Dental considerations and recommendations in Eisenmenger syndrome: A report of an unusual paediatric case
- 94 Downloads
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.
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.
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.
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.
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.
KeywordsEisenmenger syndrome Cyanotic congenital heart diseases Children Dental management
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.
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.
There was no funding received by the authors for this case report.
Compliance with ethical standards
Research involving human participants and/or animals
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.
Conflict of interest
The authors declare that they have no conflict of interest.
This case report does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in this case report.
- 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.Google Scholar
- 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.Google Scholar
- 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.