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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 214-219

Prevalence of dental caries in children with chronic heart disease


1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
2 Department of Paediatrics, Limi Children's Hospital, Abuja, Nigeria
3 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
4 Department of Medicine, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria
5 Department of Paediatrics Institute of Human Virology, Nigeria
6 Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria
7 Department of Paediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria

Date of Submission29-May-2019
Date of Acceptance20-Nov-2019
Date of Web Publication22-Jan-2020

Correspondence Address:
Dr. Umma A Ibrahim
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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DOI: 10.4103/srmjrds.srmjrds_40_19

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  Abstract 

Introduction: Chronic heart disease in children imposes a great burden in most developing countries, especially among those with congenital heart disease where early surgical intervention is difficult because of limited medical facilities. Most of our patients survive on long-time oral medications, some of which are sweetened. Therefore, there is a heightened risk of dental caries. This study sought to determine if there were more caries in children with chronic heart disease than those without heart disease.Materials and Methods: This study was cross-sectional, and oral examinations were done using mouth mirror. A convenient sampling method was adopted. Children were recruited over an 8-month period (May–December 2017). Results: This study compared 130 children with varied forms of cardiac defect with 130 children who had no chronic morbidity or any cardiac lesion. Their ages ranged from 1 to 14 years, with a mean of 5.85 +/- 3.30. The prevalence of dental caries was generally low in this report; dental caries was identified in 20.8% of all the children. Among those with cardiac defect, 30 (25.2%) had dental caries. Furthermore, caries was observed more frequently among cardiac patients on chronic medication when compared with the control, and this observation was statistically significant (X2 = 18.846, df = 1,P= 0.00). The mean decayed, missing, and filled teeth (dmft, 2.03 +/- 0.85) and (DMFT, 1.22 +/- 0.44) for primary and permanent dentition were higher among those with cardiac defect; those without cardiac lesion had a mean dmft of 1.31 +/- 0.48 and DMFT of 1.00 +/- 0.00. Conclusion: Dental caries was low in this study though most cases were reported among patients with cardiac disease.

Keywords: Cardiac disease, dental caries, mean decayed, missing, and filled teeth, mean decayed, missing, and filled teeth, permanent dentition, primary dentition


How to cite this article:
Aliyu I, Asani MO, Peter ID, Michael GC, Ibrahim H, Zubayr BM, Ibrahim HU, Kabir H, Umar UI, Mohammed A, Ibrahim UA, Gambo S. Prevalence of dental caries in children with chronic heart disease. SRM J Res Dent Sci 2019;10:214-9

How to cite this URL:
Aliyu I, Asani MO, Peter ID, Michael GC, Ibrahim H, Zubayr BM, Ibrahim HU, Kabir H, Umar UI, Mohammed A, Ibrahim UA, Gambo S. Prevalence of dental caries in children with chronic heart disease. SRM J Res Dent Sci [serial online] 2019 [cited 2020 Feb 25];10:214-9. Available from: http://www.srmjrds.in/text.asp?2019/10/4/214/276365


  Introduction Top


Chronic heart disease in children imposes a great burden in most developing countries, especially among those with congenital heart disease where early surgical intervention is difficult because of limited medical facilities; therefore, a great majority of patients would be on long-time oral medications. Some of these medications are often sweetened, therefore exposing them to the risk of dental caries, especially in those with poor oral hygiene.[1],[2] Dental caries has both early and long-time complications; there is the risk of infective endocarditis,[3],[4],[5] and on the long time, there is an association between dental caries and the risk of atherosclerosis in adults. Therefore, the importance of good oral hygiene cannot be overemphasized. Oral hygiene in children should start soon after birth with regular oral cleansing, especially following the first tooth eruption. Dental visits should be initiated from the age of 3 years; except otherwise advised, however, in children with chronic heart disease, oral hygiene is held in high premium. Stecksén-Blicks et al.[6] in their study among Swedish children and Hallett et al.[7] reported more caries among children with congenital heart disease than healthy controls. However, Tasioula et al.[8] reported more dental caries with higher decayed, missing, and filled teeth (dmft) in their controls than in children with heart disease; therefore, due to limited information in our environment, there is the need to document the pattern in our setting which will form a better basis for proper patient advice and management.

This study, therefore, sought to determine the prevalence of dental caries among children with chronic heart disease.


  Materials and Methods Top


This was a case–control study, involving children with heart disease seen at the pediatric cardiology clinic and those without heart disease seen at the pediatric outpatient department. This study was conducted over an 8-month period from May 2017 to December 2017. The children selected from a cardiology clinic were matched for age and social class with children without heart disease seen at the pediatric outpatient clinic of Aminu Kano Teaching Hospital.

The minimum sample size was determined using the formula:[9]

n = Z2 P q/d2

n = Sample size

d = Degree of accuracy desired which was set at 0.05

p = The proportion in the target population estimated to have a particular characteristic. In this study, 80.0% (0.80) shall be used based on the report of Pimentel et al.[10]

Z = Standard normal deviate, usually set at 1.96 which corresponds to 95% confidence level

q = 1.0 − p

n = (1.96)2(0.81) (0.19)/(0.05)2=236.

Therefore, the sample size was nf = 236/1 + n/N for population <10,000.[9]

where N = The population of children for which the sample was selected from 291 children were registered at the pediatric cardiology clinic as the time of this study.

Therefore, nf = 236/1 + 236/291=131.

Oral examination

One hundred and thirty-one children each from both groups were recruited.

The children were recruited through a convenience sampling method. Oral examination was conducted on each selected child after obtaining consent from the caregivers/parents and accent from children who were 7 years old or more. Oral examination was done with mouth mirror, and the obtained data were reported using the World Health Organization (WHO) criteria for deciduous and permanent teeth, i.e., the dmft and DMFT index, respectively (the sum of decayed teeth, teeth missing because of caries, and filled teeth).[7],[11] Their medical history was documented in a pro forma, and the absence or presence of dental caries was noted and documented according to international standard (dmft for those 2–5 years and dmft/DMFT for those 6–14 years);[10] those with caries were further educated on the relevance of good oral hygiene, the importance of prophylaxis for infective endocarditis, and they were referred to the dental clinic of Aminu Kano Teaching Hospital.

Ethical approval for the study was obtained from the Ethics Committee of Aminu Kano Teaching Hospital.

Inclusion criteria for children with heart disease

  • Children with congenital heart disease
  • Children with acquired heart disease
  • Children on oral medications for the treatment of heart disease.


Exclusion criteria

  • Children whose caregivers/parents declined consent.


Inclusion criteria for children without heart disease

  • Children seen in the pediatric outpatient clinic for acute illness such as malaria, upper respiratory tract infection, and diarrhea disease.


Exclusion criteria

  • Any child with chronic morbidity such as chronic kidney diseases and chronic neurologic diseases such as cerebral palsy
  • Children whose caregivers/parents declined consent.


Data analysis

All data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Chicago, Illinois, USA). Qualitative variables such as dental caries and sex were summarized as frequencies and percentages, while quantitative variable such as age was summarized as means and standard deviations, while the Chi-square or Fisher's exact test where applicable; and Student's t-test for independent sample statistics were adopted to test for relationships between variables, with P < 0.05 being set as statistically significant.


  Results Top


This study compared 130 children with varied forms of cardiac defect with 130 children who had no chronic morbidity or any cardiac lesion. There were 167 (64.2%) males and 93 (35.8%) females, with a male-to-female ratio of 1.8:1. Among the cardiac cases, there were 73 (56.2%) males and 57 (43.8%) females, with a male-to-female ratio of 1.3:1, whereas among those without cardiac defect, there were 94 (72.3%) males and 36 (27.7%) females. Their ages ranged from 1 to 14 years, with a mean of 5.85 +/- 3.30.

Majority of the respondents had tertiary education, and tap water was the main source of water supply [Table 1].
Table 1: Educational status of caregivers and source of water supply

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[Table 2] shows that denta caries was identified in 20.8% of all the children; among these, 18.5% of them had surface enamel defects (10 out of 54). Most of the children had at least two caries (66.7%), and involvement of multiple teeth (40.7%) was mostly observed. Eighty-three (31.9%) children had a family history of dental caries, whereas 177 (68.1%) had none. Fifty-six (43.1%) children with cardiac defect had acyanotic congenital heart defect, 35 (26.9%) had cyanotic congenital heart defect, whereas 39 (30.0%) had acquired heart diseases. Among those with cardiac defect, 30 (25.2%) had dental caries, whereas 89 (74.8%) did not have caries.
Table 2: Distribution of dental caries among the children

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Tap water was the most common source of drinking water among those with and without cardiac defect; however, the use of borehole water and water sachet was most common among children with cardiac defect. This observation was reported to be statistically significant (Fisher's exact: 23.182, P = 0.000) [Table 3].
Table 3: Comparing the presence cardiac defect and the source of water

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[Table 4] shows that prevalence of dental caries was generally low in this report; however, most of the children with reported dental caries had cardiac defects, and this observation was statistically significant (X2 = 18.324, df = 1, P = 0.00); however, acyanotic congenital heart disease was more common among them though this was not statistically significant (X2 = 0.796, df = 2, P = 0.679). Furthermore, dental caries was more among children with cardiac defect who were on medication, and this observation was statistically significant (X2 = 18.846, df = 1, P = 0.00); similarly, dental caries was more in family members of those with cardiac defect, and this finding was also statistically significant (X2 = 19.273, df = 1, P = 0.00).
Table 4: Comparing the cardiac characteristics of children with the presence of dental caries

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One hundred and nineteen (45.8%) children were on long-time medication, whereas 141 (54.2%) were not; however, based on the subgroups analysis, 119 (91.5%) children with cardiac defect were on medication, whereas only 11 (8.5%) were not.

Most of the children on medication did not have dental caries, however, among children with caries; those who were on a combination of diuretics, angiotensin-converting enzyme, and digoxin had more caries followed by those on diuretics alone; however, this observation was not statistically significant (Fisher's exact test: 7.320, P = 0.094) [Table 5].
Table 5: Comparing type of medication and the presence of dental caries

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The mean dft and DFT for primary and permanent dentition were higher among those with cardiac defect; these observations were statistically significant (P = 0.006 and 0.005 respectively). For the cardiac children, the dmft for the primary dentition ranged from 1 to 4, with a mean of 2.03 +/- 0.85, whereas the DMFTS for the permanent teeth was from 1 to 2, with a mean of 1.22 +/- 0.44. For those without cardiac defect, the dft for the primary dentition was from 1 to 2, with a mean of 1.31 +/- 0.48, whereas the DMFTS for the permanent dentition was from 1 to 2, with a mean of 1.00 +/- 0.00 [Table 6].
Table 6: Comparing the mean decayed, missing, and filled teeth for primary Decayed, Missing, and Filled Teeth for permanent dentition among children with and without cardiac defect

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  Discussion Top


The prevalence of dental caries was generally low in our study population. Despite that, it was more common in the group with cardiac disease; this observation was similar to that reported by Franco et al.[12] but differed from that of Hallet et al.[7] and Balmer et al.[13] who did not document any significant difference in the prevalence of caries between children with and without cardiac defects. Among factors associated with risk for dental caries in children with heart disease are overwhelming parental fixation on the child's heart disease resulting in neglect for the child's oral health, others are parental ignorance,[14] poor caregivers/parental personal oral hygiene practices, our study revealed a family history of dental caries in 31.9% of the children. Furthermore, frequent use of sweeteners such as sucrose in drug formulation, which is the usual practice in our setting, could also predispose to dental caries. This study showed that more patients on long-time medications had dental caries.

Only 54 (20.8%) cases of dental caries were documented among all the study groups, and majorities were those with cardiac defect (41, 31.5%). Although our figure was lower than the 80.5% reported by Pimentel et al.,[10] the lower caries rate in our study may be related to the relatively higher educational status of the caregivers/parents of our study population. Pimentel et al.[10] and Tagliaferro et al.[14] had reported that a lower socioeconomic and educational status may negatively influence the oral health practices of children; furthermore, pipe-borne water supplied by the municipality was reported as a source of drinking water, and this is often fluoridated[15] when compared to other sources of drinking water; again, the use of toothbrush with fluoridated toothpaste is prevalent in our setting, especially among the educated families.[16],[17],[18],[19] However, among children with cardiac lesion, dental caries were more common among those with acyanotic congenital heart disease, and this was a departure from the report of Pimentel et al.[10] who documented more cases among those with cyanotic heart disease; this disparity is understandable in our setting because surgical intervention (palliative or definitive) is limited; therefore, most cases of cyanotic congenital heart diseases (exception of tetralogy of Fallot) would die within or shortly after the neonatal period.[20],[21],[22],[23],[24]

The prevalence of dental caries in our report was similar to the 21% reported by Adeniyi and Odusanya[25] but lower than the 35.5% reported by Okoye et al.[26] and the documented Nigerian (national) prevalence of 30% and 43% for the 12 years and 15 years old, respectively;[27] however, it was higher than the 9.9% reported by Adekoya-Sofowora et al.[28] and 15.5% reported by Okoye[29] among schoolchildren. Regional differences could have accounted for the observed disparity. More cases of dental caries were recorded in the primary dentitions; this observation was similar to that reported by Sofola et al.;[27] this may be attributable to the oral health behaviors of caregivers/parents such as neglect and late commencement of proper oral hygiene in children.

The pattern of dental caries was similar to that reported by Eigbobo and Etim;[30] the primary dentition was most affected, and there were more cases of multiple dental caries per child. De Menezes et al.,[31] in their submission, described the structural predisposition of the primary dentition to caries such as less calcium and phosphorus content and a thinner enamel and dentin when compared to the permanent dentition. Again, prolonged exposure of primary dentition to cariogenic diets had been implicated.[30]

The mean dmft/DMFT for this study was similar to that of Eigbobo and Etim;[30] however, it was higher than that of Okoye[29] and Braimoh et al.,[32] but this was lower than the WHO and Federation Dentaire Internationale proposed global mean DMFT of 3.[33]


  Conclusion Top


Dental caries was more common in children with cardiac defects than the control group; however, the overall prevalence was not higher than the expected national and global prevalence. This is commendable and attributable to good oral health behavior of the respondents.

Limitation of the study

This was a single institutional-based research; therefore, generalization of our findings may be limited because of regional variation in the pattern of heart disease and differences in oral health behaviors. Probing of the teeth to ascertain the severity of lesion was avoided due to concerns of increasing the risk of bacteriemia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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