Abstract
Background
Eisenmenger syndrome (ES) is a heart cyanotic condition characterised by elevated pulmonary vascular resistance and an intra-cardiac right-to-left shunting of blood through a systemic-to-pulmonary circulation connection. Affected children usually exhibit severe hypoxia, clubbing of fingers/toes, haemoptysis, anaemia, and organ damage.
Case report
During autumn 2015, the patient and her parents arrived at the paediatric dentistry clinic. The patient presented with the main complaint of generalised inflamed gingival tissues, severely protruded upper incisors, and evident abnormal mouth breathing.
Treatment
This was performed under local analgesia, rubber-dam isolation, and antimicrobial prophylaxis with amoxicillin (50 mg/kg). The patient’s parents agreed to the treatment plan through a signed informed consent. This treatment consisted of the placement of pit and fissure sealants on the four permanent first molars (which included enamel preparation with fissurotomy burs), in-depth gingiva/dental frequent cleanings, local fluoride varnish applications, and an exhaustive programme of at-home oral hygiene (brushing, flossing, and chlorhexidine mouth rinses), including adequate nutrition. Gingivoplasty surgery to remove residual enlarged tissues was indicated for the near future.
Follow-up
The child did not return to the clinic. When contacted, the parents reported that their daughter’s systemic condition worsened significantly. She was confined to a bed at home under palliative care, with a life-span expectation of only a few months.
Conclusion
Comprehensive dental care of children with ES requires careful consideration of their medical condition, and dental care delivery should be coordinated with the paediatric cardiologist. General analgesia should be considered only in strictly selected cases, due to the high peri-operative mortality reported.
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References
American Association of Pediatric Dentistry. Clinical practice guidelines. Guideline on antibiotic prophylaxis, for dental patients at risk for infection. Pediatr Dent. 2015;37:292–7.
Bennett JM, Ehrenfeld JM, Markham L, Eagle SS. Anesthetic management and outcomes for patients with pulmonary hypertension and intracardiac shunts and Eisenmerger syndrome: a review of institutional experience. J Clin Anesth. 2014;26:286–93.
Bozich JG, Albert TW. Multiple dental extractions using general anesthesia for a patient with Down and Eisenmenger syndromes and periodontal diseases. Spec Care Dentist. 1990;10:51–4.
Butler DR, Chilvers CR, Cane RJ. The implications and management of acute odontogenic infection in association with Down and Eisenmenger syndromes and schizophrenia in a rural setting. Aust Dent J. 2007;52:61–6.
Chung EM, Sung EC, Sakurai KL. Dental management of the Down and Eisenmenger syndrome patient. J Contemp Dent Pract. 2004;5:70–80.
Das BB. Perioperative care of children with Eisenmeenger syndrome undergoing non-cardiac surgery. Pediatr Cardiol. 2015;36:1120–8.
Di Filippo S. Prophylaxis of infective endocarditis in patients with congenital heart disease in the context of recent modified guidelines. Arch Cardiovasc Dis. 2012;105:454–60.
Franco E, Saunders CP, Roberts GL, Suwanprasit A. Dental disease, caries-related microflora, and salivary IgA of children with severe congenital cardiac disease: an epidemiological and oral microbial survey. Pediatr Dent. 1996;18:228–35.
Hallett KB. Congenital heart disease. In: Moursi AM, da Fonseca MA, Truesdale AL, editors. Clinical cases in pediatric dentistry. Oxford: Wiley-Blackwell; 2012. pp. 4–10.
Hallett KB, Radford DJ, Seow WK. Oral health of children with congenital cardiac disease: a controlled study. Pediatr Dent. 1992;14:224–30.
Hallett KB, Alexander S, Wilson M, et al. Medically compromised children. Pocket Dentistry; 2015. http://pocketdentistry.com/12-medically-compromised-children/. Updated on January 14, 2015. Consulted on 19 December 2015.
Kunimatsu T, Greenan S, Yamashita A, Yamamoto T, Ikeda M. Use of moderate sedation for a patient with Down syndrome, intellectual disability, and Eisenmenger syndrome: a case report. Spec Care Dent. 2011;31:41–3.
Lyons B, Motherway C, Casey W, Doherty P. The anaesthetic management of the child with Eisenmenger’s syndrome. Can J Anaesth. 1995;42:904–9.
Martin JT, Tautz TJ, Antognini JF. Safety of regional anesthesia in Eisenmenger’s syndrome. Reg Anesth Pain Med. 2002;27:509–13.
Moons P, Canobbio MM, Budts W. Eisenmenger syndrome: a clinical review. Eur J Cardiovasc Nurs. 2009;8:237–45.
Pollard MA, Curzon ME. Dental health and salivary Streptococcus mutans levels in a group of children with heart defects. Int J Paediatr Dent. 1992;2(2):81–5.
Rosén L, Stecksén-Blicks C. Experience of dental care for children with congenital heart disease among Swedish dentists. Swed Dent J. 2007;31:85–90.
Tasioula V, Balmer R, Parsons J. Dental health and treatment in a group of children with congenital heart disease. Pediatr Dent. 2008;30:323–7.
Vongpatanasin W, Brickner E, Hills LD, Lange R. The Eisenmenger syndrome in adults. Ann Intern Med. 1998;128:745–55.
Acknowledgements
The authors wish to sincerely thank our child patient and her parents for their valuable and enthusiastic collaboration during the dental treatment and for their agreement in publishing the case study. Additionally, we appreciate the analysis carried out by the peer-reviewers to enhance the quality of the present article.
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There was no funding received by the authors for this case report.
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Contributions
Although this article was the product of the intellectual contribution of the whole research team, the specific role of each author was as follows: PACA and MSRR (both paediatric dentists) provided the clinical dental treatment to the patient reported here and participated in the conception of the case report. JACB (periodontist) and MPP (paediatric cardiologist) contributed to the dental treatment plan design and revised the manuscript critically. JAGR and AJPG (dental researchers) performed the literature review, drafted every version of the manuscript, and also revised it critically. All of the authors discussed and approved the final version of the present article.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The authors declare that they have no conflict of interest.
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This case report does not contain any studies with human participants or animals performed by any of the authors.
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Informed consent was obtained from all individual participants included in this case report.
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Calderón-Ávila, P.A., Garrocho-Rangel, J.A., Cepeda-Bravo, J.A. et al. Dental considerations and recommendations in Eisenmenger syndrome: A report of an unusual paediatric case. Eur Arch Paediatr Dent 19, 449–453 (2018). https://doi.org/10.1007/s40368-018-0366-4
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DOI: https://doi.org/10.1007/s40368-018-0366-4