04/23/2010 Prevalence of orodental findings in HIV-infected Romanian children

Resident: J. Hencler
Date: 04/23/2010
Article title: Prevalence of orodental findings in HIV-infected Romanian children
Author(s): Flaitz, DDS, MS et al
Journal: Pediatric Dentistry-23:1, 2001

Major topic: orodental findings in HIV-infected children

Type of Article: Observational

Main Purpose:
Assess the prevalence of orodental conditions in symptomatic HIV+ Romanian children.

Background:
One of the highest concentrations of children living with HIV is in Romania. They represent about 90% of all AIDS cases in Romania. Most were not infected through vertical transmission, but rather from HIV-contaminated blood products. The practice of micro-transfusions for neonates and reuse of contaminated needles in hospitals and orphanages accounts for the high HIV infection rate in Romanian children.

Overview of method of research:
Study population consisted of 173 HIV+ children who received dental care during an 8-day period from a volunteer American dental team. Med hx reviewed and screened for the need of antibiotic prophylaxis. Extremely moribund patients or ones with active TB were excluded from the study. All oral and perioral lesions, selected cutaneous lesions, permanent tooth eruption patterns, and primary and permanent dentition caries (dfs/dft, DMFS/DMFT) were recorded by 4 dentists.

Findings:
A wide variety of HIV-associated oral and perioral lesions were found. The most common manifestations included candidal infections, oral and perioral ulcers, salivary gland enlargement, NUG/PD, and linear gingival erythema. Viral-associated lesions found less commonly were labial molluscum contagiosum, oral warts, hairy leukoplakia, and herpes zoster. One or more oral/perioral lesions were found in 55% of children. Many of the children had florid cutaneous diseases due to their immunocompromised status. Dental caries in both the permanent and primary teeth were considerable. Post-op complications were noted most often with EXT due to delayed clotting as a result of HIV-associated idiopathic thrombocytopenia purpura (ITP).

Key points in the article discussion:
Candidiasis is a well recognized indicator of immune compromise and in HIV infection is a prognostic indicator of progressive disease. This was the most common oral disease in the Romanian children with almost 1/3 affected. Documented risk factors for the development of oropharyngeal candidiasis include failure to thrive, lack of anti-retroviral drug use, low CD4, and immune suppression. The occurrence of oral and perioral ulcers was similar to a 3 year longitudinal US study and included herpes labialis, aphthous stomatitis, and necrotizing stomatitis. Dental caries was considerable in both the permanent and primary dentitions. Although caries prevalence in Romanian children is markedly higher than that for the US and Europe, the HIV+ children had an even greater extent and severity of caries than their non-infected counterparts in their own nation. Both delayed eruption of the permanent teeth and over-retention of primary teeth were common findings in this study. A major concern in providing dental care for HIV-infected children in developing countries is lack of available laboratory test, especially hematologic screenings. It was discovered that delayed clotting following EXT was a common occurrence, which required close f/u. ITP secondary to HIV infection was associated with hemorrhage following EXTs. ITP can be the result of antibody-mediated platelet destruction or bone marrow failure.

Summary of conclusions:
The oral health needs of HIV infected children in developing countries are considerable, ranging from rampant caries to a wide variety of mucocutaneaous infections. Although most of these children can tolerate dental procedures, the potential risk for post-op bleeding complications is a concern when surgical procedures are required.

Assessment of article:
Good article, very sad story. The high prevalence of HIV+ children in Romania and the poor medical practices that have contributed to the spread of HIV to these children is shocking. This is a very sad situation to say the least.