Abstract
The Paediatric Congenital Heart Disease Standards and Specifications (PCHDSS) were published in May 2016 by NHS England. The standards describe in detail the cardiac care patients should expect in England. They are also the first cardiology standards to include an oral health section. The dental standards outline what oral health care patients should receive from both cardiology and dental healthcare professionals, with immediate effect. Children with congenital heart disease (CHD) are at increased risk of infective endocarditis and often have poorer oral health compared to healthy children. Children with cardiac disease can be complex to manage appropriately due to their increased dental anxiety and reduced access to dental care. The PCHDSS dental section highlights the importance of collaborative working between cardiology, primary care and paediatric dentistry. This should ensure preventive advice is delivered regularly, oral disease diagnosed early and patients managed or referred appropriately. This article will summarise CHD, the PCHDSS, its implications and discuss the oral health of children with a cardiac defect. The importance of treatment planning and dental management for this high risk group, in addition to informing readers when to refer to specialist care will also be described.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
NHS England. Paediatric Congenital Heart Disease Standards & Specifications. 2016. Available at https://www.england.nhs.uk/wp-content/uploads/2018/08/Congenitalheartdiseasestandardsand-specifications.pdf(accessed February 2019).
National Institute for Health and Care Excellence. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures. 2008. Available at https://www.nice.org.uk/guidance/cg64(accessed February 2019).
Dayer M J, Jones S, Prendergast B, Baddour L M, Lockhart P B, Thornhill M H. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet 2015; 385: 1219-1228.
National Heart, Lung and Blood Institute. What Are Congenital Heart Defects? 2019. Available at https://www.nhlbi.nih.gov/health-topics/congenitalheartdefects (accessed February 2019).
British Isles Network of Congenital Anomaly Registers. Congenital Anomaly Statistics 2011: England and Wales. 2013.Available athttp://www.binocar.org/content/annual%20report%202011_final_040913.pdf(accessed February 2019).
Knowles R L, Bull C, Wren C, Dezateux C. Mortality with congenital heart defects in England and Wales, 1959-2009: exploring technological change through period and birth cohort analysis. Archives of disease in childhood. Arch Dis Child 2012; 97: 861-865.
Thiene G, Frescura C. Anatomical and pathophysiological classification of congenital heart disease. Cardiovasc Pathol 2010; 19: 259-274.
Tynan M J, Becker A E, Macartney F J, Jimenez M Q, Shinebourne E A, Anderson R H. Nomenclature and classification of congenital heart disease. Br Heart J 1979; 41: 544-553.
Hoffman J I, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890-1900.
Reller M D, Strickland M J, Riehle-Colarusso T, Mahle W T, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr 2008; 153: 807-813.
National Institute for Cardiovascular Outcomes Research. Antenatal diagnosis. 2018. Available at https://nicor4.nicor.org.uk/chd/an_paeds.nsf/vwContent/home?Opendocument(accessed February 2019).
Botto L D, May K, Fernhoff P M et al. A population-based study of the 22q11.2 deletion: phenotype, incidence, and contribution to major birth defects in the population. Paediatrics. 2003; 112: 101-107.
Pierpont M E, Basson C T, Benson D W et al. Genetic basis for congenital heart defects: current knowledge: a scientific statement from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Paediatrics. Circulation 2007; 115: 3015-3018.
Levy H L, Guldberg P, GĂĽttler F et al. Congenital heart disease in maternal phenylketonuria: report from the Maternal PKU Collaborative Study. Pediatr Res 2001; 49: 636-642.
Wren C, Birrell G, Hawthorne G. Cardiovascular malformations in infants of diabetic mothers. Heart 2003; 89: 1217-1220.
Samrén E B, van Duijn C M, Christiaens G C, Hofman A, Lindhout D. Antiepileptic drug regimens and major congenital abnormalities in the offspring. Ann Neurol 1999; 46: 739-746.
Lammer E J, Chen D T, Hoar R Met al. Retinoic acid embryopathy. N Engl J Med 1985; 313: 837-841.
Ofori B, Oraichi D, Blais L, Rey E, Bérard A. Risk of congenital anomalies in pregnant users of non-steroidal anti-inflammatory drugs: a nested case-control study. Birth Defects Res B Dev Reprod Toxicol 2006; 77: 268-279.
Cooper W O, Hernandez-Diaz S, Arbogast P G et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354: 2443-2451.
MartĂnez-FrĂas M L, Bermejo E, RodrĂguez-Pinilla E, FrĂas J L. Risk for congenital anomalies associated with different sporadic and daily doses of alcohol consumption during pregnancy: a case-control study. Birth Defects Res A Clin Mol Teratol 2004; 70: 194-200.
Werdan K, Dietz S, Löffler B et al. Mechanisms of infective endocarditis: pathogen-host interaction and risk states. Nat Rev Cardiol 2014; 11: 35-50.
Valente A M, Jain R, Scheurer M et al. Frequency of infective endocarditis among infants and children with Staphylococcus aureus bacteraemia. Paediatrics 2005; 115: e15-e19.
Saiman L, Prince A, Gersony W M. Paediatric infective endocarditis in the modern era. J Pediatr 1993; 122: 847-853.
Day M D, Gauvreau K, Shulman S, Newburger J W. Characteristics of children hospitalized with infective endocarditis. Circulation 2009; 119: 865-870.
Baltimore R S, Gewitz M, Baddour L M et al. Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation 2015; 132: 1487-1515.
Que Y A, Moreillon P.Infective endocarditis.Nat Rev Cardiol 2011; 8: 322-336.
Lockhart P B, Brennan M T, Kent M L, Norton H J, Weinrib D A. Impact of amoxicillin prophylaxis on the incidence, nature, and duration of bacteraemia in children after intubation and dental procedures. Circulation 2004; 109: 2878-2884.
Roberts G J. Dentists are innocent! "Everyday" bacteraemia is the real culprit: a review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children. Pediatr Cardiol 1999; 20: 317-325.
Lockhart P B, Brennan M T, Thornhill M et al. Poor oral hygiene as a risk factor for infective endocarditis-related bacteraemia. J Am Dent Assoc 2009; 140: 1238-1244.
Habib G, Lancellotti P, Antunes M J et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128.
Wilson W, Taubert K A, Gewitz M et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anaesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 1736-1754.
Hallett K B, Radford D J, Seow W K. Oral health of children with congenital cardiac diseases: a controlled study. Pediatr Dent 1992; 14: 224-230.
Stecksén-Blicks C, Rydberg A, Nyman L, Asplund S, Svanberg C. Dental caries experience in children with congenital heart disease: a case-control study. Int J Paediatr Dent 2004; 14: 94-100.
Balmer R, Bu'Lock F A. The experiences with oral health and dental prevention of children with congenital heart disease. Cardiol Young 2003; 13: 439-443.
Tasioula V, Balmer R, Parsons J. Dental health and treatment in a group of children with congenital heart disease. Pediatr Dent 2008; 30: 323-328.
Hollis A, Willcoxson F, Balmer R. Parental knowledge of infective endocarditis risk status at a cardiac clinic. Int J Paediatr Dent 2012; 22 (Spec Iss): 27-28.
Balmer R, Booras G, Parsons J. The oral health of children considered very high risk for infective endocarditis. Int J Paediatr Dent 2010; 20: 173-178.
Parry J A, Khan F A. Provision of dental care for medically compromised children in the UK by general dental practitioners. Int J Paediatr Dent 2000; 10: 322-327.
Hollis A, Willcoxson F, Smith A, Balmer R. An investigation into dental anxiety among paediatric cardiology patients. Int J Paediatr Dent 2015; 25: 183-190.
The Supreme Court. Montgomery v Lanarkshire Health Board Scotland. 2015. Available at https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0136_Judgment.pdf(accessed February 2019).
Scottish Dental Clinical Effectiveness Programme. Antibiotic Prophylaxis Against Infective Endocarditis: Implementation Advice. 2018. Available at http://www.sdcep.org.uk/wp-content/uploads/2018/08/SDCEPAntibioticProphylaxisImplementationAdvice.pdf (accessed February 2019).
Leeds Congenital Hearts. Dental care in children at risk of Infective Endocarditis. 2019. Available at http://leedscongenitalhearts.com/sections/view/59/preventionandtreatmentofendocarditis (accessed February 2019).
Roberts G J, Holzel H S, Sury M R, Simmons N A, Gardner P, Longhurst P. Dental bacteraemia in children. Pediatr Cardiol 1997; 18: 24-27.
Thornhill M H, Dayer M J, Forde J M et al. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. BMJ 2011; 342: d2392.
Horner K, Eaton K (eds). Selection Criteria for Dental Radiography. 3rd ed.London: Faculty of General Dental Practice (UK), 2013.
Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 2014. Available at https://www.gov.uk/government/publications/deliveringbetteroralhealthanevidencebasedtoolkitfor-prevention(accessed February 2019).
Scottish Dental Clinical Effectiveness Programme. Prevention and Management of Dental Caries in Children: Dental Clinical Guidance. 2010. Available at http://www.sdcep.org.uk/wp-content/uploads/2013/03/SDCEP_PM_Dental_Caries_Full_Guidance1.pdf(accessed February 2019).
Innes N P, Manton D J. Minimum intervention children's dentistry-the starting point for a lifetime of oral health. Br Dent J 2017; 223: 205-213.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hughes, S., Balmer, R., Moffat, M. et al. The dental management of children with congenital heart disease following the publication of Paediatric Congenital Heart Disease Standards and Specifications. Br Dent J 226, 447–452 (2019). https://doi.org/10.1038/s41415-019-0094-0
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41415-019-0094-0
This article is cited by
-
Oral findings in paediatric patients with severe heart, liver, and kidney failure prior to organ transplantation
European Archives of Paediatric Dentistry (2024)
-
Evaluation of UK paediatric nephrology teams’ understanding, experience and perceptions of oral health outcomes and accessibility to dental care: a mixed-methods study
Pediatric Nephrology (2024)
-
Prevalence of dental caries in children with congenital heart disease
BMC Pediatrics (2022)
-
Behaviour management problems in Finnish children with operated congenital heart disease: a practice-based study
European Archives of Paediatric Dentistry (2022)


