Caring for hearts by caring for mouths

Karen HowardConsultant Paediatric DentistryRBHSC

Structure

• Link between teeth and hearts• Caring for teeth– Eating habits– Tooth brushing– Fluoride

• Regular dental care

Hearts and Teeth• Infective Endocarditis• Dental infection causes infection in heart– Gum disease– Tooth decay

• Potentially fatalAt risk• acquired valvular heart disease• valve replacement• structural congenital heart disease• hypertrophic cardiomyopathy• previous infective endocarditis

Hearts and Teeth

• Treating Dental decay– Visits to dentist– Time off school– Stress and anxiety?– General Anaesthetic

2008

• ‘the importance of maintaining good oral health’

• ‘Managing infection• Investigate and treat promptly any episodes

of infection in people at risk of infective endocarditis to reduce the risk of endocarditis developing.’

Caring for teeth

1. Eating habitsHow oftenWhat

2. Toothbrushing3. Fluoride

Structure

• Link between teeth and hearts• Caring for teeth– Eating habitsEating habits– Tooth brushing– Fluoride

• Regular dental care

How often do they eat?

• Sugars only eaten at meal times

• Sugars only eaten four times daily

Safer snacks

• Fresh vegetables• Toast• Savoury sandwiches• Cheese and crackers• Low sugar cereal• Seeds/nuts• Homemade soup• Natural popcorn• Fresh fruit

• Milk• Water

• Tea/coffee (no sugar)

Cariogenic Sugars

• Sucrose• Glucose• Dextrose• Fructose• Maltose• Galactose• Lactose

• Glucose Syrup• Hydrolysed Starch• Invert Sugar• Molasses• Treacle, honey

etc.

Reducing Amount

• Average Sugar Consumption per person per

annum in UK 44kg

– SUCROSE 36kg pppa

• Recommended 15kg pppa (Sheiham 1991)

– (10kg if no Fluoride used)

Lesser known problems

• Eating/ drinking at bedtime• Eating drinking during the night• Eating very slowly• Appetite• Supplements• Medicines

Structure

• Link between teeth and hearts• Caring for teeth– Eating habits– Tooth brushingTooth brushing– Fluoride

• Regular dental care

Toothbrushing

• Wx5 of toothbrushing

Who?

• Everyone as soon as teeth come through

• Helped by adult until 7(ish)

What toothpaste/brush?

Toothpaste• 0-3 years- Smear

1000ppm fluoride

• 3-6 years- Pea 1350-1500ppm fluoride

What toothpaste/brush?

Brush• Small head

• OR

• Oscillating power brush

Why?

• Removes plaqueplaque cause of – Tooth decay– Gum disease

• Fluoride application

When?

•Twice daily• Last thing at night • One other occasion

Where?

• All surfaces of teeth• Remember to do where teeth meet the gums• All areas of mouth

Structure

• Link between teeth and hearts• Caring for teeth– Eating habits– Tooth brushing– FluorideFluoride

• Regular dental care

Fluoride

• Toothpaste• Varnish• Mouthwash• Tablets• High fluoride toothpaste

• All available- discuss with your dentist

Structure

• Link between teeth and hearts• Caring for teeth– Eating habits– Tooth brushing– Fluoride

• Regular dental careRegular dental care

Dentist

• Regular check-ups• 6 monthly• Dentist made aware of cardiac diagnosis