Poor dental hygiene behaviors in patients with congenital heart disease increases their risk of endocarditis, according to research presented at the 12th Annual Spring Meeting on Cardiovascular Nursing.
"Patients with congenital heart disease are diagnosed and receive their initial treatment in childhood, but this does not mean that they are cured," said Philip Moons, PhD, professor in nursing science at the University of Leuven and supervisor of the two studies, in a press release. "They remain vulnerable for developing complications; for instance, we know that in patients with congenital heart disease, binge drinking can trigger life-threatening arrhythmias and that good dental hygiene helps prevent endocarditis."
— Philip Moons, PhD, University of Leuven
For the first study, lifestyle information was collected from 429 adolescents with congenital heart disease aged 14 to 19 from the longitudinal study i-DETACH (Information technology Devices and Education Program 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 Moons' research group, designed to measure the use of alcohol, cigarettes and illicit drugs, dental care, and physical activity. In adolescents with congenital heart disease, substance use increased with age (p < 0.001). Compared with matched controls, adolescents with congenital heart disease had significantly lower substance use (p < 0.001) and health risk (p < 0.001) scores, and significantly higher dental hygiene risk scores (p = 0.04).
The results reveal that, in general, the health behavior of adolescents with congenital heart disease is better than their peers, except for dental hygiene.
For the second study, the same questionnaire was used to collect lifestyle information from adults aged 16 to 48 years (average age 24 years) with single ventricle physiology, a type of congenital heart disease.
"This is a very complex congenital heart condition, and we know that these patients are more at risk for endocarditis and arrhythmias than the larger population of congenital heart disease patients," Moons said.
His team conducted a cross-sectional, case control study in 59 patients who were matched on age and gender to 172 healthy controls. In patients with single ventricle physiology, 85% drank alcohol; 26% were binge drinkers; 20% smoked cigarettes; 12% used cannabis over the past year; 20% had not visited the dentist during the last year; 46% were not flossing teeth; and 39% were not physically active.
Compared to healthy controls, patients with single ventricle physiology had better health behaviors overall. But these patients exercised less and their dental hygiene practices (mainly flossing) were poorer.
"Patients with complex conditions can have physical restrictions, so the fact that they are less physically active is perhaps not surprising," Moons said. "But the reasons behind the poorer dental hygiene practices of patients in both studies need to be investigated further."
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 endocarditis.
But researchers have since discovered that daily dental hygiene is more important for preventing endocarditis than antibiotics before a procedure.
"Systematic patient education on the importance of dental hygiene is critical for preventing endocarditis in patients with congenital heart disease," Moon emphasized.
