Assessment of oral health, salivary alterations, and parental KAP in children with congenital heart disease.

BACKGROUND: Children with congenital heart disease (CHD) are at high risk for infective endocarditis (IE), with poor oral health being a key portal for bacteraemia. Data holistically integrating clinical status, salivary defence mechanisms, and parental behaviors in this vulnerable population are scarce. AIM: To compare the oral health status, salivary parameters, Streptococcus mutans levels, and parental knowledge-attitude-practice (KAP) between children with CHD at risk for IE and healthy controls. MATERIALS AND METHODS: This cross-sectional comparative study enrolled 65 children with IE-risk CHD and 65 age- and sex-matched healthy controls (aged 3-12 years). Assessments included the DMFT/deft and Simplified Oral Hygiene Index (OHI-S). Unstimulated saliva was analyzed for flow rate, pH, buffering capacity, viscosity, osmolality, and secretory IgA. S. mutans was quantified via culture. Parental KAP was evaluated using a validated questionnaire. RESULTS: The CHD group had significantly higher mean DMFT (4.2 ± 2.1 vs. 1.8 ± 1.5; p < 0.001) and OHI-S scores (2.5 ± 0.7 vs. 1.2 ± 0.5; p < 0.001). They exhibited compromised salivary function (reduced flow, pH, buffering, sIgA; p < 0.05) and elevated pathogenic markers (viscosity, osmolality, S. mutans counts >105 CFU/mL; p < 0.001). Parental KAP scores were significantly lower in the CHD group (p < 0.001). Regression analysis identified CHD status (β = 2.1, p < 0.001), low salivary flow (β = -0.8, p = 0.002), high S. mutans (β = 0.5, p = 0.01), and poor parental practice (β = -0.3, p = 0.03) as key predictors of caries severity. CONCLUSION: Children with CHD exhibit a deleterious triad of severe caries, dysfunctional salivary defences, and inadequate parental preventive practices. These findings mandate the integration of point-of-care oral screening and structured parent education into routine cardiac follow-up to mitigate IE risk.