|Year : 2016 | Volume
| Issue : 1 | Page : 46-49
Assessment of dental caries experience, periodontal status, and oral mucosal lesions among human immunodeficiency virus seropositives with and without antiretroviral therapy: A cross-sectional study
Vijaya Hegde, Pooja J Shetty, Shubhan Alva, S Kavery Chengappa
Department of Public Health Dentistry, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India
|Date of Web Publication||15-Mar-2016|
Pooja J Shetty
Department of Public Health Dentistry, A. J. Institute of Dental Sciences, Kuntikhana, Mangalore - 575 004, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), studies shows variations in the prevalence of oral manifestations which may be attributed to differences in prescribed medications, stages of disease, way of transmission, and inadequate diet. Aim: To assess the dental caries experience, periodontal status, and oral mucosal lesions among people living with HIV/AIDS. Materials and Methods: A cross-sectional study was conducted for a period of 2 months among 130 people above the age group of 15 years, having HIV/AIDS. Oral mucosal lesions were assessed according to the World Health Organization Oral Health Assessment Form 1997; dental caries was assessed using decayed, missing, and filled teeth (DMFT) index and periodontal status was assessed using community periodontal index of treatment needs index by a single calibrated examiner. Data on antiretroviral therapy (ART) were obtained from medical records. The data were analyzed using SPSS version 16. Level of significance was set at 0.05. Results: Majority of them were females (84.6%), and 86.2% were on ART. There was no significant difference in the DMFT score among subjects with and without ART (median = 3). Fisher's exact test did not show statistically significant difference in the periodontal status between people with or without ART. Hyperpigmentation was found in 12.5% of the study subjects with ART. Conclusions: Subjects with and without ART did not show any difference in the prevalence of dental caries or periodontal status. Hyperpigmentation was the common condition found among subjects with ART. However, further follow-up studies are required to gain insight to the long-term use of ART on oral tissues.
Keywords: Acquired immunodeficiency syndrome, dental caries, human immunodeficiency virus, oral mucosal lesions
|How to cite this article:|
Hegde V, Shetty PJ, Alva S, Chengappa S K. Assessment of dental caries experience, periodontal status, and oral mucosal lesions among human immunodeficiency virus seropositives with and without antiretroviral therapy: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:46-9
|How to cite this URL:|
Hegde V, Shetty PJ, Alva S, Chengappa S K. Assessment of dental caries experience, periodontal status, and oral mucosal lesions among human immunodeficiency virus seropositives with and without antiretroviral therapy: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Dec 6];14:46-9. Available from: http://www.jiaphd.org/text.asp?2016/14/1/46/178717
| Introduction|| |
Human immunodeficiency virus (HIV), a disease of immunosuppression, has affected millions. India has the largest number of people living with HIV outside of South Africa. The prevalence of people living with HIV/acquired immunodeficiency syndrome (AIDS) in the world is approximately 34 million and in India, approximately 2.39 million people are infected with HIV.
There is adequate research regarding the frequency of oral manifestations such as angular cheilitis, candidiasis, hairy leukoplakia, and oral pigmentation, which are considered as indicators for immunosuppression. Studies show variations in the prevalence of oral manifestations which may be attributed to differences in prescribed medications, stages of disease, way of transmission, and inadequate diet.,
Variations in the dietary pattern, oral environment, and medications used could contribute to the prevalence of caries. HIV-related periodontal disease is one of the common manifestations of the disease which might be as a result of immune suppression, poor oral hygiene, or medications. Hence, a study was conducted here to assess the dental caries experience, periodontal status, and oral mucosal lesions among HIV-seropositive patients with and without antiretroviral therapy (ART).
| Materials and Methods|| |
A cross-sectional study was conducted for a period of 2 months among 130 people living with HIV/AIDS at a rehabilitative center, an organization run by a Nongovernmental Organization, Mangalore, India. Ethical clearance was obtained from the Institutional Ethical Committee before the commencement of the study. Permission was obtained from the administrators of the organization. Subjects above the age group of 15 years, who gave informed consent, were included in the study, based on convenience sampling.
A benchmark (“Gold Standard”) examiner trained and calibrated the trainee examiner. The study proforma included information on gender, ART, and literacy level. Oral mucosal lesions were assessed according to the World Health Organization oral Health Assessment Form 1997, dental caries was assessed using decayed, missing, and filled teeth (DMFT) index and periodontal status was assessed using community periodontal index of treatment needs index by a single calibrated examiner. Oral examination was done by a single calibrated examiner, and the reliability was found to be 0.86. Data on ART were obtained from the medical records and the entire questionnaire was coded in order to maintain confidentiality.
The data were analyzed using SPSS Version 16 (Chicago, SPSS Inc). Dental caries experience among people with and without ART was analyzed using Mann–Whitney U-test. Periodontal status and oral mucosal lesions among people with and without ART were analyzed using Fisher's exact test. Level of significance was set at 0.05.
| Results|| |
Among the 130 subjects who were enrolled in the study, 15.4% were males, 84.6% were females, and the mean age was 34.22 years. Among the study subjects, 86.2% were on ART. Among the study subjects, 13.8% of them were illiterate whereas 23.1% of them had completed secondary school education (10th standard) [Table 1]. The prevalence of dental caries experience (DMFT) among study subjects with ART was 73.2% and without ART was 77.8%. [Table 2] shows that the median of the DMFT of the study subjects with and without ART was 3, and there was no statistically significant difference between them.
|Table 2: Distribution of dental caries experience among study subjects with and without antiretroviral therapy|
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Healthy periodontal status was seen in 3.6% of the study subjects with ART and 11.1% of the study subjects without ART. Calculus was seen in 42.9% of the subjects with ART and 55.6% of the subjects without ART. Shallow and deep pockets were observed in 32.1% and 14.3% of the subjects with ART. The study reveals no statistically significant difference among the study subjects with and without ART (P = 0.2) [Table 3].
|Table 3: Distribution of periodontal status among study subjects with and without antiretroviral therapy|
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[Figure 1] shows that 44.6% of the study subjects needed oral prophylaxis, and 29.2% needed oral prophylaxis and root planning.
[Table 4] shows the distribution of oral mucosal conditions among study subjects with and without ART. Hyperpigmentation was seen in 12.5% of the study subjects with ART. Lichen planus, herpes simplex, bald tongue, lichen planus with hyperpigmentation was seen in 3.6% of the study subjects, respectively. The common condition among the subjects without ART was geographic tongue. However, no statistically significant difference was seen between them.
|Table 4: Distribution of oral mucosal conditions among study subjects with and without antiretroviral therapy|
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| Discussion|| |
HIV/AIDS is a global health problem affecting the immune system. Recognition of some oral manifestations of HIV disease, predicts the severity of immune suppression and disease progression. Majority of the study subjects were females compared to males, and the mean age was 34.22 years. However, studies conducted in South India have shown a higher number of male subjects when compared to females.
The prevalence of dental caries experience among study subjects with ART was 73.2% and without ART was 77.8%. However, dental caries did not show statistically significant difference among subjects with and without ART. This may be attributed to the fact that dental caries affects all populations irrespective of their immune status. In a study conducted among HIV patients in Brazil, it was reported that the DMFT index of the participants was 16.9. Bretz et al. concluded that the prevalence of caries was high among HIV-infected population from Houston, Texas.
No statistically significant difference was observed between the periodontal status of the study subjects with and without ART (P < 0.05). This finding is similar to a study conducted by Lemos et al. and Choromanska and Waszkiel  However, Ranganathan et al. revealed a greater severity and breakdown of periodontal tissues among HIV-infected. Kiran and Shetty  reported a severe periodontal breakdown with 9% of the subjects showing linear gingival erythema and 3.5% of them with necrotizing ulcerative gingivitis. The differences could be due to different indices used to record periodontal status, or it may show that immunodeficiency alone does not predispose to periodontal problems.
Hyperpigmentation was the most common finding among subjects on ART. According to a study done by Patil et al., 8.2% of the study subjects had hyperpigmentation and a prevalence of 38% was reported by Bravo et al. among Venezuelan population. Davoodi et al. reported that 42% of the study subjects of Iran had hyperpigmentation. This could be due to adrenocortical involvement by parasites giving rise to adrenal insufficiency and drugs such as azidothymidine used in ART, which leads to pigmentation. Disregulation of cytokines in HIV-infected persons promote an increased release of alpha-melanocyte stimulating hormone which may lead to mucosal hyperpigmentation. However, the presence of lichen planus, herpes simplex, and candidiasis was relatively low, which is in disagreement to other studies.
These marked differences in the prevalence of HIV-related oral lesions could be due to differences in the prescribed medications, the stage of the disease or the way of transmission. Other factors may be the examiner variability and different diagnostic criteria used. Although HIV is a disease causing immunosuppression, the study results do not show profound difference in dental caries experience, periodontal status and oral mucosal conditions among subjects with and without ART, which might be attributed to prescribed medications, stages of disease, immune status, and diet consumed. Hyperpigmentation was the common condition seen among subjects with ART, which could be attributed to medications.
There are some limitations in this study as this was conducted among institutionalized subjects representing a small sample where in-house medical and dental care is provided. Study subjects should have been compared according to their CD4 counts instead of those with and without ART.
The data obtained about the oral manifestations in people living with HIV/AIDS will enable us to plan and implement preventive and curative oral health programs. However, further follow-up studies with control group is required to gain insight into oral and perioral manifestations among HIV-infected.
| Conclusion|| |
Individuals on ART had a higher prevalence of oral mucosal lesions and periodontal diseases, but it was not statistically significant. There was no statistically significant difference in the dental caries experience among individuals with and without ART.
We acknowledge all the participants for being a part of this study. We also acknowledge the Indian Council of Medical Research for providing short-term studentship grant.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sontakke SA, Umarji HR, Karjodkar F. Comparison of oral manifestations with CD4 count in HIV-infected patients. Indian J Dent Res 2011;22:732.
Sumeena. Current epidemiological scenario of HIV/AIDS in India: National response; a rhetoric or reality. Int J Interdiscip Multidiscip Stud 2014;1:191-201.
Aleixo RQ, Scherma AP, Guimarães G, Cortelli JR, Cortelli SC. DMFT index and oral mucosal lesions associated with HIV infection: Cross-sectional study in Porto Velho, Amazonian region – Brazil. Braz J Infect Dis 2010;14:449-56.
Davoodi P, Hamian M, Nourbaksh R, Ahmadi Motamayel F. Oral manifestations related to CD4 lymphocyte count in HIV-positive patients. J Dent Res Dent Clin Dent Prospects 2010;4:115-9.
World Health Organization. Oral Health Surveys: Basic Methods. 4th
ed. Geneva: World Health Organization; 1997.
Patil BA, Mubeen, Ganapathy KS. Correlation of oral manifestations with circulating CD4+T lymphocytes in patients with HIV/AIDS in Indian Subpopulation. J Indian Acad Oral Med Radiol 2011;23:502-6.
Bretz WA, Flaitz C, Moretti A, Corby P, Schneider LG, Nichols CM. Medication usage and dental caries outcome-related variables in HIV/AIDS patients. AIDS Patient Care STDS 2000;14:549-54.
Lemos SS, Oliveira FA, Vencio EF. Periodontal disease and oral hygiene benefits in HIV seropositive and AIDS patients. Med Oral Patol Oral Cir Bucal 2010;15:e417-21.
Choromanska M, Waszkiel D. Periodontal status and treatment needs in HIV-infected patients. Adv Med Sci 2006;51 Suppl 1:110-3.
Ranganathan K, Magesh KT, Kumarasamy N, Solomon S, Viswanathan R, Johnson NW. Greater severity and extent of periodontal breakdown in 136 South Indian human immunodeficiency virus seropositive patients than in normal controls: A comparative study using community periodontal index of treatment needs. Indian J Dent Res 2007;18:55-9.
Kiran K, Shetty S. Oral and periodontal manifestations among HIV population in Southern India. Int J Basic Appl Med Sci 2013;3:184-9.
Bravo IM, Correnti M, Escalona L, Perrone M, Brito A, Tovar V, et al.
Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population. Med Oral Patol Oral Cir Bucal 2006;11:E33-9.
Masiiwa A, Naidoo S. Oral lesions in HIV-infected patients, before and after antiretroviral treatment. South Afr J Epidemiol Infect 2011;26:271-3.
[Table 1], [Table 2], [Table 3], [Table 4]