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 1.Eating habits How often What 2.Toothbrushing 3.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. Cariogenic Sugars Sucrose Glucose Dextrose Fructose Maltose Galactose Lactose Glucose Syrup Hydrolysed Starch Invert Sugar Molasses Treacle, honey etc.

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? plaque 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 Regular dental care

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