Dental management in children with tetralogy of Fallot under general anesthesia: A case report

Introduction: Tetralogy of Fallot (ToF) is a congenital heart disease frequently diagnosed in children. Children with ToF have a high risk of caries, especially in primary dentition. Preparation of the oral cavity must be done before heart surgery to mitigate risks, including the consideration of bacterial endocarditis associated with dental infections. Proper examination and diagnosis are needed to determine dental treatment and reduce these risks. This case report aims to explain dental management in children with ToF under general anesthesia (GA). Case History: A five-year-old girl came to the Pediatric Dentistry Clinic at Dr. Saiful Anwar Regional General Hospital, Malang, referred by her pediatric cardiologist for oral cavity assessment prior to heart surgery. The patient was diagnosed with ToF. Intraoral examination revealed multiple cavities and remaining roots. The patient was scheduled for tooth filling and extraction under GA and was given prophylactic antibiotics before the procedure. Discussion: Children with ToF are at high risk of bacterial endocarditis. Any dental procedure causing trauma to soft tissue or bone leading to bleeding can induce transient bacteremia. Considering these risks, dental management under GA can be conducted immediately before the heart surgery. Conclusion: Dental management in children with Tetralogy of Fallot under general anesthesia is a good choice. With the collaboration of a multidisciplinary team, including a pediatric dentist, pediatric cardiologist, and anesthesiologist, appropriate treatment can be carried out to prevent bacterial endocarditis.