Dental Care for Children and Adults with Heart Problems and Down's Syndrome

Why is dental care important?

Everyone has bacteria in their mouth which can enter the bloodstream in small numbers, but with dental disease the number of bacteria can increase and in someone with a heart defect they can cause an infection inside the heart (Endocarditis) which is a rare but life-threatening condition. Anyone who has a congenital heart defect (a hole, abnormal valve or blood vessel) is more at risk of getting Endocarditis if they have tooth decay or gum inflammation, so good dental care should be a priority. Even those who have had corrective surgery may be at risk so it is important to listen to any advice given by the cardiologist, particularly in relation to the use of antibiotic cover for dental treatments.

How can Endocarditis be prevented?

Endocarditis can be prevented by keeping a clean healthy mouth and taking action to prevent tooth decay as well as taking precautions such as taking antibiotics prior to some types of dental and medical treatments if the type of heart defect is considered to increase the risk of it occurring.

Antibiotic Cover

Up until March 2008, antibiotic cover was recommended for nearly everyone with a congenital heart defect, whether or not it had been repaired, if they needed certain types of medical or dental procedures. Following an investigation by NICE (National Institute for Health and Clinical Excellence) the recommendation has been changed so that antibiotics will only be offered for those who are considered at higher risk of getting endocarditis or where the procedure is at a site where there is already suspected infection.

There are a number of patients who are considered at increased risk due to the nature of their heart defect so it is important that you obtain advice from your cardiologist for your individual situation.

Generally, for the type of defects people with Down’s Syndrome commonly have, the risk is increased for those who:

Those who are not considered at increased risk are those who:

You can read the NICE guidelines here (NICE guideline CG64).

Accidents involving the mouth

It is not uncommon for children to have accidents which result in minor injuries to the mouth and teeth which will not require any treatment. However it is always best to check with your dentist or GP about any such injury, even if you think treatment is not required, as antibiotic cover may be recommended.

Preventing Tooth Decay

Dental Development in Children with Down's Syndrome

Children with Down's Syndrome may have delayed development of the teeth and jaw with the first (baby) teeth not appearing until the age of two and it may take another two to three years for them all to be present. Similarly the eruption of the permanent (adult) teeth may be delayed with baby teeth still being present at fourteen years; teeth may also present in an unusual order. It is very common for some of the baby and adult teeth to be missing, and for teeth to be smaller than normal.

Problems associated with Dental Treatment in people with Down's Syndrome

There are a variety of problems that need consideration by the dentist when treating someone who has Down's Syndrome:

Additional sources of information