Early Counseling to Improve Oral Health Behavior in Children with Major Congenital Heart Defects: A Randomized Controlled Trial.

Maintaining optimal oral health behavior in children with a congenital heart defect (CHD) is important in managing the risk for caries development and infective endocarditis. The aim of this study was to evaluate the impact of an early and repeat oral health promotion intervention (OHPI) among children with major CHD. Randomized controlled trial including 72 out of 91 children born in Finland April 1, 2017-October 31, 2020 with (a) major CHD potentially included in the criteria of endocarditis prophylaxis or (b) any CHD with surgical repair combined with a chromosomal syndrome. A parallel passive control (C) group of 87 healthy children were recruited at birth. CHD children were randomized 1:1 to intervention (CHD-I) and control (CHD-C) groups. The OHPI included counseling by motivational interviewing, home delivered toothpaste and toothbrushes, and written information, and was provided at baseline, 6, 12, and 18 months of age to CHD-I group. The primary outcome measure at 24 months was child's oral health behavior (toothbrushing, sugar intake, and dental care contact). The secondary outcome measures were parents' awareness of the importance of oral health behavior, and oral health behavior as a predictor for child behavior. At 24 months, toothbrushing was performed twice a day in 20/27 (74%) among CHD-I, in 13/30 (43%) among CHD-C (CHD-I vs. CHD-C p = 0.03), and in 37/50 (74%) among healthy comparisons (CHD-C vs. C p = 0.01). Electric toothbrush use was 12/27 (44%) in CHD-I, 5/30 (17%) in CHD-C (CHD-I vs. CHD-C p = 0.04), and 7/50 (14%) in healthy comparison (CHD-C vs. C p = 0.76) children. Among CHD-I, toothbrushing and use of electric toothbrush improved between 12 months and 24 months. Sugar drink intake was more common among CHD-C (CHD-C vs. C p = 0.02), but comparable to CHD-I children. Parental toothbrushing predicted child toothbrushing twice a day. There were no statistical group differences in dental care contact. Children with CHD are at risk for poor oral health behavior. This could be improved with early and repeat oral health promotion parental counseling.

Oral health behavior during early childhood in children with major congenital heart defects.

BACKGROUND: Good oral health in children with congenital heart defect (CHD) is important. AIM: To assess oral health behavior during early childhood in children with CHD in comparison with children with no known systemic conditions and to explore parental oral health behavior associated with children's behavior. DESIGN: Seventy of all 89 children born in Finland between April 1, 2017, and March 31, 2020, with (a) major CHD potentially included in the criteria of endocarditis prophylaxis or (b) any CHD with surgical repair combined with a chromosomal syndrome, and a comparison group of 87 children with no known systemic conditions were recruited. Thirty-five children with CHD were randomized to usual care (no intensified counseling) and were compared with 87 matched comparison children by a parental questionnaire assessing child and parental oral health behavior at child age at 24 months. RESULTS: Toothbrushing twice a day (p = .008) and the use of fluoride toothpaste twice a day (p = .059) were less common in children with CHD than in children in the comparison group. Nonwater drinks between meals was more common among children in the CHD group than in the comparison group (p = .015). CONCLUSION: Children with major CHD experience poorer oral health behavior in comparison with children with no known systemic conditions during early childhood.

Parental perceptions and experiences of an oral health care promotion intervention for children with congenital heart defects.

PURPOSE: Congenital heart disease (CHD) is one of the most common congenital anomalies in children. Children with major CHD are at risk for developing endocarditis. Acute endocarditis may be life threatening and lead to heart failure. The purpose of this study was to explore parental perceptions and experiences of an early oral health promotion intervention (OHPI) targeting children with major CHD at risk for developing endocarditis later in life, and use this information to examine intervention feasibility. METHODS: Nine parents (three fathers and six mothers) participating in a one and a half year OHPI were purposefully selected for qualitative evaluation of intervention feasibility using semi-structured interviews. The interviews were analysed with an inductive content analysis method. RESULTS: The analysis resulted in four main categories and 14 subcategories that describe parental perceptions and experiences of the OHPI. The four main categories were timing of first intervention contact, effortlessness of intervention process, individuality of support, and relevancy of support. CONCLUSION: Parents of children with CHD perceived the OHPI as important and feasible to be implemented in daily life in children with systemic diseases overall. Further studies on timing of first contact and use of additional Web-based support are needed.

Dental caries prevalence in children with congenital heart disease - a systematic review.

AIM: Poor oral health is related with bacteraemia that may lead to endocarditis in children with congenital heart disease (CHD). The aim of this study was to conduct a systematic literature review to compare caries prevalence in children (<18 years of age) with CHD with healthy children. MATERIAL AND METHODS: A literature search of studies from two online databases (Pubmed (MEDLINE) and Scopus) published from January 2000 to October 2019 using Medical subject heading terms Congenital Heart Disease, Congenital Heart Defect, and Caries was done, and manual search from the reference lists of selected publications. PICO (Patient/Population, Intervention, Comparison group, and Outcome) criteria was applied. Quality of the publications was assessed with the modified Newcastle-Ottawa scale. RESULTS: The search resulted in 151 articles of which nine fulfilled the inclusion criteria. Caries prevalence was significantly higher in children with CHD compared to healthy children in three out of nine studies. Information on predisposing background factors was limited but difference in caries prevalence was not attributed to SES. The quality of the studies varied. CONCLUSIONS: Although evidence is limited, the current literature indicates that children with CHD experience a higher caries prevalence compared to healthy children.