Tetralogy of Fallot: Characteristics, dental implications and case study

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 01/08/2010

Article title: Tetralogy of Fallot: Characteristics, dental implications and case study

Author(s): Roy A. Rockman, DDS

Journal: Journal of Dentistry for Children

Volume (number): page 147

Month, Year: March-April 1989

Major topic: Tetralogy of Fallot

Minor topics:

Type of Article: Informative and Case Study

Main Purpose: Familiarize the reader with this case entity and how it relates to dental treatment

Overview of method of research: Review of current treatment modalities and case review

Findings: Tetralogy of Fallot can cause Cyanosis, especially when children are under stress, which can lead to loss of consciousness, temporary paralysis, or even death. Bacterial endocarditis and brain abscesses secondary to dental treatment are also concerns.

Follow prophylactic guidelines and for acute hypoxic spells treat with O2 administration, place child in knee-to-chest position, administer morphine sulfate and/or propranolol. General anesthesia may be required as a therapeutic modality.

Key points/Summary :

Frequency and etiology

• 10% of all congenital heart disease, most common cardiac malformation resulting in cyanosis after one year of age.

Clinical features

• Children are prone to hypoxic or blue spells. Marked by anxiety and a sudden increase in cyanosis.
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• Child can become unconscious, experience paralysis, have convulsions or even die.
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• Infants like to lie on one side in a fetal position, oder kids don’t like to stand for long periods and often squat after exertion.
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• Clubbing of fingers and toes is common
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• Polycythemia may result from low arterial O₂ concentrations. Hemorrhage can result.
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• Cerebral abscess is common: 20% incidence in children over 2.

Medical Management

• Corrective surgery is performed. Often it is palliative until age 5 when the pulmonary arteries are large enough for definitive corrective surgery.
• Pediatric illness that could cause dehydration or thrombic complications are treated aggressively.

Case Report: 3.5 year old boy presents to dental clinic in Kansas with severe tetralogy of Fallot. His only medication is Digoxin. His medical condition was considered stable at that time. Hx. of Blalock-Taussig shunt was performed as palliative surgical intervention.

Dentally, the child needed full mouth rehabilitation, had poor OH and cyanotic gingiva. After parent and pediatrician consultations General Anesthesia was chosen for modality of treatment. 2 years later, the child was treated in the OR.

Primary concerns were reduction of extreme agitation, avoidance of hypoxia and maintenance of normal blood volume.

IV antibiotic prophylaxis was used.

The dentist believes that pulpotomy and pulpectomy are contraindicated for patients with cardiac complications, so many primary teeth were removed and space maintenance was done.

Assessment of article:

The article shows its age by the extreme concern over bacterial endocarditis. Also it talks about a case of cerebral abscess in a child, who had a pulpotomy performed 3 years prior and it suggests that the pulpotomy was the source of the bacteria causing the cerebral abscess. It was so speculative, it seemed like a stretch to me.

Otherwise informative and useful to know for these patients.