The impact of pediatric congenital heart disease on primary teeth structure: a histological study: Congenital heart disease effect on Teeth.

The impact of pediatric congenital heart disease on primary teeth structure: a histological study

Congenital heart disease effect on Teeth.


  • Huda Raad hawler medical university-college of dentistry
  • Omed Shihab hawler medical university-college of dentistry


congenital heart disease, primary teeth structure, enamel and dentin


Congenital heart disease (CHD) is an abnormality in the structure or function of the cardio-circulatory system present at birth and the ventricular septal defect (VSD) is the most common CHD in children. This study aimed to determine any differences in the histological structure of primary teeth between both healthy children and those children with ventricular septal defects in Erbil City.

Methods enrolled children were divided into two groups. Group I (control) & group II (CHD) aged between 6-10 years old. A total of 44 children were collected, (22 children) in each group. Enamel, dentin, and odontoblast layers were examined histologically. Unpaired t-test used for statistical analysis.

Results: The histopathological sections showed a significant difference in enamel, dentin, and odontoblast layer thickness (255.8 ± 41.68- 406.4 ±46.39), (1156 ± 116.0 - 1320 ± 117.4) and (29.74 ± 7.66 -41.38 ± 12.06) respectively, with p values (P < 0.0001) for enamel and dentin layer, and P < 0.0004  for odontoblast layer. A study of the images in the CHD group showed that the tooth tissue lost its integrity and cohesion in some places, and the thickness of the enamel and dentin layer in this group was significantly reduced compared to group I.  Tissue loss in enamel, pulp, and dentin cell were observed. Also, connective tissue layers in the pulp were disrupted. Conclusions: CHD can alter the natural structure formation of primary teeth. Histologically, enamel, dentin, and odontoblasts layer thickness reduction are found in primary teeth in children with ventricular septal defects.


van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011 Nov 15;58(21):2241-7. doi: 10.1016/j.jacc.2011.08.025.

FitzGerald K, Fleming P, Franklin O. Dental health and management for children with congenital heart disease. Prim Dent Care. 2010 Jan;17(1):21-5. doi: 10.1308/135576110790307690.

Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002 Jun 19;39(12):1890-900. doi: 10.1016/s0735-1097(02)01886-7.

Pinto NM, Waitzman N, Nelson R, Minich LL, Krikov S, Botto LD. Early Childhood Inpatient Costs of Critical Congenital Heart Disease. J Pediatr. 2018 Dec;203:371-379.e7. doi: 10.1016/j.jpeds.2018.07.060. Epub 2018 Sep 26.

Saraç F, Derelioğlu SŞ, Şengül F, Laloğlu F, Ceviz N. The Evaluation of Oral Health Condition and Oral and Dental Care in Children with Congenital Heart Disease. Journal of Clinical Medicine. 2023; 12(11):3674.

El-Hawary YM, El-Sayed B, Abd-Alhakem G, Ibrahim FM. Deciduous teeth structure changes in congenital heart disease: Ultrastructure and microanalysis. Interv Med Appl Sci. 2014 Sep;6(3):111-7. doi: 10.1556/IMAS.6.2014.3.3.

Folwaczny M, Bauer F, Grünberg C. Significance of oral health in adult patients with congenital heart disease. Cardiovasc Diagn Ther. 2019 Oct;9(Suppl 2):S377-S387. doi: 10.21037/cdt.2018.09.17.

Pimentel EL, Azevedo VM, Castro Rde A, Reis LC, De Lorenzo A. Caries experience in young children with congenital heart disease in a developing country. Braz Oral Res. 2013 Mar-Apr;27(2):103-8. doi: 10.1590/s1806-83242013000100016.

Pourmoghaddas Z, Meskin M, Sabri M, Norousali Tehrani MH, Najafi T. Dental Caries and Gingival Evaluation in Children with Congenital Heart Disease. Int J Prev Med. 2018 Jun 19;9:52. doi: 10.4103/ijpvm.IJPVM_401_15.

Cantekin K, Gumus H, Torun YA, Sahin H. The evaluation of developmental enamel defects and dental treatment conditions in a group of Turkish children with congenital heart disease. Cardiol Young. 2015 Feb;25(2):312-6. doi: 10.1017/S1047951113002308.

Koerdt S, Hartz J, Hollatz S et al. Prevalence of dental caries in children with congenital heart disease. BMC Pediatr. 2022 Dec 12;22(1):711. doi: 10.1186/s12887-022-03769-2.

Nishimura RA, Carabello BA, Faxon DP et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008 Aug 19;118(8):887-96. doi: 10.1161/CIRCULATIONAHA.108.190377.

Suvarna SK, Layton C (Histologist), Bancroft JD. Bancroft’s theory and practice of histological techniques [Internet]. 8th ed. Elsevier; 2019; p.356.

Mathew G, Agha R, Albrecht J, et al. STROCSS 2021: Strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery. Int J Surg. 2021 Dec;96:106165. doi: 10.1016/j.ijsu.2021.106165.

Hallett KB, Radford DJ, Seow WK. Oral health of children with congenital cardiac diseases: a controlled study. Pediatr Dent. 1992 Jul-Aug;14(4):224-30.

Al-Etbi NO, Al-Alousi WS. Enamel defects in relation to nutritional status among a group of children with congenital heart disease (Ventricular septal defect). J Bagh College Dentistry. 2011;23(3):124–9.

Oliver KJ, Cheung M, Hallett K, Manton DJ. Caries experience of children with cardiac conditions attending the Royal Children's Hospital of Melbourne. Aust Dent J. 2018 Dec;63(4):429-440. doi: 10.1111/adj.12647.

Popescu M, Ionescu M, Scrieciu M, et al. Etiology Study of Acquired Developmental Defects of Enamel and Their Association with Dental Caries in Children between 3 and 19 Years Old from Dolj County, Romania. Children (Basel). 2022 Sep 14;9(9):1386. doi: 10.3390/children9091386.

Aliyu I, Asani MO, Peter ID, et al. Prevalence of dental caries in children with chronic heart disease. SRM Journal of Research in Dental Sciences. 2019 Jan ; 10(4):214.

Karikoski E, Sarkola T, Blomqvist M. Dental caries prevalence in children with congenital heart disease - a systematic review. Acta Odontol Scand. 2021 Apr;79(3):232-240. doi: 10.1080/00016357.2020.1849792.







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The impact of pediatric congenital heart disease on primary teeth structure: a histological study: Congenital heart disease effect on Teeth. . Acta Biomed [Internet]. 2023 Dec. 5 [cited 2024 May 20];94(6):e2023260. Available from: