Assessment of oral health, salivary alterations, and parental KAP in children with congenital heart disease

Background Children with congenital heart disease (CHD) are at high risk for infective endocarditis (IE), with poor oral health being a key portal for bacteraemia. Data holistically integrating clinical status, salivary defence mechanisms, and parental behaviors in this vulnerable population are scarce. Aim To compare the oral health status, salivary parameters, Streptococcus mutans levels, and parental knowledge-attitude-practice (KAP) between children with CHD at risk for IE and healthy controls. Materials and methods This cross-sectional comparative study enrolled 65 children with IE-risk CHD and 65 age- and sex-matched healthy controls (aged 3-12 years). Assessments included the DMFT/deft and Simplified Oral Hygiene Index (OHI-S). Unstimulated saliva was analyzed for flow rate, pH, buffering capacity, viscosity, osmolality, and secretory IgA. S. mutans was quantified via culture. Parental KAP was evaluated using a validated questionnaire. Results The CHD group had significantly higher mean DMFT (4.2 ± 2.1 vs. 1.8 ± 1.5; p < 0.001) and OHI-S scores (2.5 ± 0.7 vs. 1.2 ± 0.5; p < 0.001). They exhibited compromised salivary function (reduced flow, pH, buffering, sIgA; p < 0.05) and elevated pathogenic markers (viscosity, osmolality, S. mutans counts >10 5 CFU/mL; p < 0.001). Parental KAP scores were significantly lower in the CHD group (p < 0.001). Regression analysis identified CHD status (β = 2.1, p < 0.001), low salivary flow (β = −0.8, p = 0.002), high S. mutans (β = 0.5, p = 0.01), and poor parental practice (β = −0.3, p = 0.03) as key predictors of caries severity. Conclusion Children with CHD exhibit a deleterious triad of severe caries, dysfunctional salivary defences, and inadequate parental preventive practices. These findings mandate the integration of point-of-care oral screening and structured parent education into routine cardiac follow-up to mitigate IE risk.