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prevention International magazine for oral health No. 1, 2018

systemic diseases | For children with systemic disease, the situation is dif- ferent. Children with heart disease have a demonstrably higher prevalence of caries. On average, four to seven teeth are affected. Children with kidney disease have a risk of caries comparable to that of healthy children; how- ever, this group presents a much higher risk of developing gingivitis. Gingivitis could thus be understood as enabling bacteria to enter the bloodstream. Children with cystic fibrosis also have a very low caries prevalence, but ow- ing to the frequent intake of antibiotics, the composition of their saliva is altered, so in this patient group, frequent enamel hypoplasia has been determined. Why should paediatric dentistry be interested in such interactions? If there are potentially about 700 different species of bacteria in the mouth, and children with heart disease have an increased risk of caries, the danger actually ex- ists that these bacteria will reach the bloodstream via the mouth. We are speaking here of bacteraemia. Bac- teraemia is not a disease in itself and is not a risk for a healthy patient; the immune system automatically fights the invading bacteria. For patients with systemic disease, the starting point is different. It is therefore not surpris- ing that, with bacteraemia, oral streptococci, in partic- ular the viridans streptococci, can be detected. Blood cultures reveal, for example, that viridans streptococci, as part of the oral cavity, are also responsible for 50 per cent of infectious endocarditis cases. Of course, bacte- raemia does not automatically lead to endocarditis. As I said, a healthy body can normally deal with such bacte- ria. Patients with pre-existing conditions like heart dis- ease, however, have a higher risk of endocarditis. Ideally, children with a serious heart disease should have their teeth cleaned prior to upcoming heart surgery. How frequently does bacteraemia develop after den- tal procedures? Occult bacteraemia can result from routine activities such as toothbrushing, but of course also through dif- ferent dental procedures. Bacteraemia develops most frequently after surgeries like tooth extractions. Here, the frequency is usually 100 per cent. These bacteria can be released during periodontal procedures, such as scaling and root planing, and even during professional tooth cleaning, bacteria enter the bloodstream in around 40 per cent of patients. It is very interesting that, even af- ter brushing and interdental care, the frequency of bac- teraemia is about 68 per cent. As I said, a healthy body normally deals with such bacteria, but the picture is dif- ferent for patients with systemic disease, particularly chil- dren with congenital heart disease. If we find a carious lesion in these children, we would treat this immediately in consultation with the paediatric cardiologist in order to avoid further infections. For our paediatric colleagues, it is more difficult to diagnose carious lesions. We do, however, have an excellent working relationship with our colleagues from the paediatric clinic. They are well trained and refer patients to us promptly and regularly for check-ups before surgical procedures. You also mentioned cystic fibrosis, a congenital metabolic disease that leads to the formation of thick mucus, for example in the lungs, intestine and liver. What interactions have you observed between this genetic defect and a patient’s dental status? D r K a r o l i n H ö f e r m o c . k c o t s r e t t u h S / a n n A a n i t o b b u S © prevention 1 2018 29

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