Poor oral health ‘puts heart patients at risk’

The poor dental hygiene behaviours of patients with congenital heart disease could increase their risk of endocarditis.

That’s according to experts in two recent studies.

The studies were supervised by Professor Philip Moons, professor in nursing science at the University of Leuven, Belgium, and guest professor at Copenhagen University Hospital, Denmark.

For the first study (FPN 34) 1, lifestyle information was collected from 429 adolescents with congenital heart disease aged 14-19 years from the longitudinal study i-DETACH (Information technology Devices and Education programme for Transitioning Adolescents with Congenital Heart disease).

Of these, 401 were matched with a control of the same age and gender without congenital heart disease.

All participants completed a questionnaire, developed by the research group of Professor Moons, which measures the use of alcohol, cigarettes and illicit drugs, dental care and physical activity.

These behaviours are particularly important to the health of patients with congenital heart disease.

An ‘overall health risk score’ was calculated using the substance use risk score, dental hygiene risk score, and the absence of physical activity. The three risk scores were transformed to a scale ranging from 0 (no risk) to 100 (maximum risk).

Scores were compared across different age groups.

In adolescents with congenital heart disease, substance use increased with age.

Compared with matched controls, adolescents with congenital heart disease had significantly lower substance use and health risk scores, and significantly higher dental hygiene risk scores.

‘The fact that adolescents with congenital heart disease have better health behaviour overall than the general population is understandable, given the amount of input they have had from healthcare professionals over their lives. But we need to do more to understand why their dental hygiene is not as good as expected,’ Professor Moons said.

For the second study (FPN 158), the same questionnaire was used to collect lifestyle information from adults aged 16-48 years (average age 24 years) with a type of congenital heart disease called single ventricle physiology.

Compared to healthy controls, patients with single ventricle physiology had better health behaviours overall.

But patients exercised less and their dental hygiene practices (mainly flossing) was poorer.

‘Patients with complex conditions can have physical restrictions so the fact that they are less physically active is perhaps not surprising. But the reasons behind the poorer dental hygiene practices of patients in both studies need to be investigated further,’ Professor Moons said.

In the past, efforts to prevent endocarditis in patients with congenital heart disease focused on taking antibiotics one hour before a dental procedure.

This prevented bacteria released into the blood from damaged gums travelling to the heart and causing an infection (endocarditis).

But researchers have since discovered that daily dental hygiene is more important for preventing endocarditis than antibiotics before a procedure.

‘Systematic structured patient education on the importance of dental hygiene is critical for preventing endocarditis in patients with congenital heart disease,’ he added.

The findings were presented in two studies at the 12th Annual Spring Meeting on Cardiovascular Nursing, 16-17 March, in Copenhagen, Denmark.

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