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Scripta Scientifica Medicinae Dentalis

Prevalence of dental decay among children suffering from congenital heart diseases

Teodora Nikolova, Radosveta Andreeva


Introduction: In general, dental decay and periodontal diseases have low mortality, but both have high levels of distribution and are responsible for pain in the oral cavity region, loss of teeth, and represent risk factors for other systemic complications, especially among children.

Aim: The aim of this article is to assess dental decay prevalence in a group of children with congenital heart diseases (CHDs) and to compare it with the same indicator in a group of healthy, age- and gender-matched controls.

Materials and Methods: Subject of monitoring of the prospective clinical research are 100 children from Varna region. Half of them (n=50) were diagnosed with CHDs and the other half (n=50) were healthy controls. Both groups were also divided into two age groups: from 4 to 7 years of age (n CHDs = 25; n Ctr. = 25) and from 8 to 17 years of age (n CHDs = 25; n Ctr. = 25). The dental status was examined and registered according to WHO, using the dmft/DMFT index. Possible risk factors for dental caries development were also registered.

Results: Children with CHDs had statistically significant higher mean values of dmft/DMFT indices than healthy controls (age group 4-7 years: 5.5±3.2 vs. 4.3±1.2; age group 8-17 years: 5.6±2.9 vs. 3.6±2.3). The registered fillings among patients with CHDs were scarce. A total of 71% of patients with CHDs were subjected to regular oral medications intake due to the main chronic disease. Children with heart anomalies were mainly of low socio-economic status and had not received more intensive dental prophylaxis than healthy controls. A total of 98% of all examined patients (n=100) were affected by dental decay (dmft/DMFT > 0).


Conclusion:  The findings from this research clearly show that the group of children with CHDs are more severely affected by dental decay than the control group of healthy children. Children with CHDs are at disadvantage, because the development of oral diseases in these patients may affect their overall medical condition. Prolonged oral pharmacotherapy and low socio-economic status, which affect oral health, are possible risk factors for dental decay development in these medically compromised children.


congenital heart disease (CHD); DMFT; pediatric dentistry; risk factors

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Shivachev P, Marinov L, Varbanova B et al. Structure of Neonatal Heart Pathology in the Region of Varna for the last 17 years. First national neonatal congress. 12-14.10.2006, Sofia; Summaries:41-2. (in Bulgarian).

Shivachev P, Marinov L, Tzonzarova M, Lazarov S, Mitev P. Postoperative mortality rates and risk factors in patients with critical congenital heart defects. Paediatrics. 2013; 53(4):21-5. (in Bulgarian).

Ali HM, Mustafa M, Hasabalrasol S, Elshazali OH, Nasir EF, Ali RW, et al. Presence of plaque, gingivitis and caries in Sudanese children with congenital heart defects. Clin Oral Investig. 2017; 21(4): 1299–307. doi: 10.1007/s00784-016-1884-2.

Ali HM, Mustafa M, Nasir EF, Lie SA, Hasabalrasol S, Elshazali OH, et al. Oral-health-related background factors and dental service utilisation among Sudanese children with and without a congenital heart defects. BMC Oral Health. 2016; 16(1): 123. doi: 10.1186/s12903-016-0318-5

Busuttil Naudi A, Mooney G, El-Bahannasawy E, Vincent C, Wadhwa E, Robinson D, et al. The dental health and preventative habits of cardiac patients attending the Royal Hospital for Sick Children Glasgow. Eur Arch Paediatr Dent. 2006;7(1):23–30.

Garrocho-Rangel A, Echavarría-García A, Rosales-Bérber M, Flores-Velázquez J, Pozos-Guillén A. Dental management of pediatric patients affected by pulmonary atresia with ventricular septal defect: A scoping review. Med Oral Patol Oral Cir Bucal. 2017; 22(4): e458–e466.

Hayes PA, Fasules J. Dental screening of pediatric cardiac surgical patients. ASDC J Dent Child. 2001;68(4):255-8, 288-9.

Sun RR, Liu M, Lu L, Zheng Y, Zhang P. Congenital heart disease: Causes, diagnosis, symptoms, and treatments. Cell Biochem Biophys. 2015;72(3):857-60. doi: 10.1007/s12013-015-0551-6.

The National Board of Health and Welfare (Socialstyrelsen). Nationella riktlinjer for hjartsjukvard 2008 (In Swedish). Socialstyrelsens publikationer. 2008; artikelnummer 2008:102-7.

NIH (2014) National Heart, Lung and Blood Institute, USA. How are congenital heart defects treated? Available at:

Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O'Connell J, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93(5):841-2.

Pomarico L, Czauski G, Portela MB, de Souza IP, Kneipp L, de Araujo Soares RM, et al. Cariogenic and erosive potential of the medication used by HIV-infected children: pH and sugar concentration. Community Dent Health. 2008;25(3):170-2.

O'Sullivan EA, Curzon ME. Salivary factors affecting dental erosion in children. Caries Res. 2000; 34(1):82-7. doi: 10.1159/000016574.

Nederfors T, Isaksson R, Mornstad H, Dahlof C. Prevalence of perceived symptoms of dry mouth in an adult Swedish population-relation to age, sex and pharmacotherapy. Community Dent Oral Epidemiol. 1997;25(3):211-6.

Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth. Gerodontology. 1986;5(2):75-99.

Berger EN. Attitudes and preventive dental health behaviour in children with congenital cardiac disease. Aust Dent J. 1978;23(1):87-90.

Franco E, Saunders CP, Roberts GJ, Suwanprasit A. Dental disease, caries related microflora and salivary IgA of children with severe congenital cardiac disease: an epidemiological and oral microbial survey. Pediatr Dent. 1996;18(3):228-35.

Hallett KB, Radford DJ, Seow WK. Oral health of children with congenital cardiac diseases: a controlled study. Pediatr Dent. 1992;14(4):224-30.

Pollard MA, Curzon ME. Dental health and salivary Streptococcus mutans levels in a group of children with heart defects. Int J Paediatr Dent. 1992; 2(2):81-5.

Tasioula V, Balmer R, Parsons J. Dental health and treatment in a group of children with congenital heart disease. Pediatr Dent. 2008;30(4):323-8.

Sivertsen TB, Asmus J, Greve G, Åstrøm AN, Skeie MS. Oral health among children with congenital heart defects in Western Norway. Eur Arch Paediatr Dent. 2016 t;17(5):397-406. doi: 10.1007/s40368-016-0243-y.

Larmas M. Has dental caries prevalence some connection with caries index values in adults? Caries Res. 2010;44(1):81-4. doi: 10.1159/000279327.

Cappelli DP, Mobley CC. Prevention in Clinical Oral Health Care. St. Louis, MO. Mosby Elsevier. 2008.

Peneva M, Rashkova M, Doychinova L. Epidemiology of dental decay among children with different diagnostic baseline. Problems Dent Med. 2007; 23:37-46. (in Bulgarian).



About The Authors

Teodora Nikolova
Medical University of Varna

Department of Pediatric Dental Medicine, Faculty of Dental Medicine

Radosveta Andreeva
Medical University of Varna

Department of Pediatric Dental Medicine, Faculty of Dental Medicine

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