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DP52: IMPACT OF INEQUITIES IN ACCESS TO ORAL HEALTH CARE ON TIMING OF PEDIATRIC CARDIAC PROCEDURES
Riya Gupta1; Timothy M Maul, PhD, CCP2; Sofia Salazar, PhD2; Karen S Bender, MD2
1University of Central Florida College of Medicine; 2Nemours Children's Hospital
Introduction: Children with congenital heart disease (CHD) often require timely cardiac interventions to improve survival rates and quality of life. Children with CHD requiring cardiac intervention are at risk for infective endocarditis related to poor oral health and dental disease. Comprehensive dental evaluations and treatments are often required before cardiac surgeries to mitigate this risk.
At the Nemours Children’s Hospital (NCH) Cardiac Center, some patients with CHD may experience delays in cardiac procedures due to challenges in accessing timely dental care. Factors such as socioeconomic status (SES), insurance coverage, and geographic location may contribute to these delays. While prior studies have examined disparities in preventive dental care access among children with congenital heart disease, no published studies to date have specifically quantified how these barriers influence the timing of dental clearance prior to cardiac procedures in children with cardiac diagnoses.
The objective of this study is to evaluate whether a delay in completing cardiac procedures due to difficulty in achieving dental clearance is associated with age, race/ethnicity, insurance status, and estimated SES disadvantage based on ZIP code among patients with CHD at NCH, Orlando, FL.
Methods: This is an IRB-approved retrospective chart review of NCH Cardiac Center patients age 2 years or older that received an elective cardiac surgery, cardiac catheterization, electrophysiology study, or ICD/pacemaker implant between January 1, 2021, and June 1, 2025. Procedures with a preoperative dental evaluation were included. Emergent procedures were excluded. The presence of procedure delay and the number of days delayed were determined from the date of request of dental evaluation compared to the dates of scheduled vs. actual procedure dates. SES measures (poverty rate, unemployment rate, and median household income) were derived from the American Community Survey Selected Economic Characteristics Table based on Florida ZIP codes. Statistical analyses include chi-square and Mann-Whitney U tests, with forward stepwise logistic regression to analyze predictors of delay. Predictors were chosen based on goodness-of-fit tests. Analyses were performed in SPSS v25.
Results: Of 919 procedures screened, 126 included documentation of dental clearance, and 114 procedures from 85 unique patients met inclusion criteria. Age and unemployment rate were independently associated with the presence of delay. The median delay duration was 320.5 days (IQR 79.5–438.3). Demographic characteristics and cardiac condition/procedure distributions are summarized in Tables 1 and 2. Logistic regression results are presented in Table 3.
Discussion/Conclusion: These findings suggest that unemployment rate and age may contribute to dental clearance–related delays in pediatric cardiac care. This study is limited by small sample size; a larger cohort is needed to meaningfully add other predictors to the model and to quantitatively analyze the number of days delayed based on predictors. The retrospective design limits causal inference because of potential unmeasured confounders that could bias results. Future studies should examine additional SES factors, such as primary language and distance from the hospital. Interventions targeting dental care access may help reduce disparities and improve timeliness of cardiac care in children with CHD.
