Medical ConditionsCardiac & respiratory: Congenital heart disease

Congenital heart disease

Also called: CHD; acyanotic and cyanotic heart defects

Overview

Board takeaway: Confirm the exact lesion, repair, residual defects, and medications before invasive care; decide prophylaxis and anesthesia from those findings.

Congenital heart defects are the most common birth defects; sustained oral health is part of cardiac care.

How does Congenital heart disease affect dental management?

Cardiology consultation: confirm the diagnosis, repair status, residual defects, cardiac function, medications, and need for prophylaxis.
Prophylaxis: for qualifying cardiac anatomy and gingival/periapical manipulation or mucosal perforation, use the indicated single dose 30–60 minutes before. Apply procedure exemptions: routine local anesthesia through noninfected tissue, radiographs, removable appliance placement, orthodontic adjustment/bracket placement, natural exfoliation, and traumatic lip/mucosal bleeding do not require IE prophylaxis. AAPD 2026.
Antithrombotic medication: identify the specific drug and plan local hemostasis. INR assessment applies to warfarin, not to every anticoagulant or antiplatelet drug. ADA dental guidance.
Sedation and GA: Sedation and general anesthesia: hospital setting for complex or unstable patients
Prevention: Aggressive prevention before cardiac surgery and throughout life; dental infection is an endocarditis risk
Tooth prognosis: Choose restoration, pulp therapy, or extraction from pulpal diagnosis, restorability, expected tooth survival, follow-up access, and cardiac treatment timing. High IE risk alone is not a blanket indication to extract a restorable primary tooth
Antithrombotic changes: do not stop or reduce prescribed anticoagulants or antiplatelets independently. Most routine dental procedures can use local hemostasis; higher bleeding risk or extensive surgery needs a prescriber-directed plan. ADA: medication management.

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Confirm cardiac eligibility with cardiology and apply dental procedure exemptions. This pathway addresses infective endocarditis; compromised-host indications are separate.

AAPD 2026.

Exam pearl

What is Congenital heart disease?

A structural problem of the heart or great vessels present at birth, ranging from small holes that close on their own to complex defects requiring several surgeries.

What are the main systemic features of Congenital heart disease?

Acyanotic (left-to-right shunts and obstructions): VSD (most common), ASD, PDA, coarctation, aortic and pulmonary stenosis
Cyanotic (right-to-left shunting): tetralogy of Fallot, transposition of the great arteries, hypoplastic left heart, tricuspid atresia
Heart failure: Heart failure, poor growth, fatigue with feeding
Cyanotic disease: Cyanosis, clubbing, polycythemia, and bleeding tendency in cyanotic defects
Syndromes: Associated syndromes: Down, DiGeorge (22q11.2 deletion), Turner, Williams, Noonan
Medications: Medications: diuretics, digoxin, anticoagulants, aspirin

What oral findings occur in Congenital heart disease?

Caries: Higher caries risk: sugar-containing medications, frequent feeding, and enamel defects
Development: Delayed eruption and enamel hypoplasia
Bleeding: Cyanotic mucosa may occur; assess bleeding from associated hemostatic abnormalities and antithrombotic treatment rather than attributing it to an elevated red-cell count alone
Gingiva: Gingival overgrowth from calcium channel blockers or cyclosporine after transplant

A child had a VSD closed with a patch 2 years ago and has no residual defect. Is prophylaxis needed?

No. A defect completely repaired with prosthetic material needs prophylaxis only for the first six months after repair, unless a residual defect remains at or next to the patch.

Why is dental clearance requested before cardiac surgery?

Why: Oral infections can seed bacteria onto new prosthetic material or damaged endocardium.
Before surgery: Identify and treat active infection and teeth likely to become symptomatic around surgery, allowing healing time coordinated with cardiology.
After clearance: Continue daily hygiene and regular dental care; dental “clearance” and prophylaxis cannot guarantee prevention of endocarditis.

Sources

How does Congenital heart disease affect dental management?

Cardiology consultation: confirm the diagnosis, repair status, residual defects, cardiac function, medications, and need for prophylaxis.

Prophylaxis: for qualifying cardiac anatomy and gingival/periapical manipulation or mucosal perforation, use the indicated single dose 30–60 minutes before. Apply procedure exemptions: routine local anesthesia through noninfected tissue, radiographs, removable appliance placement, orthodontic adjustment/bracket placement, natural exfoliation, and traumatic lip/mucosal bleeding do not require IE prophylaxis. AAPD 2026.

Antithrombotic medication: identify the specific drug and plan local hemostasis. INR assessment applies to warfarin, not to every anticoagulant or antiplatelet drug. ADA dental guidance.

Sedation and GA: Sedation and general anesthesia: hospital setting for complex or unstable patients

Prevention: Aggressive prevention before cardiac surgery and throughout life; dental infection is an endocarditis risk

Tooth prognosis: Choose restoration, pulp therapy, or extraction from pulpal diagnosis, restorability, expected tooth survival, follow-up access, and cardiac treatment timing. High IE risk alone is not a blanket indication to extract a restorable primary tooth

Antithrombotic changes: do not stop or reduce prescribed anticoagulants or antiplatelets independently. Most routine dental procedures can use local hemostasis; higher bleeding risk or extensive surgery needs a prescriber-directed plan. ADA: medication management.

Loading diagram…

Confirm cardiac eligibility with cardiology and apply dental procedure exemptions. This pathway addresses infective endocarditis; compromised-host indications are separate.

What are the main systemic features of Congenital heart disease?

Acyanotic (left-to-right shunts and obstructions): VSD (most common), ASD, PDA, coarctation, aortic and pulmonary stenosis

Cyanotic (right-to-left shunting): tetralogy of Fallot, transposition of the great arteries, hypoplastic left heart, tricuspid atresia

Heart failure: Heart failure, poor growth, fatigue with feeding

Cyanotic disease: Cyanosis, clubbing, polycythemia, and bleeding tendency in cyanotic defects

Syndromes: Associated syndromes: Down, DiGeorge (22q11.2 deletion), Turner, Williams, Noonan

Medications: Medications: diuretics, digoxin, anticoagulants, aspirin

What oral findings occur in Congenital heart disease?

Caries: Higher caries risk: sugar-containing medications, frequent feeding, and enamel defects

Development: Delayed eruption and enamel hypoplasia

Bleeding: Cyanotic mucosa may occur; assess bleeding from associated hemostatic abnormalities and antithrombotic treatment rather than attributing it to an elevated red-cell count alone

Gingiva: Gingival overgrowth from calcium channel blockers or cyclosporine after transplant

Why is dental clearance requested before cardiac surgery?

Why: Oral infections can seed bacteria onto new prosthetic material or damaged endocardium.

Before surgery: Identify and treat active infection and teeth likely to become symptomatic around surgery, allowing healing time coordinated with cardiology.

After clearance: Continue daily hygiene and regular dental care; dental “clearance” and prophylaxis cannot guarantee prevention of endocarditis.