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Monday, January 18, 2010

Dental health and cardiac kids

Zach had his bi-annual visit to the dentist today. This is the second time we have visited this particular dentist. We started out at the pediatric dentist that Rebecca had always gone to, but he was not able to monitor Zach like our cardiologist wanted when using sedation or laughing gas, so we are going to one in Greenville --- close to the Hospital and the cardiologists. Plus, Dr. Jen will provide the monitoring if needed.

Dr. Jen and her staff are wonderful! Their office is a fun place to be (that is until they want to start doing stuff to you, right, Zach?). I documented today's visit in the hopes of helping Zach become more comfortable with the whole process.

Dental health is very important for our little cardiac kids. I found some information in and article on
If Your Child Has a Heart Defect: "... the riskiest thing to do is to ignore dental health, which may allow teeth to develop cavities and gums to become infected. Along with taking antibiotics correctly, it's important for children with heart defects to take good care of their teeth by brushing and flossing properly. Your child should begin visiting a dentist as early as possible, and those visits should be as frequent as the dentist recommends"

Furthermore, the American Heart Association provides the following recommendations about preventing endocarditis (an infection in the heart's inner lining or valves) in conjunction with dental work:
Congenital Cardiovascular Defects: "Endocarditis: The American Heart Association has recently changed its guidelines for prevention of endocarditis. Some children who used to take antibiotics before going to the dentist no longer have to do so.
The AHA now recommends these routine antibiotics before dental visits for patients who are at the highest risk for adverse outcomes if they develop endocarditis. This includes:
1. People with a prosthetic cardiac valve
2. People who have previously had endocarditis
3. People with certain types of congenital heart defects, including
a. Unrepaired cyanotic congenital heart defects, including palliative shunts and conduits
b. Completely repaired congenital heart defects with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure (prophylaxis is recommended for first six months because endothelialization of prosthetic material occurs within six months after the procedure)
c. Repaired congenital heart defect with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
4. Cardiac transplantation recipients who develop heart valve dysfunction
Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of congenital heart disease.
Good dental hygiene can help lower the risk of endocarditis. For more information about dental hygiene and preventing endocarditis, ask your pediatric cardiologist."

So, Zach happily ("Mmmmm --- bubblegum flavor!) took his dose of Amoxicillin one hour before his appointment time. The entire office is decorated like a jungle, with murals on the walls, animal footprints on the floor and even on the ceiling, and a neat play area off of the waiting room. There is a cave with a TV and an upstairs loft area with a huge chalkboard. Zach loved it!

At home, we still use training toothpaste, so Mrs. Kaye just put a tiny bit of real toothpaste on his new toothbrush. I brushed Zach's teeth and tried to get him to spit out the toothpaste. He is so funny! He has the action of spitting down pat, except nothing comes out. I'm not really sure I want him to learn how to spit!

They also have this really cool play area back in the examination area. As you can see, Zach enjoyed himself in there, too. You notice how willing he was so far to show off all his teeth?

So, we met Mrs. Karen for the first time and she and Zach had a great time playing with all of her tools. She showed him Mr. Thirsty, her vacuum. I was a little worried that Zach would freak out about that, because at home, he is scared of the vacuum cleaner. He was fine with Mr. Thirsty because he doesn't make near as much noise.

Mr. Thirsty eagerly sucked up the water that she squirted on the chair! Zach thought that was cool.

She had some "sungackes" for Zach to wear so her flashlight wouldn't shine in his eyes. He tried them on but decided that they were not his style.

Then, Mrs. Karen showed him Mr. Tickle. He got to squeeze it and feel how it spins around and around. Mr Tickle tickled his finger!
Mrs. Karen said that Zach could choose what flavor he wanted Mr. Tickle to tickle on his teeth: grape, chocolate, bubblegum, and raspberry. I thought for sure he would go for the bubblegum, but he chose chocolate. A boy after my own heart!

Zach even let Mr. Tickle polish up a few of his teeth! We were so proud! Then things started to go downhill...

"I want to go ova deh!!!" To the play area. Who could blame him?
Eventually, they moved him into the "quiet room" so he wouldn't disturb the other little boy who was laying bravely on the next chair, waiting to get his teeth cleaned.

I chose to omit the pictures of us holding him down so she could clean the rest of his teeth. He let Mommy floss his teeth then. Dr. Jen came in to see him, but he was ready to go by that time. We held him down again so she could take a look, check a couple of teeth, and paint on this fluoride stuff.
Not the way I hoped it would happen, but it's all for his own good. We heart parents are used to watching (and forcing) our children to endure lots of stuff that we would rather they didn't have to go through. But we do it because we love them!

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