Dental disease, caries related microflora and salivary IgA of children with severe congenital cardiac disease: an epidemiological and oral microbial survey.

The objectives were to determine levels of dental caries, plaque accumulation, gingival inflammation, knowledge of dental health practices, and oral bacterial loading of S. mutans, Lactobacillus sp., Candida sp., and salivary IgA in the mouths of children afflicted with severe congenital heart disease. A total of 60 children from the cardiac units of the Hospital for Sick Children and Guys Hospital Paediatric Department were compared with 60 case-matched control children from the Department of Orthodontics and Paediatric Dentistry, UMDS (Guys Dental School), London. Using the methodology of the World Health Organization, the decayed, missing and filled surfaces and teeth of primary (dmft) and permanent (DMFT) were compared. There were similar levels of caries in the cardiac (dmft 3.9 and DMFT 2.7) and the control (dmft 3.7 and DMFT 2.0). A significant difference was the proportion of untreated carious lesions in the cardiac group (52%) compared to the control group (32%; P < 0.001). Standard oral microbiological techniques were used to isolate S. mutans, Lactobacillus sp., Candida sp., and conventional methods for estimating salivary IgA. There was no difference between the cardiac and the control group. Children with severe congenital cardiac disease have moderately high levels of dental caries with a significantly greater amount of untreated disease. The high bacterial loading associated with high levels of bacterial dental plaque and gingivitis may put cardiac patients at unnecessary risk of developing bacterial endocarditis.