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Dental surveillance in the adult congenital heart disease population
  1. Alison Louise Drayton1,
  2. John J O'Sullivan2,
  3. Graham Walton3
  1. 1Newcastle University Medical School, Newcastle Upon Tyne, UK
  2. 2Department of Cardiothoracic Services, Freeman Hospital, Newcastle Upon Tyne, UK
  3. 3Department of Restorative Dentistry, Newcastle Dental Hospital, Newcastle Upon Tyne, UK
  1. Correspondence to Dr John J O'Sullivan, Department of Cardiothoracic Services, Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, UK; john.o'sullivan{at}

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To the Editor, we read with interest the editorial by Chambers et al1 exploring the issue of dental surveillance in the UK and its relationship with infective endocarditis, here referenced. This editorial highlights the requirement for comprehensive dental surveillance to detect and manage poor oral health (a significant risk factor for bacteraemia) as an essential preventative strategy for infective endocarditis and its potentially life-threatening complications. The authors comment that ‘approximately 30% of the population do not attend a dentist regularly’ and correctly focus on the issue of cost as a potential factor in this relatively poor attendance rate.

This issue has particular significance for the adult congenital heart disease (ACHD) population in whom endocarditis occurs more frequently. We recently conducted an audit project in this group, surveying 50 consecutive ACHD clinic patients and documenting their self-reported dental attendance in comparison with the NICE recommendation (maximum 2-year intervals between routine appointments).2 Despite 90% of our sample being registered with a dentist, 20% did not attend for regular dental reviews at all. A subgroup analysis of patients with highest endocarditis risk (per the European Society of Cardiology definition)3 and special needs patients (who exhibit dental problems more frequently)4 revealed a similarly inadequate level of dental attendance.

Interestingly, anxiety/dislike of attending the dentist, not cost, was the most commonly reported barrier to dental care, affecting just over one third of our sample. Cost was reported by only 17% of patients.

We agree that cost is a significant factor in determining attendance for dental reviews but, in the congenital heart disease population and those with special needs, fear and anxiety may be at least as common. It is our view that for the ACHD population, anxiety relating to dental visits should be addressed proactively in paediatric clinics.

We strongly concur with Chambers et al that investment in strategies for the prevention of infective endocarditis would be very worthwhile for the National Health Service. We would emphasise that additional measures to improve education and decrease anxiety surrounding dental surveillance are also needed, especially for the increasing ACHD population, as demonstrated from our data.


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  • Contributors AD conducted the audit project and prepared the manuscript and accepts overall responsibility for the publication. JOS and GW contributed to study design and revised the manuscript for publication.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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  • PostScript
    Martin H Thornhill John B Chambers Mark Dayer Bernard D Prendergast Jonathan Sandoe Stephen Westaby