Oral Health Considerations in HIV-Infected Children
- 461 Downloads
Children with the human immunodeficiency virus (HIV) have a higher probability of hard and soft oral tissue diseases because of their compromised immune systems and socioeconomic factors such as poor access to medical and dental care and limited availability of fluoridated water or toothpaste. To improve health outcomes and help monitor the progression of HIV, a preventive, child-specific oral health protocol for children with HIV that is easy to use and appropriate for all different resource settings should be established. Further, both medical and dental health practitioners should incorporate such a protocol into their care routine for HIV-infected children. Using proactive oral health risk assessments complemented by scheduled follow-up visits based on individual risk determination can prevent opportunistic infection, track the HIV disease trajectory, and monitor the effectiveness of highly active antiretroviral therapy (HAART) while improving the quality of life and longevity of children living with HIV.
KeywordsPediatrics Oral health HIV Oral manifestations Co-infections HIV-infected children Early childhood caries (ECC) Caries management by risk assessment (CAMBRA)
The authors wish to recognize and thank Eric C. Chen, Eric Lan, Rebecca Pizzitola, and Debra L. Tom for their research, technical writing and editorial assistance.
Compliance with Ethics Guidelines
Conflict of Interest
Franciso J. Ramos-Gomez declares that he has no conflict of interest.
Morenike Oluwatoyin Folayan declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• Joint United Nations Programme on HIV/AIDS. Global report: UNAIDS report on the global AIDS epidemic 2012. UNAIDS / JC2417E. 2012. Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_en.pdf.Accessed April 4, 2013. Summary of the state of HIV worldwide.
- 2.• Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveillance Report, Supplemental Report. 2012;17:1–27. Available at: http://www.cdc.gov/hiv/surveillance/resources/reports/2010supp_vol17no3/index.htm. Accessed April 5, 2013. This is a summary of the state of HIV in the United States.
- 3.Petersen PE. The world oral health report 2003: continuous improvement of oral health in the 21st century—the approach of the WHO global health programme. Community Dent Oral Epidemiol. 2003;31:3–24. Available at: http://www.who.int/oral_health/media/en/orh_report03_en.pdf. Accessed April 4, 2013.
- 6.• American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC); classifications, consequences, and preventive strategies. Pediatr Dent. 2011;33(Special Issue):24–5. This is a policy statement.Google Scholar
- 8.U.S. Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.Google Scholar
- 10.Exposito-Delgado AJ, Valleio-Bolanos AE, Martos-Cobo E. Oral manifestations of HIV infection in infants: a review article. Med Oral Pathol Oral Cir Bucal. 2004;9:410–20.Google Scholar
- 12.•• Patton L et al. Urban legends series: oral manifestations of HIV infection. Oral Dis. 2013;10:1–18. This discusses HIV oral lesion identification in children.Google Scholar
- 16.Adejuyigbe EO, Owotade FJ, Folayan MO, Adedigba M, Anyabolu H. Oro-facial lesion in human immunodeficiency virus infected children in Ile-Ife, Nigeria. J Paediat Infect Dis. 2007;2:1–6.Google Scholar
- 25.Allan JD, Connolly KJ, Fitch H, Jackson-Pope L, McLaren C, Canetta R, et al. Long-term follow-up of didanosine administered orally twice daily to patients with advanced human immunodeficiency virus infection and hematologic intolerance of zidovudine. Clin Infect Dis. 1993;16 Suppl 1:S46–51.PubMedCrossRefGoogle Scholar
- 42.Abiona TC. Growth patterns of exclusively breastfed infants in Ife Central Local Government Area, Osun State: implications for timing of complimentary feeding. Dissertation, National Postgraduate Medical College, Nigeria, submitted. 2001.Google Scholar
- 45.Kottler DP. Nutritional support in AIDS. Am J Gastroenterol. 1990;86:539–41.Google Scholar
- 52.Holderbaum RM, Veeck EB, Oliveira HW, da Silva CL, Fernandes A. Comparison among dental, skeletal and chronological development in HIV-positive children: a radiographic study. Braz Oral Res. 2005;19. http://dx.doi.org/10.1590/S1806-83242005000300010 Accessed August 15, 2011.
- 54.Nahirya-Ntege P, et al. Young HIV-infected children and their adult caregivers prefer tablets to syrup antiretroviral medications in Africa. Plos One. 2012. Retrieved April 12, 2013 from http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036186.
- 55.Hick M et al. Dental caries in HIV-infected children: a longitudinal study. Pediatr Dent. 2000;22:359–63.Google Scholar
- 56.Howell R et al. Oral soft tissue manifestations and CD4 lymphocyte counts in HIV-infected children. Pediatr Dent. 1996;18:129–36.Google Scholar
- 57.•• Beema J. Prevalence of dental caries and its correlation with the immunologic profile in HIV-infected children on antiretroviral therapy. Eur J Paediatr Dent. 2011;12:87–90. This reference found a decrease in the absolute lymphocyte count associated with an increase in caries prevalence.Google Scholar
- 58.Ramos-Gomez F et al. Orofacial manifestations and management of HIV-infected children. Oral Maxillofac Surg Child Adolesc. 1994;6:37–47.Google Scholar
- 60.Shapiro M, et al. Access to HIV care: initial results from the HIV Cost and Services Utilization Study. Santa Monica, CA: RAND Corporation. 2000. Retrieved April 8, 2013 from http://www.rand.org/pubs/research_briefs/RB4530.
- 61.Peterson PE. Policy for prevention of oral manifestations in HIV/AIDS: the approach of the WHO Global Oral Health Program. Advances in Dental Research. 2006;19:17–20. Retrieved April 8, 2013 from http://www.who.int/oral_health/action/communicable/Policy.pdf.
- 63.• Ramos-Gomez F et al. Mother and youth access (MAYA) maternal chlorhexidine, counseling and pediatric fluoride varnish randomized clinical trial to prevent early childhood caries. Int J Paediatr Dent. 2011;22:1–11. This discusses the transmission of maternal bacteria strains to newborn infants of high risk, low income mothers.Google Scholar
- 64.Ramos-Gomez F, Ng M. Six step protocol for a successful infant oral care visit. Pediatr Dent Today. 2009;2009:38–40.Google Scholar
- 66.•• Ramoz-Gomez F, Ng M. Into the future: keeping healthy teeth caries free: pediatric CAMBRA protocols. J Calif Dent Assoc. 2011;38:723–33. Caries risk assessment and infant oral care protocol.Google Scholar
- 68.Ramos-Gomez F, Greenspan D, Greenspan J. Orofacial manifestations and management of HIV-infected children. Oral Maxillofac Surg Clin N Am. 1994;6:37–47.Google Scholar
- 70.Reznik D. Oral manifestations of HIV disease. Top HIV Med. 2005;135:143–8.Google Scholar
- 74.Folayan MO, Ozeigbe EO, Oyedele T, Ola D. Factors limiting dental service utilization by pupils in Ile-Ife, Nigeria. Unpublished work.Google Scholar
- 76.• American Academy of Pediatric Dentistry. Policy on the dental home. Pediatr Dent. 2011;33(Special Issue):24–5. This is a policy statement.Google Scholar
- 77.• American Academy of Pediatric Dentistry. Guideline on caries risk assessment and management for infants, children, and adolescents. Pediatr Dent. 2011;34(Special Issue):118–25. Retrieved April 11, 2013 from http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment.pdf. This is a policy statement.
- 78.American Dental Association. ADA statement on early childhood caries. 2004. Retrieved April 11, 2013 from http://www.ada.org/2057.aspx.
- 79.American Association of Public Health Dentistry. First oral health assessment policy. 2004. Retrieved April 11, 2013 from http://aaphd.org/default.asp?page=FirstHealthPolicy.htm.