Supplementary Material for: Early counselling to improve oral health behavior in children with major congenital heart defects – a randomized controlled trial

Maintaining optimal oral health behavior in children with a congenital heart defect (CHD) is important in managing the risk for caries development and infective endocarditis. The aim of this study was to evaluate the impact of an early and repeat oral health promotion intervention (OHPI) among of children with major CHD. Randomized controlled trial including 72 out of 91 children born in Finland 1.4.2017-31.10.2020 with a) major CHD potentially included in the criteria of endocarditis prophylaxis or b) any CHD with surgical repair combined with a chromosomal syndrome. A parallel passive control (C) group of 87 healthy children were recruited at birth. CHD children were randomized 1:1 to intervention (CHD-I) and control (CHD-C) groups. The OHPI included counselling by motivational interviewing, home delivered toothpaste and toothbrushes, and written information, and was provided at baseline, 6, 12, and 18 months of age to CHD-I group. The primary outcome measure at 24 months was child’s oral health behavior (toothbrushing, sugar intake, and dental care contact). The secondary outcome measures were parents’ awareness of the importance of oral health behavior, and oral health behavior as a predictor for child behavior. At 24 months, toothbrushing was performed twice a day in 20/27 (74%) among CHD-I, in 13/30 (43 %) among CHD-C (CHD-I vs CHD-C p=0.031), and in 37/50 (74 %) among healthy comparisons (CHD-C vs C p=0.009). Electric toothbrush use was 12/27 (44 %) in CHD-I, 5/30 (17 %) in CHD-C (CHD-I vs CHD-C p=0.041), and 7/50 (14%) in healthy comparison (CHD-C vs C p=0.756) children. Among CHD-I, toothbrushing and use of electric toothbrush improved between 12 months and 24 months. Sugar drink intake was more common among CHD-C (CHD-C vs C p=0.015), but comparable to CHD-I children. Parental toothbrushing predicted child toothbrushing twice a day. There were no statistical group differences in dental care contact. Children with CHD are at risk for poor oral health behavior. This could be improved with early and repeat oral health promotion parental counselling.

对于患有先天性心脏病（CHD）的儿童而言，维持最优口腔健康行为，对控制龋病发生与感染性心内膜炎的发病风险具有重要意义。本研究旨在评估早期重复实施的口腔健康促进干预（OHPI）对患有重症先天性心脏病儿童的影响。

本研究为随机对照试验，纳入了2017年4月1日至2020年10月31日在芬兰出生的91名儿童中的72名，纳入标准为：a）符合心内膜炎预防指征的重症先天性心脏病患儿；或b）合并染色体综合征且接受手术修复的各类先天性心脏病患儿。另在新生儿阶段招募了87名健康儿童作为平行被动对照（C）组。先天性心脏病患儿按1:1比例随机分为干预组（CHD-I）与对照组（CHD-C）。

CHD-I组在基线、患儿6、12及18月龄时接受口腔健康促进干预，具体内容包括动机访谈咨询、家庭赠送牙膏与牙刷，以及书面健康指导。

本研究的主要结局指标为患儿24月龄时的口腔健康行为（包括刷牙行为、糖摄入情况及牙科就诊情况）；次要结局指标则为家长对口腔健康行为重要性的认知，以及口腔健康行为对儿童行为的预测价值。

在24月龄时，CHD-I组中有20/27例（74%）儿童每日刷牙2次，CHD-C组为13/30例（43%）（CHD-I组 vs CHD-C组，p=0.031），健康对照组为37/50例（74%）（CHD-C组 vs C组，p=0.009）。电动牙刷使用情况方面，CHD-I组为12/27例（44%），CHD-C组为5/30例（17%）（CHD-I组 vs CHD-C组，p=0.041），健康对照组为7/50例（14%）（CHD-C组 vs C组，p=0.756）。在CHD-I组中，患儿的刷牙行为与电动牙刷使用率在12月龄至24月龄间有所提升。含糖饮料摄入在CHD-C组中更为常见（CHD-C组 vs C组，p=0.015），但与CHD-I组无显著差异。家长的刷牙行为可预测儿童每日2次的刷牙行为。各组间的牙科就诊情况无统计学差异。

先天性心脏病儿童存在口腔健康行为不佳的风险，而通过早期重复开展的口腔健康促进与家长咨询，可有效改善这一状况。