Clinicians’ Perspectives On Challenges In Complying With The National Cardiac Standards On Dental Care Of Children With Congenital Heart Disease: A Two Part Study

Background: Children with congenital heart disease are often at increased risk of infective
endocarditis and its associated mortalities. Meticulous dental care and prevention in this
cohort of children is of extreme importance.
Aim: To explore compliance of children in Yorkshire with congenital heart disease, born
subsequent to the implementation of the Congenital Heart Disease Standards and
Specifications (CHDS) 2016.
Design: This two-part study looked at the proportion of children appropriately referred for
specialist paediatric dental screening at the age of two years within Yorkshire and the Humber.
Semi-structured interviews were subsequently conducted using the theoretical domains
framework to identify and describe current behaviours and barriers amongst cardiology
consultants, nurses and paediatric dental specialists and consultants.
Results: One patient of the 49 had been referred for dental screening as per the standards.
Five core themes were identified during interviews. Clarification of standards was raised by the
dentists, for example who should screen the patient and follow them up. In general, clinical
priority was given to the referrals received from cardiology. Challenges associated with the
current referral process included a lack of delegation amongst staff. Organisation barriers were
predominantly based on the lack of specialist dentists in the region and the lack of nursing
staff to do the referrals. The value of communication between cardiology and paediatric
dentistry was also highlighted.
Conclusions: The standards are not well implemented at present, with low numbers being
referred. Barriers need to be discussed within the region to help overcome them.