Dentistry

• Dental hygiene is of the utmost importance from as early an age as possible - brush 2-3 times daily at least 1 hour after meals, restrict food to mealtimes (unless your kid has eating problems and needs frequent fuelling) in order to reduce decay risk. Encourage tongue brushing/cleaning, especially if you child has a cardiac problem as it reduces the risk of endocarditis.

• Use a fluoride toothpaste or fluoride supplement, unless you have heavily fluoridated water already anyway, from the moment your child has their first tooth.

• Visit the dentist regularly, usually every 3 months as opposed to the recommended 6 months

• Any child with cardiac problems should be given an antibiotic 1 hour prior to dental procedures, even a scale and polish

• She said that an x-ray at Angus' age would tell them about all the teeth he was missing, but she didn't want to do it until he was in for any necessary procedure requiring a general anaesthetic - she would do it then along with any other dental work.

• Braces can be useful during the teen years to fill or maintain gaps ready for implants or partial dentures once the full complement of adult teeth are through.

• Coatings can be put on the fissures in the molars to prevent decay, but little kids who can't sit still, need an anaesthetic for this, so don't bother if your child has heart and lung problems until they're in for a procedure needing anaesthetic anyway. Fluoride treatments can be applied to teeth as well to toughen up the enamel.

• Partial dentures (plate) can be given to young children to fill in the gaps but only if they're upset about the way they look, and they'll tolerate them.

• The bad news for parents of kids with heart problems is that dental implants are inadvisable as they present a constant endocarditis risk. Children with heart problems will be far safer with bridgework and partial dentures to fill gaps as adults.

• If your child is 100% tube fed then they can't get dental caries. They can get tartar build up however, and this can become a problem if it builds up along the gum line. It's still very important to get them used to having their teeth brushed.

So, if your child has no heart or lung problems, then just take them to the dentist more often and be very strict with dental hygiene to protect that very thin enamel. Have full x-rays done at some point during childhood to determine whether they'll benefit from orthodontic treatment during their teens pending implants or bridgework as adults.

If your child has got heart problems then inform their dentist when they're going in for any procedure requiring a general anaesthetic so that their dental work can be done at the same time, thus reducing risks to their health with too many unnecessary anaesthetics.

Malocclusion (a mismatch when you clamp your teeth together to bite or chew) is common in children with EvC because of missing and mis-shapen teeth top and bottom. Good orthodontic treatment with braces and partial dentures to maintain, widen or close gaps can help. If the problem is due to skeletal abnormalities of the jaw bones, then surgery will be required. This is not common, however.