single ventricle hearts often need extra calories in their diet, so nutritious snacks should be planned as part of your child's day eg three meals plus two or three snacks, instead of constant 'grazing' which is bad for teeth.

• Sweet drinks including squash and fruit juices, sweets and fruit should be limited to immediately after meals just before the children clean their teeth.

• Water and plain milk are the best drinks for teeth, however many children with single ventricle hearts will have calorie supplements in milk or juice (or high-calorie milk) at some point as babies or children, which means that extra care will be needed with teeth cleaning.

• Request sugar-free medicines on your child's repeat prescriptions - this is sometimes abbreviated to 'SF'. If your child can manage tablets instead of liquid medicines, this may be helpful from a dental point of view.

Antibiotic cover during dental treatment

• For some children with single ventricle heart conditions, antibiotics may need to be prescribed if any dental treatment is necessary. See note. There is no need to give antibiotics when baby teeth fall out, as this is a natural process with no risk to the child.

• Oral piercing should be avoided at all cost. It is very likely to cause nasty infections even in otherwise healthy people.

Do cardiac medications have any impact on dental care?

Most children with single ventricle heart conditions take anticoagulants such as Warfarin or Aspirin. As these medications make it more difficult for blood to clot, some dental procedures, such as having a tooth removed, could cause more bleeding than in another child.

Remind your dentist about these medications before any dental treatment begins. He or she might ask for your child to have an extra blood test a few days before the procedure. If you have a home testing kit (CoaguChek machine), it would be really helpful to your dentist if you can take an INR reading on the morning of the procedure.