April 4th, 2017
Of Little Hearts and Little Teeth
Recently, I had to cancel a child’s heart surgery because she had multiple cavities. I recall spending close to an hour explaining the surgical process and obtaining a complete history and physical only to then discover obvious caries on multiple teeth during an oral exam.
Turning to the parents, I asked when their daughter had last seen a dentist, not shocked to hear, “Never.” I remember the look of defeat on their faces when I told them she would have to see a dentist before undergoing surgery. Traumatized by this news, the parents told me they hadn’t seen a dentist because their child had heart disease and it wasn’t a priority. Imagine their surprise when this seemingly small detail caused their daughter’s needed surgery to be canceled.
Although my world of cardiology and the world of dentistry don’t collide every day, when they do, it usually has a big impact on me and my patients. Despite the infrequency of these moments, they remind me of the importance of dental health care beyond good hygiene.
Children are recommended to have their first dental visit by age 1. The earlier that dental health is established as routine primary care, the earlier it becomes habit. Though professional care is necessary for maintaining oral health, sadly, a recent statistic I saw indicates that 25 percent of poor children have not seen a dentist before kindergarten.
In my experience, most of my patients lack the understanding of the importance of a healthy mouth and its relationship to overall health. As a provider, I see this as an obstacle that shouldn’t exist.
So, some things I am doing include educating my patients about the importance of brushing and flossing, and avoiding soda and other foods with excess sugar. Also stressing the importance of seeing a dentist every six months, or at least when possible. In addition, I have begun to educate parents of small children to be more involved in the act of teeth brushing, as the average toddler does not have the dexterity to properly brush his or her teeth.
In our current political climate, I do not foresee access to dental care improving. I am not a dentist and certainly do not claim to be an expert in dental hygiene. However, as a provider, the duty to give patients appropriate anticipatory guidance regarding a healthy mouth is something I take seriously.
With regard to my preoperative cardiac surgery patients, our coordinators advise parents that their child needs to see a dentist prior to surgery. And since the above incident, I make sure that dental care is one of the first history and physical questions I ask when entering a patient’s room. Talking about oral health and the need for a dentist isn’t always easy; however, it is devastating to have to tell a parent that their child cannot undergo open heart surgery until a cavity is treated. And preventing that seems well worth it.
References on Children’s Oral Health