Oral health status and HIV related oral manifestations of children and adolescents living with HIV/AIDS aged 2-15 yrs in Nairobi and Mombasa
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Background: HIV infection in children is associated with immune suppression and susceptibility to various opportunistic infections. There is also an increased risk of dental diseases. Objective: Was to determine the oral health status and HIV related oral manifestations in children living with HIV/AIDS. Setting: Nyumbani and New Life childrens homes and outpatient Comprehensive Care Centres at Kenyatta National Hospital and Coast Province General Hospital. Study design: Cross-sectional descriptive study over a period of three months. Subjects: Two hundred and thirty seven children aged between 2-15 years living with HIV infection/AIDS. Methodology: The parents /guardians of the children answered a structured questionnaire on the oral health practices, oral complaints and whether the children were on ARV's. A clinical oro-facial examination of the study subjects was undertaken to determine the oral health status and prevalence of HIV oral lesions. The findings were then recorded in a modified WHO oral health assessment form. The data were analysed using S.P.S.S. version 11.0. Descriptive and inferential statistics were done using the X2,Mann Whitney U, Kruskal-Wallis and Student T tests setting the p value at 0.05. Results: Of the 237 participants, there were 112(47.3%) males and 125(52.7%) females, with mean age of 7.5 years. A fair oral hygiene was elicited in 161(67.9%) while 49(20.7%) presented with high plaque scores and only 27(11.4%) had good oral hygiene. Two hundred and five (86.5%) children presented with gingivitis among whom 115(48.5%) had mild gingivitis, 89(37.6%) moderate gingivitis and one child (0.4%) severe gingivitis. The deciduous dentition caries prevalence was 84.4% with a mean dmft of 6.38(± S05.45). Caries prevalence in the permanent dentition was 78.3% and the mean OMFT score was 3.35 (± SO 3.55). The dental parameters varied according to the study centres, gender, oral health practices, oral complaints and immune suppression state. The prevalence of HIV related oral manifestations was 45.8%. Candidiasis was the most common (40.9%), 6.3% had oral ulcerations, 3.7% bilateral parotid 4 enlargement and 1.7% linear gingival erythema. The frequency of oral manifestations was higher amongst children from the Comprehensive Care Centers (p<O.05), those with increased severity of gingivitis, primary dentition caries, poor oral health practices, and oral complaints (p<0.05). Conclusion: The oral health status of children living with HIV/AIOS is generally poor with a high prevalence of dental disease and HIV related oral manifestations. Recommendations: Primary care of HIV infected children should include dental management to alleviate symptoms associated with oral opportunistic infections related to HIV infection and institution of preventive oral health care measures.