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 Table of Contents  
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 52

Dental caries and gingival evaluation in children with congenital heart disease

1 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Pediatric Dentistry, Shahrekord University of Medical Sciences, Shahrekord, Iran
3 Department of Pediatric Dentistry, Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission08-Jan-2016
Date of Acceptance28-Jan-2017
Date of Web Publication19-Jun-2018

Correspondence Address:
Tahereh Najafi
Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpvm.IJPVM_401_15

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Background: Dental health is one of the most important health burdens of children health. The association between dental health and endocarditis has been already demonstrated, but there is controversy about different frequency of dental caries, periodontitis, and saliva microorganism in comparison to healthy population and children with congenital heart diseases (CHDs). In this study, we evaluated these differences. Methods: Seventy-six healthy children and 68 CHD patients were enrolled in the present case–control study. Dental decay, periodontitis, oral microorganisms, serum calcium, phosphorus, and frequency of carbohydrate and protein consumption of all participants were evaluated by standards method. Results: CHD patients experienced more periodontitis, but the difference was not significant (0.12 vs. 0.09, P = 0.2). In healthy children, the mean saliva colony counts of Streptococcus mutans were more significant (50639 ± 3324 vs. 35285 ± 27226, P = 0.03), which was diminished by adjusting the carbohydrate consumption. The mean colony count of Lactobacilli in children with CHD was nonsignificant higher than healthy children (P = 0.3). Conclusions: Pediatric patients with CHD experience insignificantly higher dental decay, periodontitis, and saliva Lactobacilli colony counts. The frequency of decayed tooth and gingival diseases in healthy children is high, and hence, more dental care attention in our health system is needed for healthy children.

Keywords: Congenital heart disease, dental caries, periodontal disease

How to cite this article:
Pourmoghaddas Z, Meskin M, Sabri M, Norousali Tehrani MH, Najafi T. Dental caries and gingival evaluation in children with congenital heart disease. Int J Prev Med 2018;9:52

How to cite this URL:
Pourmoghaddas Z, Meskin M, Sabri M, Norousali Tehrani MH, Najafi T. Dental caries and gingival evaluation in children with congenital heart disease. Int J Prev Med [serial online] 2018 [cited 2022 Jun 27];9:52. Available from: https://www.ijpvmjournal.net/text.asp?2018/9/1/52/234771

  Introduction Top

One of the most important health problems in normal child population worldwide is dental caries and periodontal diseases.[1] These two global health problems are more considered in children with congenital heart disease (CHD).[2] The importance is because of CHD high prevalence of about 8–10/1000 births and the susceptibility of these children to endocarditis.[3] The infectious endocarditis is associated with induced bacteremia by dental procedures and dental brushing and flossing.[4]

Formation and progression of dental caries are related to oral microorganisms. Streptococcus mutans and Lactobacillus spp. are two main microorganisms.[5]S. mutans is colonized after first dental eruption and Lactobacillus is found in oral cavity before the first eruption.[6],[7] Findings show a positive correlation between consumption of carbohydrates and colonization of these two microorganisms.[8] Studies have shown that S. mutans begins the initial formation of caries and the Lactobacillus causes further development of carious lesions.[9] Findings of some researches have shown that these organisms grow more in the oral cavity of patients with CHD. On the other hand, other groups of researchers suggested that initiation of dental caries in children with CHD may be due to low calcium in dental enamel of this population.[10] Furthermore, hypoxia in children with cyanotic CHD was another factor associated with dental caries in a number of studies.[11]

Periodontal disease is another risk of endocarditis in patients suffering from CHD.[12] Bad oral hygiene, taking different kinds of medications, insufficient food and minerals consumption are the risk factors for the initiation of periodontal disease in children with congenital cardiovascular disease.[13],[14] Besides, research findings have suggested the positive correlation between periodontal disease and congenital cardiovascular problems.[15]

As far as we have searched, there are controversial data about the differences in oral health in normal children and patients with CHD.[16],[17],[18] This controversy is more prominent, especially in developing countries;[16] therefore, in the present study, we evaluate the saliva microorganism, dental caries, and periodontal disease in children with and without CHD. In addition, we seek to control for the effect of other causes of dental caries in CHD patients such as calcium and phosphorus and frequency of food ingestion.

  Methods Top

In the present case–control study, 76 healthy and 69 children with CHD were included in the study. Ethical Committee of Isfahan University of Medical Sciences approved the protocol of this study (ethical number: 394244). The patients with CHD were enrolled as by convenience sampling from the patients referring pediatric heart clinics affiliated with the Isfahan University of Medical sciences. The healthy children were randomly enrolled from the children who accepted our calls for dental evaluation. Participants in two groups were matched by their age and sex. Informed consent was signed by parents of all children. Among included participants, those who took any kinds of antibiotics, probiotics, and synbiotics in the last month were excluded from the study.

The demographic data (age, gender, family income), medical history (kind of CHD, cyanotic or noncyanotic), and frequency of toothbrushing and flossing were collected. Parents filled out the food frequency questionnaire [19] for the frequency of carbohydrate and protein intake of their children in during the last month. Body weight and height of all children were measured by standards methods by pediatric resident, and their body mass index was calculated.[20]

Dental evaluation of study participants

One pediatric dentist examined all children and dental caries was reported according to the World Health Organization criteria as the number of decayed, missing, and filled teeth (DMFT).[21] Periodontitis was evaluated by gingival bleeding index. According to this method, gentle probing of orifice of the gingiva is done, and then, in 10 s, bleeding is observed. If bleeding happens, the test is positive and then the number of positive sites is recorded and expressed as a percentage of the number of the examined teeth site.[22] The simplified oral hygiene index [23] was used for detecting children oral hygiene. Before saliva sampling, the blood samples of the children were collected to measure the serum level of calcium and phosphorus among them. Two millimeters saliva of children was taken and brought to Alzahra Hospital Laboratory, Isfahan University of Medical Sciences, within 1 h after sampling.

Streptococcus mutans

For determination of S. mutans count, 20 μl of saliva sample was spread on Mitis Salivarius agar (Difco) supplemented with 0.2 U/ml bacitracin and sucrose (15% w/v). Serial dilution and spread plate technique were used for viable cell count. The duplicated agar plates of each dilution were incubated anaerobically (85% N2, 5% CO2, and 10% H2) at 30°C for 72 h.[23] Observing the colonial morphology on Mitis Salivarius agar, hemolysis on blood agar medium and biochemical tests including Gram staining, Voges–Proskauer test, and sugar fermentation tests including mannitol, sucrose, raffinose, sorbitol, and salicin were used for the identification of S. mutans. Then, these colonies were counted by measuring the original concentration of S. mutans in the saliva in colony forming units (CFUs)/mL.[24]

In the present study, Rogosa agar (Unipath, Basingstoke, UK) was used for detecting total count of Lactobacilli in saliva samples. 20 μl of saliva samples was spread on Rogosa agar, and as per the above method, serial dilution and spread plate technique were used for viable cell count. Medium was also incubated anaerobically (85% N2, 5% CO2, and 10% H2) at 30°C for 72 h. Lactobacilli were identified with colony characters by the Gram staining method. Lactobacilli appeared straight, rod-shaped and in pairs of varying length. Number of colonies was counted using a digital counter and its concentration in saliva was expressed in CFU/mL.[24],[25] Two study groups were stratified into three categories according to DMFT (DMFT = 0, DMFT = 1–3, DMFT ≥3).[26] The colony count of S. mutans and Lactobacilli was categorized into low, medium, and high.[27]

Statistical analysis

The analyses were done by IBM SPSS Statistics 20.0 software (SPSS Inc., Chicago, Illinois). Student's t-test and Chi-square test were used to find the significant differences between the groups. Moreover, a P ≤ 0.05 was considered statistically significant. This questionnaire is a validated semi-quantitative questionnaire [19],[28] and is used for detecting the frequency consumption of carbohydrate and proteins. The data of this questionnaire were analyzed in Nutritionist III software (version 7.0; N-Squared Computing, Salem, OR, USA).
Table 1: Frequency of demographics variables among study participants

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  Results Top

One hundred forty-two children consisting of 74 healthy and 68 CHD children were assessed in the present study. Thirty-eight patients had cyanotic heart diseases and 44 children with congenital cardiovascular disease were reported to undergo surgery. The demographic data of all participants are shown in [Table 1]. There were not any significant differences in demographic data between the two groups.

Healthy child consumed significantly higher carbohydrate (P = 0.01), and also, the frequency of tooth brushing in this group was significantly higher than children with CHD (P = 0.02). According to Debris Index, poor oral hygiene condition was not significantly higher in children with CHD in comparison with healthy children (17.2 ± 4.91 vs. 16.8 ± 4.19, P = 0.09). Although the DMFT score was higher in patients in comparison with healthy children, there was no significant difference (6.4 ± 2.46 vs. 5.5 ± 2.16; P = 0.14). Among study participants, 32.43% healthy children and 18.84% of the children with CHD experienced no or mild dental caries. According to gingival index, the children with congenital cardiovascular diseases experienced insignificantly higher periodontitis (2.34 ± 2.44 vs. 1.97 ± 2.33, P = 0.2). Only 30 (40.5%) healthy children and 21 (30.8%) children with CHD had no signs of periodontitis. In healthy children, the mean saliva colony counts of S. mutans were significantly higher (50639 ± 3324 vs. 35285 ± 27226, P = 0.03). Higher consumption of carbohydrate among children with CHD was responsible for this difference (P = 0.07). However, the mean colony count of Lactobacilli in children with CHD was insignificantly higher (P = 0.3). By adjusting the tooth brushing in the two groups, similar results were obtained. [Table 2] and [Table 3] show that there is no significant correlation between the frequency of decay, missing, illed teeth and colony count of  Streptococcus mutans Scientific Name Search obacilli.
Table 2: Frequency of decayed, missing, and fi lled teeth among study participants according their streptococud mutans

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Table 3: Frequency of decayed, missing, and filled teeth among study participants according their Lactobacilli colony counts

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Data in [Table 4] and [Table 5] show no significant correlation between categorized saliva S. mutans and categorized saliva Lactobacilli and gingival bleeding index, respectively.
Table 4: Correlation of gingival bleeding and saliva Streptococcus mutans among healthy and congenital heart diseases child

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Table 5: Correlation of gingival bleeding and categorized saliva Lactobacilli among healthy and congenital heart diseases child

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  Discussion Top

Our data suggested no significantly higher saliva pathologic microorganism and also no significant correlation between saliva S. mutans and Lactobacilli and dental caries and periodontitis in the children with congenital cardiovascular diseases. Along with the present study findings, Balmar et al[29] and Hartzell [30]et al reported no more dental caries and bad oral hygiene in children with CHD. According to these researchers, the dental care of children with CHD and knowledge of their parents about dental care and endocarditis influence children's oral hygiene. The patients of this study were enrolled from those referring heart clinics with special routine dental examination, which could partially explain our findings. On the other hand, the mean score of DMFT in healthy group was in moderate category of decayed tooth, showing that normal children may have poor dental hygiene and poor follow-up in our region in comparison with different parts of the world.[31],[32]

Researchers demonstrated a correlation of saliva pathogenic microorganisms with dietary intake.[33],[34] According to our results, healthy children use more carbohydrates, and also, S. mutans grows more significantly in their saliva. Investigations have shown the more growth rate of this organism is due to carbohydrate consumption in this group. This finding is in line with other studies.[35],[36]

Our results could not show a significant correlation between higher Lactobacilli and S. mutans colony counts and DMFT in children with and without CHD. In studies of Gomar-Vercher et al.[37] and Hallett et al.,[17] saliva pathogenic microorganisms were not significantly correlated with dental caries and the researchers suggested other mechanisms other than saliva microorganisms which could be involved in tooth decay.[38]

We checked the calcium and phosphorus level of all participants, and all participants had normal ranges of these electrolytes. As a result, low calcium and phosphorous level could not correlate with moderate DMFT scores in both groups.

We used the saliva for microorganisms' colony counts. Umar et al.[24] found that in different age group, the saliva S. mutans colony counts had different reliability and correlation with decays, and it was lowest in adolescents and children. Therefore, our finding may be due to using saliva instead of dental caries microorganisms.

Periodontal diseases have been evaluated by different methods.[38],[39] The gingival bleeding index was used in the present study as a tool for children periodontitis evaluation. Our findings show that the prevalence of periodontics is similar to that in other developing countries [40] but is higher than many countries in Latin America.[41] Cortelli et al. showed that the periodontitis was not associated with saliva microorganisms.[42] In line with our and Cortelli et al. results, Belstrom et al. confirmed that salivary microorganisms were not correlated with periodontitis.[43] Recently, immune-inflammatory host response has been introduced as the main cause of periodontal disease.[44] The factors which activate the pathway of arachidonic metabolism are currently known as the main cause of periodontitis other than pathogenic microorganisms;[45] therefore, as we evaluated the association of gingival index with S. mutans and Lactobacilli alone without considering other factors, our results could be justified.

  Conclusions Top

Pediatric patients with CHD experience in significantly higher dental decay, periodontitis, and saliva Lactobacilli colony counts. The frequency of decayed tooth and gingival diseases in healthy children is high, and hence, more dental care attention in our health system is needed for healthy children.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9.  Back to cited text no. 1
Hallett KB, Radford DJ, Seow WK. Oral health of children with congenital cardiac diseases: A controlled study. Pediatr Dent 1992;14:224-30.  Back to cited text no. 2
al-Sarheed M, Angeletou A, Ashley PF, Lucas VS, Whitehead B, Roberts GJ. An investigation of the oral status and reported oral care of children with heart and heart-lung transplants. Int J Paediatr Dent 2000;10:298-305.  Back to cited text no. 3
da Silva DB, Souza IP, Cunha MC. Knowledge, attitudes and status of oral health in children at risk for infective endocarditis. Int J Paediatr Dent 2002;12:124-31.  Back to cited text no. 4
Carlsson J, Grahnén H, Jonsson G. Lactobacilli and streptococci in the mouth of children. Caries Res 1975;9:333-9.  Back to cited text no. 5
Guggenheim B. Streptococci of dental plaques. Caries Res 1968;2:147-63.  Back to cited text no. 6
Fitzgerald RJ, Adams BO, Fitzgerald DB, Knox KW. Cariogenicity of human plaque lactobacilli in gnotobiotic rats. J Dent Res 1981;60:919-26.  Back to cited text no. 7
Keyes PH. The infectious and transmissible nature of experimental dental caries. Findings and implications. Arch Oral Biol 1960;1:304-20.  Back to cited text no. 8
Kuramitsu HK. Virulence factors of mutans streptococci: Role of molecular genetics. Crit Rev Oral Biol Med 1993;4:159-76.  Back to cited text no. 9
El-Hawary YM, El-Sayed B, Abd-Alhakem G, Ibrahim FM. Deciduous teeth structure changes in congenital heart disease: Ultrastructure and microanalysis. Interv Med Appl Sci 2014;6:111-7.  Back to cited text no. 10
Kellerhoff NM, Lussi A. Molar-incisor hypomineralization. Schweiz Monatsschr Zahnmed 2004;114:243-53.  Back to cited text no. 11
da Fonseca MA, Evans M, Teske D, Thikkurissy S, Amini H. The impact of oral health on the quality of life of young patients with congenital cardiac disease. Cardiol Young 2009;19:252-6.  Back to cited text no. 12
Stecksén-Blicks C, Rydberg A, Nyman L, Asplund S, Svanberg C. Dental caries experience in children with congenital heart disease: A case-control study. Int J Paediatr Dent 2004;14:94-100.  Back to cited text no. 13
Celenligil-Nazliel H, Palali A, Ayhan A, Ruacan S. Analysis of in situ proliferative activity in oral gingival epithelium in patients with xerostomia. J Periodontol 2003;74:247-54.  Back to cited text no. 14
Farsi N, Al Amoudi N, Farsi J, Bokhary S, Sonbul H. Periodontal health and its relationship with salivary factors among different age groups in a Saudi population. Oral Health Prev Dent 2008;6:147-54.  Back to cited text no. 15
Pimentel EL, Azevedo VM, Castro Rde A, Reis LC, De Lorenzo A. Caries experience in young children with congenital heart disease in a developing country. Braz Oral Res 2013;27:103-8.  Back to cited text no. 16
Hallett KB, Radford DJ, Seow WK. Oral health of children with congenital cardiac diseases: A controlled study. Pediatr Dent 1992;14:224-30.  Back to cited text no. 17
da Silva DB, Souza IP, Cunha MC. Knowledge, attitudes and status of oral health in children at risk for infective endocarditis. Int J Paediatr Dent 2002;12:124-31.  Back to cited text no. 18
Azadbakht L, Esmaillzadeh A. Macro and Micro-Nutrients Intake, Food Groups Consumption and Dietary Habits among Female Students in Isfahan University of Medical Sciences. Iran Red Crescent Med J 2012;14:204-9.  Back to cited text no. 19
Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. I. Arch Dis Child 1966;41:454-71.  Back to cited text no. 20
Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: International survey. BMJ 2007;335:194.  Back to cited text no. 21
Mwatha A, Olson M, Souza S, Ward M, Jenkins W, Amini P, et al. Gingival Health and Plaque Regrowth Response Following a Four-Week Interdental Hygiene Intervention. J Clin Dent 2017;28(1 Spec No A):A36-44.  Back to cited text no. 22
Greene JC. The Oral Hygiene Index--development and uses. J Periodontol 1967;38:Suppl:625-37.  Back to cited text no. 23
Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975;25:229-35.  Back to cited text no. 24
Tehrani MH, Asghari G, Hajiahmadi M. Comparing Streptococcus mutans and Lactobacillus colony count changes following green tea mouth rinse or sodium fluoride mouth rinse use in children (Randomized double-blind controlled clinical trial). Dent Res J (Isfahan) 2011;8 Suppl 1:S58-63.  Back to cited text no. 25
Hegde PP, Ashok Kumar BR, Ankola VA. Dental caries experience and salivary levels of Streptococcus mutans and Lactobacilli in 13-15 years old children of Belgaum city, Karnataka. J Indian Soc Pedod Prev Dent 2005;23:23-6.  Back to cited text no. 26
[PUBMED]  [Full text]  
Holbrook WP. Dental caries and cariogenic factors in pre-school urban Icelandic children. Caries Res 1993;27:431-7.  Back to cited text no. 27
Azadbakht L, Esmaillzadeh A. Red meat intake is associated with metabolic syndrome and the plasma C-reactive protein concentration in women. J Nutr 2009;139:335-9.  Back to cited text no. 28
Balmer R, Booras G, Parsons J. The oral health of children considered very high risk for infective endocarditis. Int J Paediatr Dent 2010;20:173-8.  Back to cited text no. 29
Hartzell JD, Torres D, Kim P, Wortmann G. Incidence of bacteremia after routine tooth brushing. Am J Med Sci 2005;329:178-80.  Back to cited text no. 30
Nanda J, Sachdev V, Sandhu M, Deep-Singh-Nanda K. Correlation between dental caries experience and mutans streptococci counts using saliva and plaque as microbial risk indicators in 3-8 year old children. A cross Sectional study. J Clin Exp Dent 2015;7:e114-8.  Back to cited text no. 31
Mahejabeen R, Sudha P, Kulkarni SS, Anegundi R. Dental caries prevalence among preschool children of Hubli: Dharwad city. J Indian Soc Pedod Prev Dent 2006;24:19-22.  Back to cited text no. 32
[PUBMED]  [Full text]  
Gábris K, Nagy G, Madléna M, Dénes Z, Márton S, Keszthelyi G, et al. Associations between microbiological and salivary caries activity tests and caries experience in Hungarian adolescents. Caries Res 1999;33:191-5.  Back to cited text no. 33
Keene HJ, Shklair IL. Relationship of Streptococcus mutans carrier status to the development of carious lesions in initially cariesfree recruits. J Dent Res 1974;53:1295.  Back to cited text no. 34
Fitzgerald RJ, Fitzgerald DB. The microbiologic status of test animals in relation to caries research. In: Tanzer JM, editor. Animal Models in Cariology: Proceedings of a Symposium and Workshop on Animal Models in Cariology, April 21-23, 1980. Washington, DC: Information Retrieval Inc.; 1981. p. 89-95.  Back to cited text no. 35
Freedman ML, Tanzer JM. Dissociation of plaque formation from glucan-induced agglutination in mutants of Streptococcus mutans. Infect Immun 1974;10:189-96.  Back to cited text no. 36
Gomar-Vercher S, Cabrera-Rubio R, Mira A, Montiel-Company JM, Almerich-Silla JM. Relationship of children's salivary microbiota with their caries status: A pyrosequencing study. Clin Oral Investig 2014;18:2087-94.  Back to cited text no. 37
Armitage GC. Periodontal diseases: Diagnosis. Ann Periodontol 1996;1:37-215.  Back to cited text no. 38
Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975;25:229-35.  Back to cited text no. 39
Botero JE, Rösing CK, Duque A, Jaramillo A, Contreras A. Periodontal disease in children and adolescents of Latin America. Periodontol 2000 2015;67:34-57.  Back to cited text no. 40
Martinez J. La odontologia en America Latina, en numeros. Dent Trib 2011. Available from: http://www.dental-tribune.com/articles/content/scope/news/region/hispanic/id/6623#.  Back to cited text no. 41
Cortelli SC, Aquino DR, Cortelli JR, Raslan SA, Roman-Torres CV, et al. Periodontal pathogens and clinical periodontal status of school children: A cross-sectional study. Oral Hyg Health 2014;2:131.  Back to cited text no. 42
Belstrøm D, Fiehn NE, Nielsen CH, Klepac-Ceraj V, Paster BJ, Twetman S, et al. Differentiation of salivary bacterial profiles of subjects with periodontitis and dental caries. J Oral Microbiol 2015;7:27429.  Back to cited text no. 43
Graves DT, Li J, Cochran DL. Inflammation and uncoupling as mechanisms of periodontal bone loss. J Dent Res 2011;90:143-53.  Back to cited text no. 44
Pouliot M, Clish CB, Petasis NA, Van Dyke TE, Serhan CN. Lipoxin A(4) analogues inhibit leukocyte recruitment to Porphyromonas gingivalis: A role for cyclooxygenase-2 and lipoxins in periodontal disease. Biochemistry 2000;39:4761-8.  Back to cited text no. 45


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

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