Caring for hearts by caring for mouths

1. Caring for hearts by caring for mouths Karen Howard Consultant Paediatric Dentistry RBHSC

2. Structure • Link between teeth and hearts • Caring for teeth • Eating habits • Tooth brushing • Fluoride • Regular dental care

3. Hearts and Teeth • Infective Endocarditis • Dental infection causes infection in heart • Gum disease • Tooth decay • Potentially fatal At risk • acquired valvular heart disease • valve replacement • structural congenital heart disease • hypertrophic cardiomyopathy • previous infective endocarditis

4. Hearts and Teeth • Treating Dental decay • Visits to dentist • Time off school • Stress and anxiety? • General Anaesthetic

5. 2008 • ‘the importance of maintaining good oral health’ • ‘Managing infection • Investigate and treat promptly any episodes of infection in people at risk of infective endocarditis to reduce the risk of endocarditis developing.’

6. Caring for teeth • Eating habits How often What • Toothbrushing • Fluoride

7. Structure • Link between teeth and hearts • Caring for teeth • Eating habits • Tooth brushing • Fluoride • Regular dental care

8. How often do they eat? • Sugars only eaten at meal times • Sugars only eaten four times daily

9. Safer snacks • Fresh vegetables • Toast • Savoury sandwiches • Cheese and crackers • Low sugar cereal • Seeds/nuts • Homemade soup • Natural popcorn • Fresh fruit • Milk • Water • Tea/coffee (no sugar)

10. Sucrose Glucose Dextrose Fructose Maltose Galactose Lactose Glucose Syrup Hydrolysed Starch Invert Sugar Molasses Treacle, honey etc. Cariogenic Sugars

11. Reducing Amount • Average Sugar Consumption per person per annum in UK 44kg • SUCROSE 36kg pppa • Recommended 15kg pppa (Sheiham 1991) • (10kg if no Fluoride used)

12. Lesser known problems • Eating/ drinking at bedtime • Eating drinking during the night • Eating very slowly • Appetite • Supplements • Medicines

13. Structure • Link between teeth and hearts • Caring for teeth • Eating habits • Tooth brushing • Fluoride • Regular dental care

14. Toothbrushing • Wx5 of toothbrushing

15. Who? • Everyone as soon as teeth come through • Helped by adult until 7(ish)

16. What toothpaste/brush? Toothpaste • 0-3 years- Smear 1000ppm fluoride • 3-6 years- Pea 1350-1500ppm fluoride

17. What toothpaste/brush? Brush • Small head • OR • Oscillating power brush

18. Why? • Removes plaque cause of • Tooth decay • Gum disease • Fluoride application

19. When? • Twice daily • Last thing at night • One other occasion

20. Where? • All surfaces of teeth • Remember to do where teeth meet the gums • All areas of mouth

21. Structure • Link between teeth and hearts • Caring for teeth • Eating habits • Tooth brushing • Fluoride • Regular dental care

22. Fluoride • Toothpaste • Varnish • Mouthwash • Tablets • High fluoride toothpaste • All available- discuss with your dentist

23. Structure • Link between teeth and hearts • Caring for teeth • Eating habits • Tooth brushing • Fluoride • Regular dental care

24. Dentist • Regular check-ups • 6 monthly • Dentist made aware of cardiac diagnosis