Hollatz Stefan, Wacker-Gussmann Annette, Wilberg Saskia, Folwaczny Matthias, Neidenbach Rhoia, Kaemmerer Harald, Ewert Peter, Oberhoffer Renate
Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, München, Germany.
Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, München, Germany.
Cardiovasc Diagn Ther. 2019 Oct;9(Suppl 2):S281-S291. doi: 10.21037/cdt.2019.01.01.
Poor oral health is known to be a risk factor for infective endocarditis (IE) and acquired cardiovascular disease. Many patients with congenital heart disease (CHD) are at risk for developing IE. Excellent oral health is deemed essential to prevent IE, a potentially life-threatening condition, and therefore is important in adults with congenital heart defects (ACHD). As data on oral heath in ACHD are scarce, the current study aims to assess the prevalence of caries among ACHD and the knowledge of patients about oral health as a risk factor for IE and cardiovascular disease.
A cross-sectional study included ACHD who subsequently presented at the German Heart Center Munich. The participants completed a questionnaire assessing oral health and risk awareness. Additionally, as an indicator of caries prevalence, a dentist documented the DMFT index (sum of decayed, missing and filled teeth).
The median age of the 112 participants was 31.5 (range, 18-77) years. Forty-three patients (38%) were unaware of a correlation between oral health and heart disease. Twelve participants (11%) did not know about poor oral health being a risk factor for cardiovascular diseases. Less than half of the surveyed patients knew the term endocarditis. An additional twelve patients (11%) reported caveats against dental treatment because of their CHD. In twenty-three patients (21%), caries was found at the dentine level. The mean DMFT index, representing caries prevalence, was 7.91 (±6.54). There was no correlation between the Bethesda criteria of CHD and the DMFT index (P=0.69). The DMFT index was higher in patients at high risk for IE (P<0.01). However, this difference in the caries score was mainly due to more extracted and filled teeth in the high-risk patients for IE, whereas the number of decayed teeth did not differ significantly (P=0.09).
The awareness of the importance of optimized oral health in ACHD needs to be improved.
已知口腔健康状况不佳是感染性心内膜炎（IE）和后天性心血管疾病的危险因素。许多先天性心脏病（CHD）患者有发生IE的风险。良好的口腔健康被认为是预防IE（一种潜在的危及生命的疾病）的关键，因此对于患有先天性心脏缺陷的成年人（ACHD）很重要。由于关于ACHD口腔健康的数据稀缺，本研究旨在评估ACHD中龋齿的患病率以及患者对口腔健康作为IE和心血管疾病危险因素的认知。
一项横断面研究纳入了随后在慕尼黑德国心脏中心就诊的ACHD患者。参与者完成了一份评估口腔健康和风险意识的问卷。此外，作为龋齿患病率的指标，一名牙医记录了DMFT指数（龋、失、补牙数之和）。
112名参与者的中位年龄为31.5岁（范围18 - 77岁）。43名患者（38%）未意识到口腔健康与心脏病之间的关联。12名参与者（11%）不知道口腔健康状况不佳是心血管疾病的危险因素。不到一半的被调查患者知道感染性心内膜炎这个术语。另外12名患者（11%）因患有CHD而报告了牙科治疗的注意事项。23名患者（21%）在牙本质水平发现了龋齿。代表龋齿患病率的平均DMFT指数为7.91（±6.54）。CHD的贝塞斯达标准与DMFT指数之间无相关性（P = 0.69）。IE高危患者的DMFT指数更高（P < 0.01）。然而，龋齿评分的这种差异主要是由于IE高危患者中更多的拔牙和补牙，而龋齿数量无显著差异（P = 0.09）。
需要提高对优化ACHD口腔健康重要性的认识。
