Association between Congenital Heart Diseases and Oral Health in Children: A Systematic Review
Congenital heart disease; oral health; dental caries; periodontal health; enamel defects; pediatric cardiology; oral health-related quality of life
AuthorsAbstractBackground: Worldwide, congenital heart disease (CHD) is the most common type of birth abnormality, with advancing medical care creating a growing population of survivors requiring comprehensive long-term management including oral health care. The relationship between CHD and oral health is multifaceted, potentially affecting dental caries, periodontal status, enamel development, and quality of life, while poor oral health may increase the risk of life-threatening infective endocarditis. Objective: The objective of this systematic review was to thoroughly assess and compile the data currently available about the relationship between congenital heart disease and pediatric oral health outcomes, including dental caries experience, periodontal status, oral hygiene measures, enamel defects, oral health-related quality of life, barriers to dental care, and treatment needs. Methods: A comprehensive search for papers published between January 2021 and January 2026 was done in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Included were observational and interventional studies that looked at the oral health outcomes of children with CHD between the ages of 0 and 18. Two reviewers independently selected the studies, extracted the data, and evaluated the quality using Joanna Briggs Institute standards. Because of the differences across the research, a narrative synthesis was carried out. … Results: Seventeen studies from 11 countries, comprising 2,236 children with CHD and 4,485 controls, were included. Consistently poorer periodontal health was demonstrated across multiple studies, with significantly higher plaque indices, gingival indices, and oral hygiene scores in CHD children compared to controls. Enamel defects were substantially more prevalent in CHD populations (15.9-16.5%) versus controls (4.7%), with significant associations between hypoxic episodes and enamel anomalies. Dental caries findings were heterogeneous: approximately half of studies reported significantly higher caries experience in CHD children, while others found no significant differences. Treatment needs indices exceeded 85% with low care indices (10.8-12.4%), indicating critical gaps in restorative dental care access. Dental extractions comprised the majority (86%) of treatments under general anesthesia, with mean costs of $4,395 per procedure. Significant barriers included dental fear, parental knowledge deficits, and logistical challenges. Targeted oral hygiene education programs significantly improved parental knowledge and children's oral hygiene status. Conclusions: Compared to their healthy classmates, children with congenital heart disease have noticeably worse dental health, particularly regarding periodontal status and enamel defects linked to hypoxic episodes. Despite heterogeneous caries findings, critically high treatment needs and low care indices reveal substantial gaps in dental care access. Interdisciplinary collaboration between pediatric cardiologists and dentists is essential to establish systematic referral pathways and early preventive interventions to improve both oral and systemic health outcomes in this vulnerable population.
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