การวางแผนการรักษาทางทันตกรรมภายใต้การดมยาสลบในผู้ป่วยเด็ก โรคหัวใจพิการแต่กำเนิดชนิดฟัลโลต์เตตระโลจี: รายงานกรณีศึกษา
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Abstract
Tetralogy of Fallot (TOF) is a complex cyanotic congenital heart disease associated with a high risk of infective endocarditis caused by oral microorganisms. This case report aimed to present the planning and management of comprehensive dental treatment under general anesthesia in a pediatric patient with TOF, emphasizing multidisciplinary approach .
A 4-year-3-month-old Thai boy with unrepair TOF, associated anorectal malformation, renal abnormalities, and hematologic disorders, presented with multiple dental caries and uncooperative behavior during dental treatment. Comprehensive dental rehabilitation under general anesthesia was planned. Preoperative evaluation was performed collaboratively with pediatric cardiologists and anesthesiologists, and antibiotic prophylaxis for infective endocarditis was administered before treatment. Dental procedures included multiple restorations, stainless steel crowns, and extractions. No intraoperative complications occurred. However, during postoperative recovery, the patient developed upper airway obstruction with oxygen desaturation to 60%. The condition was promptly recognized and successfully managed without further complications.
Effective elimination of oral infectious foci helped optimize the patient’s condition for safe cardiac surgery. General anesthesia is a suitable option for pediatric patients with complex medical conditions and poor cooperation. Careful multidisciplinary planning, close monitoring, and long-term preventive care in accordance with guidelines for high-caries-risk patient groups.
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References
Hashim Mahmood, Hamza Javed, Syed Abdullah Haider, Abeeha Mahmood, Muhammad Wali. Tetralogy of Fallot: A Comprehensive Review of Pathophysiology, Diagnosis, and Management. Int ClincMed Case Rep Jour 2024;3(4):1-13.
Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002;39(12):1890-900. doi: 10.1016/s0735-1097(02)01886-7.
Chandler CL, Silva-Junior MF. Dental care of hospitalized pediatric patient with tetralogy of Fallot: a case report. RGO, Rev Gaúch Odontol 2022;70:e20220004. http://dx.doi.org/10.1590/1981-86372022000420200049
Hughes S, Balmer R, Moffat M, Willcoxson F. The dental management of children with congenital heart disease following the publication of Paediatric Congenital Heart Disease Standards and Specifications. Br Dent J 2019;226(6):447-52. doi: 10.1038/s41415-019-0094-0.
Tasioula V, Balmer R, Parsons J. Dental health and treatment in a group of children with congenital heart disease. Pediatr Dent 2008;30(4):323-8. PMID: 18767512.
Parry JA, Khan FA. Provision of dental care for medically compromised children in the UK by General Dental Practitioners. Int J Paediatr Dent 2000;10(4):322-7. doi: 10.1046/j.1365-263x.2000.00207.x.
de Freitas Miranda Filho AE, da Silva Soares DH, Alves dos Santos PL, Reis Chaves M, Marques NCT, Orsi Júnior JM, et al. Dental treatment in child with congenital heart disease under general anesthesia: Clinical case report. Res. Soc. Dev 2021;10(6):e56510615907. DOI: 10.33448/rsd-v10i6.15907.
Cahyono ID, Satoto HH, Martyarini SA. General Anesthesia Technique in Tetralogy of Fallot Patient Undergo Tooth Extraction Surgery. JAI 2019;11(1):38-41. https://doi.org/10.14710/jai.v11i1.23257.
Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, et al. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation 2021;143(20):e963-e978. doi: 10.1161/CIR.0000000000000969.
Glenny AM, Oliver R, Roberts GJ, Hooper L, Worthington HV. Antibiotics for the prophylaxis of bacterial endocarditis in dentistry. Cochrane Database Syst Rev 2013;(10):CD003813. doi: 10.1002/14651858.CD003813.pub4.
Cornejo KBZ, Brener IV, Bouchan DR. Manejo estomatológico del paciente pediátrico con cardiopatía congénita: revisión de la literatura. Univ Odontol 2011;30(64):57-66.
American Academy of Pediatric Dentistry. Antibiotic prophylaxis for dental patients at risk for infection. In: American Academy of Pediatric Dentistry. The reference manual of pediatric dentistry. Chicago (IL) : American Academy of Pediatric Dentistry ; 2023. : 542-8.
Sasmita IS, Kirana AMK, Gunawan KL. Mouth preparation management in children with atrial septal defect type of congenital heart disease under general anaesthesia. Dentika Dent J 2011;16(2):189-93.
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. J Clin Med 2023;12(11):3674. doi: 10.3390/jcm12113674.
Gedik S, Gedik R, Gedik TN. Tetralogy of Fallot: Report of 30 cases and dental considerations with review of literature. WIMJ Open 2015;2(2):102–5. DOI: 10.7727/wimjopen.2014.229
Khan MK. Management of Dental Problems in a Case of Tetralogy of Fallot. J Datta Meghe Inst Med Sci Univ 2025;20(1):171-5. DOI: 10.4103/jdmimsu.jdmimsu_667_24
Junghare SW, Desurkar V. Congenital heart diseases and anaesthesia. Indian J Anaesth 2017;61(9):744-752. doi: 10.4103/ija.IJA_415_17.
Lestari AR, Prayogo RD, Tasyakuranti MN, Indriasari L, Tedjosasongko U. Dental management in children with tetralogy of Fallot under general anesthesia: A case report. WJARR 2024;22(03):851–6. DOI: https://doi.org/10.30574/wjarr.2024.22.3.1780
FitzGerald K, Fleming P, Franklin O. Dental health and management for children with congenital heart disease. Prim Dent Care 2010;17(1):21-5. doi: 10.1308/135576110790307690.
Dunlop RM, Sanders BJ, Jones JE, Walker LA, Caldwell RL. Pulp therapy in pediatric patients with congenital heart disease: survey of American Academy of Pediatric Dentistry members. J Dent Child (Chic) 2013;80(3):139-44. PMID: 24351695
Kolçakoğlu K, Korkut DI, Yücel G, Kızılcı E. Dental approaches in children with congenital heart disease treated under general anesthesia for oral rehabilitation. Med Oral Patol Oral Cir Bucal 2024;29(4):e451-e457.doi: 10.4317/medoral.26304.
Casaña-Ruiz M, Aura-Tormos JI, Marques-Martinez L, Garcia-Miralles E, Perez-Bermejo M. Effectiveness of Space Maintainers in Pediatric Patients: A Systematic Review and Meta-Analysis. Dent J (Basel) 2025;13(1):32. doi: 10.3390/dj13010032.
Murin PJ, Wang J, Martins YC. Sleep-Disordered Breathing and Interactions with Opioids: A Narrative Review. J Clin Med 2025;14(13):4758. doi: 10.3390/jcm14134758.
Baik A, Alamoudi N, El-Housseiny A, Altuwirqi A. Fluoride Varnishes for Preventing Occlusal Dental Caries: A Review. Dent J (Basel) 2021;9(6):64. doi: 10.3390/dj9060064.
American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants, children, and adolescents. In: American Academy of Pediatric Dentistry. The Reference Manual of Pediatric Dentistry. Chicago (IL) : American Academy of Pediatric Dentistry ; 2025 : 325-31.
