The burden of dental disease in children with acute rheumatic fever and rheumatic heart disease at a tertiary paediatric hospital

Background Dental caries, in at-risk populations, can be associated with a diagnosis of acute rheumatic fever (ARF) and/or rheumatic heart disease (RHD). Prophylactic antibiotics, prior to at-risk dental procedures, are required in RHD to avoid seeding of oral commensal organisms and the development of infective endocarditis. Dental care is paramount for ARF/RHD patients to reduce the risk of endocarditis optimising oral hygiene is necessary. Health care access and education remain critical factors in both pathologies. We aimed to assess the oral health status of patients with ARF/RHD at Perth Children’s Hospital (PCH). Methods A retrospective review of the medical records of all paediatric patients with ARF and/or RHD referred for dental review at PCH, between January 2004 and December 2019, was performed. Patients requiring General Anaesthetic Procedures (GAP), were compared to non-GAP patients. Demographic, cardiac and dental clinical data were compared. World Health Organization categorisation of Decayed, Missing, Filled Teeth (DMFT) scores were used to determine caries experience. Results Of the 457 patients on cardiology records with ARF/RHD, we found 75 (16% of total ARF/RHD patients) also underwent dental review at PCH. Of those, 54 had a diagnosis of RHD, while 21 had isolated ARF. There were 34 of the 75 patients undergoing dental review, with GAP patients were more likely to identify as Indigenous (100% versus 76%; p < 0.01) than non-GAP patients. A further 21 of the 34 GAP patients had high level dental disease. Most patients came from regional/remote areas with higher levels of socioeconomic disadvantage. Conclusions The oral status of children with ARF/RHD is under appreciated but deserves consideration and priority. ARF/RHD children within the PCH service had poor oral health status that often-required GAP dental treatment. Our study reflects service overlap and the need for more research in oral health of this high-risk population to prioritise service delivery.