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 Children's Health

April 2010
Pay Attention to Your Child’s Oral Hygiene
Dr Dhritabrata Das
You Could Be Saving Her From Heart Trouble!

Sohini* has been down with fever since the last two weeks. The family physician even got a blood report and a chest X-ray taken. They looked normal, but the girl continued to look ill. A switch in antibiotics did not help. Sohini had to be admitted to hospital.

There was a hole in between the two lower chambers of the heart
of this seven-year old, a condition called Ventricular Septal Defect (VSD). The echocardiogram showed infection inside the heart, which was serious - and could be fatal - if not aggressively managed.

Sohini’s heart infection had probably come from her teeth!
This was a medically known as infective endocarditis, her shattered parents were told. Mahesh* and Deepika* work in an MNC’s call centre and depended on a maid to care for Sohini. They never knew that their darling little one had cavities in her teeth, which resulted in such a serious condition.

Oral hygiene is of utmost importance for children with structural heart defects.
Eight out of every 1000 babies are born with some kind of heart defect, and these children need more oral care than normal ones.
* Name changed to protect privacy

6 Dos for Children with Heart Defects
  • If your child has any type of heart defect (hole in the heart, abnormal circulation route, valve defects, etc.) he/she will need special dental care. This is also true for those treated with patch, conduit, artificial valve, stents and devices, for the first six months after treatment.
  • Make a healthy oral hygiene routine from the very beginning, even before the teeth start to emerge. Cleaning of gums and tongue is also important because they are a source of germs too. Ask your paediatrician for guidance.
  • Even for children with healthy teeth, an annual dental visit should form an essential part of the health routine. 
  • Teeth cavities, if any, should be detected early and corrective treatment should be initiated. A number of conservative methods of cavity management are currently available. 
  • Before any dental procedure, consult with your child’s cardiologist. Inform the child’s condition to your dentist and if antibiotic is prescribed, please ensure that the course is completed.
  • As your child grows up, explain the importance of good oral health to him/her and entrust the responsibility to maintain his/her dental health.
Most congenital heart defects can be treated very successfully today and children can enjoy a normal, active playful life, growing up just like any other child. With a little vigilance and awareness of dental health, you can watch their heart smile too.

Brushing and Cleaning Away the Infective Bacteria
More than 700 different types of bacteria have been found in the mouth cavity. Activities like chewing food, brushing the teeth or having a tooth extracted expose the bacteria to the bloodstream. But the risk of infection is enhanced when the teeth and tissues around them are not healthy.

So, avoiding dental disease becomes even more important for children who have a heart problem, as this can lead to infection inside the heart. In such children, procedures like dental extraction need appropriate antibiotic coverage immediately before and after the procedure.

In any case, risk of exposure to bacteria in the bloodstream is unavoidable, because it happens even when we are simply talking. So, maintaining good oral hygiene can make a big difference for those who have natural tendency to develop infection in the heart, because of structural problems inside.

Care for your child’s teeth from the time they first appear, as they can be affected by tooth decay. After each feed, wipe your baby’s teeth and gums with a clean, damp washcloth or a gauze pad. Clean the tongue as well.

Don’t let your baby fall asleep with the bottle in her mouth. Baby bottle decay is caused over time by frequent exposure to liquids containing sugar. These include milk, ‘formula’, and fruit juices. The sugary liquids pool around the teeth for long periods of time as your baby sleeps, leading to cavities that first develop in the upper and lower front teeth. Try giving your baby a bottle filled with water at naptime. If you breast-feed, avoid letting the baby nurse continuously.
Dr. Dhritabrata Das is Consultant Paediatric Cardiologist at Apollo Gleneagles Hospital, Kolkata

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