Pulpotomy versus Extraction of Primary Molars in Children with Congenital Heart Diseases (CHD)

Introduction: Dental management of a child with CHD is a procedure that requires special considerations due to predisposition to infective endocarditis (IE). The incidence of bacteremia can be induced by variable dental procedures, such as teeth extractions, root canal treatment, pulpotomies, interproximal fillings and application of rubber dam or stainless steel crowns (SSC). Pediatric dentists in the past decades, tend to perform extractions rather than pulpotomies of the deep carious primary molars to prevent possible infection of those teeth that may induce IE. The aim of the present study was to evaluate the presence of bacteremia in children with CHD who received dental extractions or pulpotomies of the primary molars under general anesthesia (GA). Patients and Methods: A total of 60 patients with CHD (age 2-7 years old) from Prince Sultan Cardiac Centre (PSCC) and PSMMC in Riyadh were evaluated by pediatric cardiologist for complete blood count (CBC), blood culture and Echocardiography. The patients received prophylactic antibiotics prior to dental treatment under GA. All patients were low to moderate risk to IE. The patients were randomly divided into two groups: 30 patients received formocresol pulpotomies (FP) and SSCs and 30 patients had extractions of primary molars with vital deep carious lesions. Results: The mean age of patients was 3.9 years from FP group and 4.8 years from extractions group. Fifty eight patients were low risk to IE and 2 patients were at moderate risk. Following dental rehabilitation in the follow up visits over a three years period, there were no vegetation or signs of IE. The clinical and radiographic findings for pulpally treated teeth showed no signs of dental abscesses or apical lesions. Discussion and Conclusion: The present study showed that there was no vegetation in echocardiogram between the two groups of patients who received either pulpotomy or extractions of primary molar teeth in patients with (CHD). In addition, pulpotomy is not a risk factor to induce IE in patients with CHD. However, all patients received antibiotic prophylaxis prior dental rehabilitation.