Each year in the United States, 40,000 newborns are born with a congenital heart defect and more that 50% will require at least one invasive surgery in their lifetime. Congenital heart defects (CHD) place children at risk for:

1. Bacterial endocarditis: Dental procedures that involve disruption of the gingival tissue or oral mucosa may develop oral bacteremia.
2. Bleeding risk: Children on anticoagulation therapies post surgical intervention are at risk for bleeding.
3. Dental caries: Many patients with CHD take sucrose-containing medications several times daily.
4. Xerostomia: Certain cardiac medications (diuretics, ACE inhibitors) may cause and increased risk.
5. Malocclusion: Children with CHD have a higher incidence of malocclusion (mesiocclusion and distocclusion).

Alleviating Measures

• Obtain a thorough medical and dental history at each visit
• Consult with patients pediatric and/or cardiology provider to determine if antibiotic prophylaxis therapy is indicated or anticoagulant therapy should be paused
• Refer to the American Heart Association Guidelines on Antibiotic Prophylaxis (AHA, 2008)
• Rinse mouth with water and spit after taking liquid medications
• Chew sugar-free gum to stimulate salivary flow and restore moisture
• Use caries preventive measures (sealants, fluoride supplements, antimicrobial mouthwashes)
• Screen for significant crowding, abnormal dentition development, premature tooth loss and refer for orthodontia as indicated