Dental care for the pediatric cardiac patient.

The treatment plan for the pediatric cardiac patient must include the following: 1. A complete medical history that will elicit adequate information with respect to the patient's possible heart condition. 2. Consultation with the family physician, pediatrician and/or cardiologist to learn the specific nature of the defect, specific past history, the child's ability to tolerate stress and anxiety, current medication and any specific recommendations for patient management. 3. Antibiotic prophylaxis, in an effort to prevent endocarditis, for all dental procedures that are likely to result in gingival bleeding, including routine professional cleaning. Application of chlorhexidine may be used as an adjunct to antibiotic prophylaxis, particularly in patients who are at high risk and/or with poor dental hygiene. 4. Prompt and vigorous treatment of all infections, with extraction to be considered as the preferred treatment for endodontically involved primary teeth. 5. A frank and open discussion with the parents and patient, detailing the importance of strict oral hygiene and regular dental care for both the oral and general health of the patient. As important as appropriate antibiotic prophylaxis is to the patient's continued health, it must be stated in summation that the dentist's efforts to foster optimal oral health are perhaps even more significant. Dental manipulation is in no way essential to the genesis of bacteremia, and it must be assumed that frequent showers of organisms are the rule in individuals who neglect their mouths. Perhaps the dentist performs the greatest service for this group when he or she succeeds in significantly modifying their oral hygiene behavior, thus preventing inadvertent septic "suicide".