Oral and Dental Health in the Child with Chronic Health Conditions

Children with chronic health conditions have an increased risk of oral health problems due to the disease itself or the medication used. Exacerbations are caused by the low priority to oral health by the parents, their difficulty in restricting their children’s consumption of sugar-containing food/beverage, and their high tolerance. Several factors may complicate the management of oral health-related problems, including the risks posed by the disease itself such as in cardiac or hematological diseases, the limited knowledge and experience of general dentists, and the disruptions in cooperation between the dentist and pediatrician/treatment team. Of the oral diseases worldwide, dental caries and periodontal disease are the most prevalent and can directly impact the general health and quality of life. Children with certain chronic health conditions such as compromised immunity or cardiovascular diseases may be more prone to the effects of oral diseases. Therefore, establishment of proper oral hygiene, caries preventive measures, and appropriate treatments are essential to manage medically compromised children. In the present chapter, oral manifestations of certain childhood chronic diseases (asthma, congenital heart diseases, chronic kidney disease, bleeding disorders, and childhood cancer) and the dental and oral care considerations have been reviewed.

Keywords: Dental caries, asthma, congenital heart disease, chronic kidney disease, bleeding disorders

DOI :10.26650/B/CH32.2024.010.041 IUP :10.26650/B/CH32.2024.010.041 Full Text (PDF)

Kroni̇k Sağlık Sorunu Olan Çocukta Ağız Di̇ş Sağlığı

Yeliz Güven

Kronik sağlık sorunu olan çocuklarda hastalığın kendisine ya da kullanılan ilaçlara bağlı olarak ağız diş sağlığı sorunları daha yüksek oranda gözlenmektedir. Özellikle yaşamın ilk yıllarında çocuğun kronik sağlık problemine odaklanan ailelerin ağız-diş bakımını geri planda tutmaları bu sorunların daha şiddetli yaşanmasına yol açabilmektedir. Bir diğer etken ailelerin çocuklarına şeker içerikli yiyecek/içecek tüketiminde kısıtlama getirmekte zorlanmaları ve daha hoşgörülü olma eğiliminde olmalarıdır. Kardiyak ya da hematolojik hastalıklarda olduğu gibi hastalığın oluşturduğu riskler nedeniyle dental tedavinin daha komplike hale gelmesi, genel diş hekimlerinin bilgi ve deneyimlerinin sınırlı olması ve diş hekimi ile pediatrist/tedavi ekibinin iş birliğindeki aksaklıklar da ağız diş sağlığı ile ilgili problemlerin yönetimini zorlaştırmaktadır. Diş çürüğü ve periodontal hastalık en çok gözlenen global ağız sağlığı sorunları olup, genel sağlık üzerinde ve çocuğun yaşam kalitesinde önemli etkilere sahiptir. Özellikle bağışıklık sisteminin baskılandığı kanserler ya da kalp hastalığı gibi bazı kronik hastalıklarda çocuklar ağız diş sağlığı problemlerinden daha çok etkilenirler. Bu nedenle özellikle kronik sağlık sorunları olan çocuklarda ağız sağlığının optimum düzeyde tutulması, koruyucu ve önleyici uygulamalar ve spesifik tedavi yaklaşımları önem kazanmaktadır. Bu bölümde çocukluk döneminde görülen ve ağız diş sağlığı üzerinde belirgin etkileri olan astım, konjenital kalp hastalıkları, kronik böbrek hastalığı, kanama bozuklukları ve pediatrik kanserler gibi kronik hastalıkların spesifik ağız içi bulgularının yanı sıra ağız diş bakımında ve tedavide dikkat edilmesi gereken faktörler derlenmiştir.

Keywords: Diş çürüğü, astım, konjenital kalp hastalığı, kronik böbrek hastalığı, kanama bozuklukları

References

1. American Academy of Pediatric Dentistry (AAPD). Management of dental patients with special health care needs. The Reference Manual of Pediatric Dentistry Chicago, Ill.: 2021:287-94. google scholar
2. Chin JR, Kowolik JE, Stookey GK. Dental caries in the child and adolescent. In: McDonald R, Avery D, Dean J, editors. McDonald and Avery’s Dentistry for the Child and Adolescent. 10 ed. Missouri: Elsevier; 2016. p. 155-76. google scholar
3. American Academy of Pediatric Dentistry (AAPD). Policy on Early Childhood Caries (ECC): consequences and preventive strategies. The Reference Manual of Pediatric Dentistry Chicago, Ill 2021; 81-4. google scholar
4. Kühnisch J, Ekstrand KR, Pretty I, Twetman S, van Loveren C, Gizani S, et al. Best clinical practice gui-dance for management of early caries lesions in children and young adults: an EAPD policy document. Eur Arch Paediatr Dent 2016; 17: 3-12. google scholar
5. Moursi AM, Fernandez JB, Daronch M, Zee L, Jones CL. Nutrition and oral health considerations in children with special health care needs: Implications for oral health care providers. Pediatr Dent 2010; 32: 333-42. google scholar
6. Toumba KJ, Twetman S, Splieth C, Parnell C, van Loveren C, Lygidakis N. Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. Eur Arch Paediatr Dent 2019; 20: 507-16. google scholar
7. Muller-Bolla M, Courson F. Toothbrushing methods to use in children: a systematic review. Oral Health Prev Dent 2013; 11 : 341-7. google scholar
8. Hughes CV, Dean JA. Mechanical and chemotherapeutic home oral hygiene. In: McDonald R, Avery D, Dean J, editors. McDonald and Avery’s Dentistry for the Child and Adolescent. 10 ed. Missouri: Elsevier; 2016. p. 120-37. google scholar
9. Davidovich E, Shafir S, Shay B, Zini A. Plaque removal by a powered toothbrush versus a manual toothb-rush in children: a systematic review and meta-analysis. Pediatr Dent 2020; 42: 280-7. google scholar
10. Doğan MC, Alaçam A, Aşici N, Odabaş M, Seydaoğlu G. Clinical evaluation of the plaque-removing ability of three different toothbrushes in a mentally disabled group. Acta Odontol Scand 2004; 62: 350-4. google scholar
11. Weddell JA, Sanders BJ, Jones JE. Dental problems of children with special health care needs. In: McDonald R, Avery D, Dean J, editors. McDonald and Avery’s Dentistry for the Child and Adolescent. 10 ed. Missouri: Elsevier; 2016. p. 513-39. google scholar
12. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2013(7):Cd002279. google scholar
13. Koch G, Poulsen S, Twetman S, Stecksen-Blicks C. Caries prevention. In: Koch G, Poulsen S, Espelid I, Haubek D, editors. Pediatric dentistry: a clinical approach. 3 ed. New Jersey: John Wiley & Sons; 2017. p. 114-29. google scholar
14. Wells MH. Pit and fissure sealants: scientific and clinical rationale. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH, editors. Pediatric Dentistry: Infancy through Adolescence. 6 ed: Elsevier; 2019. p. 461-81. e2. google scholar
15. Gani F, Caminati M, Bellavia F, Baroso A, Faccioni P, Pancera P, et al. Oral health in asthmatic patients: a review : Asthma and its therapy may impact on oral health. Clin Mol Allergy 2020; 18:22. google scholar
16. Harrington N, Prado N, Barry S. Dental treatment in children with asthma - a review. Br Dent J 2016;220(6):299-302. google scholar
17. Ryberg M, Möller C, Ericson T. Saliva composition and caries development in asthmatic patients treated with beta 2-adrenoceptor agonists: a 4-year follow-up study. Scand J Dent Res 1991; 99:212-8. google scholar
18. Baghani E, Ouanounou A. The dental management of the asthmatic patients. Spec Care Dentist 2021; 41: 309-18. google scholar
19. Dahllöf G, Jacobsen PE, Martens L. Children with chronic health conditions: implications for oral health. In: Koch G, Poulsen S, Espelid I, Haubek D, editors. Pediatric Dentistry: A Clinical Approach. 3rd ed: John Wiley & Sons, Ltd; 2017. p. 316-33. google scholar
20. Garot E, Rouas P, Somani C, Taylor GD, Wong F, Lygidakis NA. An update of the aetiological factors invol-ved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis. Eur Arch Paediatr Dent 2022; 23: 23-38. google scholar
21. Lima LJS, Ramos-Jorge ML, Soares MEC. Prenatal, perinatal and postnatal events associated with hypo-mineralized second primary molar: a systematic review with meta-analysis. Clin Oral Investig 2021; 25: 6501-16. google scholar
22. Karikoski E, Sarkola T, Blomqvist M. Dental caries prevalence in children with congenital heart disease - a systematic review. Acta Odontol Scand 2021; 79: 232-40. google scholar
23. Sivertsen TB, Âstrom AN, Greve G, ABmus J, Skeie MS. Effectiveness of an oral health intervention program for children with congenital heart defects. BMC Oral Health 2018; 18 :50. google scholar
24. Sivertsen TB, ABmus J, Greve G, Âstrom AN, Skeie MS. Oral health among children with congenital heart defects in Western Norway. Eur Arch Paediatr Dent 2016; 17: 397-406. google scholar
25. Cantekin K, Cantekin I, Torun Y. Comprehensive dental evaluation of children with congenital or acquired heart disease. Cardiol Young 2013; 23: 705-10. google scholar
26. Hallett KB, Radford DJ, Seow WK. Oral health of children with congenital cardiac diseases: a controlled study. Pediatr Dent 1992; 14: 224-30. google scholar
27. Balmer R, Bu’Lock FA. The experiences with oral health and dental prevention of children with congenital heart disease. Cardiol Young 2003; 13: 439-43. google scholar
28. Valente AM, Jain R, Scheurer M, Fowler VG, Jr., Corey GR, Bengur AR, et al. Frequency of infective en-docarditis among infants and children with Staphylococcus aureus bacteremia. Pediatrics 2005; 115: e15-9. google scholar
29. Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, et al. Infective endocardi-tis in childhood: 2015 update: a scientific statement from the merican Heart Association. Circulation 2015; 132: 1487-515. google scholar
30. Lockhart PB, Brennan MT, Kent ML, Norton HJ, Weinrib DA. Impact of amoxicillin prophylaxis on the incidence, nature, and duration of bacteremia in children after intubation and dental procedures. Circulation 2004; 109: 2878-84. google scholar
31. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Associ-ation Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 1736-54. google scholar
32. Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, et al. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation 2021; 143: e963-e78. google scholar
33. American Academy of Pediatric Dentistry (AAPD). Antibiotic prophylaxis for dental patients at risk for infection. The Reference Manual of Pediatric Dentistry Chicago, Ill 2021:465-70. google scholar
34. Andaloro C, Sessa C, Bua N, Mantia I. Chronic kidney disease in children: Assessment of oral health status. Dent Med Probl 2018; 55: 23-8. google scholar
35. Sezer B, Kaya R, Kodaman Dokumacıgil N, Sıddıkoğlu D, Güven S, Yıldız N, et al. Assessment of the oral health status of children with chronic kidney disease. Pediatr Nephrol 2022. google scholar
36. Velan E, Sheller B. Oral health in children with chronic kidney disease. Pediatr Nephrol 2021; 36: 3067-75. google scholar
37. Seow WK. Developmental defects of enamel and dentine: challenges for basic science research and clinical management. Aust Dent J 2014;59 Suppl 1:143-54. google scholar
38. Subramaniam P, Gupta M, Mehta A. Oral health status in children with renal disorders. J Clin Pediatr Dent 2012; 37: 89-93. google scholar
39. Martins C, Siqueira WL, Guimarâes Primo LS. Oral and salivary flow characteristics of a group of Brazilian children and adolescents with chronic renal failure. Pediatr Nephrol 2008; 23: 619-24. google scholar
40. Davidopoulou S, Chatzigianni A. Craniofacial morphology and dental maturity in children with reduced so-matic growth of different aetiology and the effect of growth hormone treatment. Prog Orthod 2017; 18: 10. google scholar
41. Limeira FIR, Yamauti M, Moreira AN, Galdino TM, de Magalhâes CS, Abreu LG. Dental caries and deve-lopmental defects of enamel in individuals with chronic kidney disease: Systematic review and meta-analy-sis. Oral Dis 2019; 25: 1446-64. google scholar
42. Tuma M, Silva Andrade N, Correia Aires R, Cristelli MP, Medina Pestana JO, Gallottini M. Oral findings in kidney transplant children and adolescents. Int J Paediatr Dent 2022; 32: 894-902. google scholar
43. Ertuğrul F, Elbek-Cubukçu C, Sabah E, Mir S. The oral health status of children undergoing hemodialysis treatment. Turk J Pediatr 2003; 45: 108-13. google scholar
44. Owais AI, Nowak AJ. Prevention of Dental Disease. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH, editors. Pediatric Dentistry: Infancy through Adolescence. 6 ed. Philadelphia: Elsevier; 2019. p. 282-92. e2. google scholar
45. Hallett KB, Alexander S, Wilson M, Munns C, Cameron AC, Widmer RP. Medically compromised children. In: Cameron AC, Widmer RP, editors. Handbook of Pediatric Dentistry. 4th ed. Australia: Mosby Elsevier; 2013. p. 329-83. google scholar
46. Arrieta-Blanco JJ, Onate-Sânchez R, Martmez-Löpez F, Onate-Cabrerizo D, Cabrerizo-Merino MD. Inhe-rited, congenital and acquired disorders by hemostasis (vascular, platelet & plasmatic phases) with reper-cussions in the therapeutic oral sphere. Med Oral Patol Oral Cir Bucal 2014; 19: e280-8. google scholar
47. Shastry SP, Kaul R, Baroudi K, Umar D. Hemophilia A: Dental considerations and management. J Int Soc Prev Community Dent 2014;4(Suppl 3):S147-52. google scholar
48. Boström EA, Lira-Junior R. Non-Malignant Blood Disorders and Their Impact on Oral Health: an Overview. Current Oral Health Reports 2019; 6: 161-8. google scholar
49. da Fonseca MA. Oral and dental care of local and systemic diseases. In: Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH, editors. Pediatric Dentistry: Infancy through Adolescence. Philadelphia: Elsevier; 2019. p. 66-76.e2. google scholar
50. Adeyemo T, Adeyemo W, Adediran A, Akinbami AJ, Akanmu A. Orofacial manifestations of hematological disorders: Anemia and hemostatic disorders. Indian J Dent Res 2011; 22: 454-61. google scholar
51. Anderson JAM, Brewer A, Creagh D, Hook S, Mainwaring J, McKernan A, et al. Guidance on the dental management of patients with haemophilia and congenital bleeding disorders. Br Dent J 2013; 215 :497-504. google scholar
52. Weickert L, Miesbach W, Alesci SR, Eickholz P, Nickles K. Is gingival bleeding a symptom of patients with type 1 von Willebrand disease? A case-control study. J Clin Periodontol 2014; 41: 766-71. google scholar
53. Gupta PV, Chellani H. Hematological Disorders. In: Gupta PV, Hegde AM, editors. Pediatric dentistry for special child. 1 ed. New Delhi: JP Medical Ltd; 2016. google scholar
54. Sonis AL, Musselman RJ. Oral bleeding in classic hemophilia. Oral Surg Oral Med Oral Pathol 1982; 53: 363-6. google scholar
55. Sanders BJ, Shapiro AD, Hock RA, Manaloor JJ, Weddell JA. Management of the medically compromised patient: hematologic disorders, cancer, hepatitis, and Aids. In: McDonald R, Avery D, Dean J, editors. Mc-Donald and Avery’s Dentistry for the Child and Adolescent. 10 ed. Missouri: Elsevier; 2016. p. 540-62. google scholar
56. Yee R, Duggal MS, Wong VYY, Lam JCM. An update on the dental management of children with haemop-hilia. Prim Dent J 2021; 10: 45-51. google scholar
57. Coetzee MJ. The use of topical crushed tranexamic acid tablets to control bleeding after dental surgery and from skin ulcers in haemophilia. Haemophilia 2007; 13: 443-4. google scholar
58. Abed H, Ainousa A. Dental management of patients with inherited bleeding disorders: a multidisciplinary approach. Gen Dent 2017; 65: 56-60. google scholar
59. Srivastava A, Santagostino E, Dougall A, Kitchen S, Sutherland M, Pipe SW, et al. WFH Guidelines for the Management of Hemophilia, 3rd edition. Haemophilia 2020;26 Suppl 6:1-158. google scholar
60. Ritwik P, Chrisentery-Singleton TE. Oral and dental considerations in pediatric cancers. Cancer Metastasis Rev 2020;39(1):43-53. google scholar
61. American Academy of Pediatric Dentistry (AAPD). Dental Management of Pediatric Patients Receiving Immunosuppressive Therapy and/or Head and Neck Radiation. The Reference Manual of Pediatric Dentistry Chicago, Ill 2022:1-20. google scholar
62. Ferrandez-Pujante A, Perez-Silva A, Serna-Munoz C, Fuster-Soler JL, Galera-Minarro AM, Cabello I, et al. Prevention and treatment of oral complications in hematologic childhood cancer patients: An Update. Children (Basel) 2022;9(4): 566. google scholar
63. Valera MC, Noirrit-Esclassan E, Pasquet M, Vaysse F. Oral complications and dental care in children with acute lymphoblastic leukaemia. J Oral Pathol Med 2015;44(7):483-9. google scholar
64. Cammarata-Scalisi F, Girardi K, Strocchio L, Merli P, Garret-Bernardin A, Galeotti A, et al. Oral Manifes-tations and Complications in Childhood Acute Myeloid Leukemia. Cancers (Basel) 2020; 12: 1634. google scholar
65. Padmini C, Bai KY. Oral and Dental Considerations in Pediatric Leukemic Patient. ISRN Hematol 2014; 2014: 895721. google scholar

Follow-Up and Community Care of the Child With a Chronic Disease

CHAPTER

Oral and Dental Health in the Child with Chronic Health Conditions

Kroni̇k Sağlık Sorunu Olan Çocukta Ağız Di̇ş Sağlığı

References

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