Dental Care for Children and Adults with Heart Problems and Down's Syndrome

Why is dental care important?

Everyone has bacteria in their mouth which can enter the bloodstream, but in someone with a heart defect they can cause an infection inside the heart (Endocarditis) which in some cases can prove fatal. Anyone who has a congenital heart defect (a hole, abnormal valve or blood vessel) is at risk of getting Endocarditis if they have tooth decay or gum inflammation, so good dental care should be a priority. Even those who have had corrective surgery may be at risk so it is important to listen to any advice given by the cardiologist, particularly in relation to the use of antibiotic cover for dental treatments.

How can Endocarditis be prevented?

Endocarditis can be prevented by keeping a clean healthy mouth and taking action to prevent tooth decay as well as taking precautions such as taking antibiotics prior to some types of dental and medical treatments.

Antibiotic Cover
It is generally recommended that those at risk from Endocarditis should be given antibiotic cover before the following procedures are carried out:

• Extractions
• Fillings that touch the gum margin
• Gum Surgery
• Scale and Polish

Nerve treatment of baby teeth (root canal therapy), should not be undertaken, if the decay affects the nerve, then the tooth should be taken out. However it is sometimes acceptable in permanent teeth if carried out in a single visit under antibiotic cover, but if there is any risk of infection, the tooth should be taken out.

When baby teeth become loose and fall out naturally there is no need for antibiotics.

Accidents involving the mouth  It is not uncommon for children to have accidents which result in minor injuries to the mouth and teeth which will not require any treatment. However it is always best to check with your dentist or GP about any such injury, even if you think treatment is not required, as antibiotic cover may be recommended.

Preventing Tooth Decay

• Diet is an important factor in preventing tooth decay and it is a good idea to encourage a healthy and balanced diet with reduced sugars from an early age. When sugar is eaten, bacteria in the mouth turn it into acid and if this acid is present in the mouth for long periods it breaks down the tooth enamel and decay begins. It is best to avoid sweets and sugary foods between meals, but if they are given it is preferable if it is straight after a meal and then if possible brush the teeth with fluoride toothpaste to help neutralise the acid
• Fluoride is absorbed into the enamel of the teeth helping strengthen them. It can be given as toothpaste, tablets, drops, mouthwash, gel or in the water (you may need to ask your dentist if the water in your area is fluoridated.) As the adult teeth are already forming long before eruption, some dentists may recommend fluoride drops from as early as 6 months of age.
• Fissure sealants are plastic coatings which can be used by the dentist to coat the biting surfaces of the permanent molars, thus blocking the deep fissures where decay often starts and making the teeth easier to clean. It is important that fissure sealants are applied as soon as the permanent molars erupt before any decay can begin
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