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PREVALENCE OF DENTAL DECAY AMONG CHILDREN SUFFERING FROM CONGENITAL HEART DISEASES

MATERIALS AND METHODS: Subject of monitoring of the prospective clinical research are 100 children from Varna region. Half of them (n=50) were diagnosed with CHDs and the other half (n=50) were healthy controls. Both groups were also divided into two age groups: from 4 to 7 years of age (n CHDs = 25; n Ctr. = 25) and from 8 to 17 years of age (n CHDs = 25; n Ctr. = 25). The dental status was examined and registered according to WHO, using the dmft/DMFT index. Possible risk factors for dental caries development were also registered.


INTRODUCTION
Congenital heart disease (CHD) is one of the most common congenital anomalies with an incidence of approximately 8-10 cases per 1000 live births (1)(2)(3)(4)(5)(6)(7)(8)(9). If left untreated, CHD is the single greatest cause of death during the neonatal period after full-time pregnancies in the industrialized part of the world (8,9). It is clear that children with CHDs frequently require regular long-term medication, but the knowledge of oral health effects, caused by longterm medication in medically compromised chil- 23 tion. The caries experience for a child is expressed as the total number of teeth or surfaces that are decayed (d), missing (m), or filled (f). The dmft index expresses the number of affected teeth in the primary dentition, with scores ranging from 0 to 20 for children. Because of the difficulty in distinguishing between teeth extracted due to caries and those that have naturally exfoliated, missing teeth may be ignored according to some protocols. In this case, it is called the df index (23). In our clinical research, we registered as "missing" (m) only primary teeth, which were lost due to caries and its complications.
The dental status of the children was diagnosed by visual observation and scored on teeth with an initial diagnostic threshold D1b or initial enamel lesions, visible without drying (24). Possible risk factors for dental caries development, such as prolonged medication, poor oral hygiene, improper diet and/ or low socio-economic status of the family were also registered.

RESULTS AND DISCUSSION
After analyzing the data from all patients` cards, it became clear that 94% of children with CHD we examined (n=50) had been subjected to surgical treatment of their malformations. Regular intake of medications due to their chronic cardiac disease continues for 71% of the patients from the same group. Dental prophylaxis for both groups examined (CHD/ Ctr) was limited to the once-a-day usage of fluoride containing toothpaste. Children with CHDs were not subjected to more intensive dental prophylaxis.
The results from the clinical examinations showed that 98% of all patients had decayed teeth (Fig. 1). The DMFT values, calculated for the age group from 8 to 17 years of age, were 5.6±2.9 for CHD group vs. 3.6±2.3 for their healthy peers. The dmft values, calculated for the age group from 4 to 7 years of age, were respectively 5.5±3.2 for the CHD group vs. 4.3±1.2 for the control group (Table 1) (Fig.  2). There was a statistically significant difference (p<0.05) between both age groups within the CHD group, compared to the results of the corresponding age groups of healthy children.
It is concerning that the greatest portion of all individual dmft/DMFT values calculated came from dren, is sparse (10,11). Many of the medications for long-term treatment have high endogenous acidity and/or contain sucrose (12,13). There is a strong correlation between xerostomia and pharmacological treatment (12)(13)(14), and many pharmaceutical preparations are listed as xerogenic (15). There is a need to improve the oral health indices by conducting education and training for both dental and medical health care providers about oral health problems and their prevention in this new group of patients.
A number of studies have been carried out on the caries prevalence in children with CHD, but only five of them were controlled (16)(17)(18)(19)(20). According to one of them children with CHD had higher mean values of dmft/DMFT indices than healthy children and only a few of them had experienced fillings, indicating an unmet need for operative treatment (17,21).

AIM
The aim of this article is to assess caries prevalence in a group of children with CHD and to compare it with the same indicator in a group of healthy controls. Information about possible risk factors for oral diseases development is also gathered.

MATERIALS AND METHODS
Subject of monitoring of the prospective clinical research are 100 children from Varna region. Half of them (n=50) were diagnosed with CHD and the other half (n=50) were healthy controls. Both groups were also divided into two age groups: from 4 to 7 years of age (n CHDs = 25; n Ctr. = 25) and from 8 to 17 years of age (n CHDs = 25; n Ctr. = 25). The dental status was registered according to WHO by the dmft/DMFT index.
The Decayed, Missing, Filled (DMF) index has been used for almost 80 years and is well established as the key measure of caries experience in dental epidemiology (22). The DMF index is applied to the permanent dentition and is expressed as the total number of teeth or surfaces that are decayed (D), missing (M), or filled (F) in an individual. When the index is applied to teeth specifically, it is called the DMFT index, and scores per individual can range from 0 to 28 or 32, depending on whether the third molars are included in the scoring (22).

CONCLUSION
Children with CHDs from Varna region are more severely affected by dental decay than healthy age-and gender-matched controls.
Those children from the CHD group, exposed to prolonged medication due to the main cardiac disease, had higher values of the dmft/ DMFT indices than children from the same group with no prescribed therapy.
The intake of some medications, used for longterm therapy in pediatric cardiology, may increase the risk for dental decay development. This is due to their high values of endogenous acidity, sucrose content and/or their ability to affect salivary secretion and the buffering capacity of saliva.
A great number (71%) of children from the CHD group continue the regular intake of medications, though they have surgical corrections of the cardiac malformation.
Children with CHDs were not subjected to more active dental prophylaxis, compared to healthy peers.
The low socio-economic and educational status of the families of children with CHDs from the region of Varna, as well as the lack of motivation for oral care, also increased the risk for dental decay development.
Children with CHDs are at disadvantage, because the development of oral diseases in these patients may affect their overall medical condition.