|Year : 2016 | Volume
| Issue : 2 | Page : 103-106
Dental caries status in human immunodeficiency virus-positive and acquired immunodeficiency syndrome patients
Amit Malhotra1, Jyoti Ahlawat1, Mithra N Hegde2, Ananya Mahajan3
1 Department of Conservative Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
2 Department of Conservative Dentistry, A.B. Shetty Memorial Institute of Dental Science, Mangalore, Karnataka, India
3 Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
|Date of Submission||02-May-2016|
|Date of Acceptance||04-Aug-2016|
|Date of Web Publication||16-Nov-2016|
Dr. Amit Malhotra
Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
Purpose: There is a major population suffering from human immunodeficiency virus (HIV) infection in the world yet not many studies documenting dental caries disease status in HIV +ve and acquired immunodeficiency syndrome patients are published. The present research was aimed to assess dental caries in HIV infected population, through measurement of decayed, missing, and filled (DMF) index.
Materials and Methods: The study is a randomized and cross-sectional in nature. A total of One hundred HIV +ve patients were analyzed. They were distributed into two test groups: Group I (test) - 50 patients evidently HIV +ve with CD4 count >200 and Group II (test) - 50 patients evidently HIV +ve with CD4 count more than 200, respectively, whereas Group III (control) included 50 HIV −ve patients. Information was collected and analyzed regarding age, gender, skin color, habits, general and oral diseases, highly active antiretroviral therapy.
Results: The mean DMF teeth score for Group I, Group II, and Control Group were found to be 17.64, 17.30, and 11.462, respectively. The results were analyzed using ANOVA and Tukey HSD, the difference in caries status was found to be very highly significant between both Group I and control, Group II and control; but was not significant in between the test groups, Group I and Group II.
Conclusion: An increase in dental caries was observed in HIV + ve individuals as compared to normal population but it did not increase markedly with a decrease in CD4 count.
Keywords: Acquired immune deficiency syndrome, dental caries, human immunodeficiency virus
|How to cite this article:|
Malhotra A, Ahlawat J, Hegde MN, Mahajan A. Dental caries status in human immunodeficiency virus-positive and acquired immunodeficiency syndrome patients. Indian J Oral Sci 2016;7:103-6
|How to cite this URL:|
Malhotra A, Ahlawat J, Hegde MN, Mahajan A. Dental caries status in human immunodeficiency virus-positive and acquired immunodeficiency syndrome patients. Indian J Oral Sci [serial online] 2016 [cited 2019 Sep 21];7:103-6. Available from: http://www.indjos.com/text.asp?2016/7/2/103/194235
| Introduction|| |
The acquired immunodeficiency syndrome (AIDS) was and still is one of the pathologies of greatest interest for the international scientific community; consequently, information about it has greatly advanced in a relatively short time. AIDS is an advanced stage of human immunodeficiency virus (HIV) infection when CD4 count is below 200/cu.mm.  AIDS incidence and mortality rate has become reduced in some countries, after the introduction of highly active antiretroviral therapy (HAART), but undesirable adverse effects related to the therapy itself became noticeable, many of which occur in the oral cavity. Among the many adverse effects, we have identified xerostomia and dental caries, which is present in most patients living with HIV, and has been attributed to HIV contamination itself and/or due to immunosuppression as well as because of treatment with HAART. 
Reports of oral findings associated with HIV infection have focused on oral mucosal lesions and periodontal disease. Studies that include dental caries experience in HIV-seropositive adults are rare. 
The review of literature revealed that: (1) Studies documenting the effect of advanced HIV disease on salivary secretion and dental caries were not there, (2) there was no justifiable standardization of age, gender of enrolled subjects, (3) no attention was paid to the existing medical conditions such as hypertension and diabetes which by itself affect the salivary factors and in turn dental caries, (4) there is a major population suffering from HIV infection in India but no study of their caries experience has been documented.
| Materials and Methods|| |
One hundred and fifty individuals, of both genders, between 20 and 40-year-old were included in the study. The ethical clearance was taken from the respective institutions. The 100 HIV+ve patients were divided into two groups based on their CD 4 lymphocyte count as follows:
- Group I - 50 with CD 4 lymphocyte count <200/cu.mm
- Group II - 50 with CD4 lymphocyte count ≥200/cu.mm
- Control group comprising 50 patients.
The study was done in following centers:
- ART Centre, Wenlock Hospital, Mangalore
- A.B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore
- K.S. Hegde Medical Academy (OPD of Medical College), Deralakatte, Mangalore.
Selection criterion followed for the test group
- All proven cases of HIV status with one Western Blot and two enzyme-linked immunosorbent assay (ELISA) test positive
- Subjects between the age group of 20 and 40 years.
Selection criteria followed in case of control patients
- Subjects yielding negative results for ELISA test
- Subject in a healthy state both intra-orally and extra-orally.
- Patient suffering from chronic disease
- Subject under any kind of medication.
All subjects in moribund stage or in terminal stage of illness or who could not be followed up for longer duration were also excluded from the study.
Procedure followed for recruitment of subject
Subjects who satisfied the inclusion criteria were given the complete information regarding the nature of study, their participatory role with respect to physical examination and implication of the study. They were also asked to sign an informed consent form before their recruitment into study.
The case history was recorded in a prescribed format and oral examination was done.
- Examination was performed with subject seated comfortably
- Standard codes were used for recording data which enabled proper data processing
- Examination was carried out with autoclaved instruments for each subject.
The oral examination was performed by the researcher himself, after training and calibration by the supervisor, which consisted of standardization of the methodology applied in the collection of data, such as detection of oral cavity diseases, decayed, missing, and filled teeth (DMFT) index and using personal protection equipment. In all three groups, the DMFT index was determined. Clinical examination of the oral cavity was done with relative isolation, mirror, and an exploratory probe, using artificial lightning. Lack of teeth, presence of cavities, and restored teeth were evaluated.
DMFT/dmft index was measured by calculating the number of DMFT fulfilling the following criteria:
D/d = The number of decayed teeth - Teeth with active untreated decay
- If a tooth has both decay and a filling only decay is counted, not the filling.
- If recurrent decay is present, it is counted as decay, not filling.
M/m = the number of teeth missing
A tooth is counted as missing only if due to dental caries, NOT due to periodontal, orthodontic, extraction or trauma.
M = Based on 28 teeth permanent dentition (third molars were excluded).
F/f = the number of filled teeth
All the readings were recorded on the WHO oral health assessment form.
The study is a randomized cross-sectional study and point prevalence of each carious lesion was noted. Since the nature of data congregated was nominal, ANOVA, and Tukey HSD were used to compare the three groups. "P value" was ascertained and the value of <0.05 was interpreted as significant.
| Results|| |
The subjects enrolled in the study were in the age group of 20-40 years with the mean age of 30-33 years in all the three groups. The demographic data of the subjects has been summarized [Graph 1].
The mean DMFT score for Group I, Group II, and control group were found to be 17.64, 17.30, and 11.462, respectively. The mean DMFT score was found to be more in males than females and more in 31-40 age group than 21-30 years though the difference is not significant [Graph 2].
The ANOVA test was used to compare three groups, the result showed very high significance [Table 1].
|Table 1: Comparison of decayed, missing and filled teeth between acquired immunodeficiency syndrome infected, human immunodeficiency virus‑positive and human immunodeficiency virus‑negative using the ANOVA test|
Click here to view
The intergroup comparison results using Tukey HSD between both Group I and control, Group II and control were found to be very highly significant; but was not significant in between the test groups, Group I and Group II [Table 2].
|Table 2: Intergroup comparison of decayed, missing and filled teeth using the Tukey honest significant difference test|
Click here to view
| Discussion|| |
The most common method of recording caries for epidemiological studies is the DMFT index and DMF surfaces. 
This study showed a very highly significant relationship between HIV infection and dental caries. This is in accordance with the results found by Phelan et al.  The increase was found to be more in males than females and in the 31-40 age group but our results differed from those observed in studies relating the same factors on normal population. , This difference is may be due to the decreased average CD4 count in males enrolled for the study and because specific time of onset of the disease was not taken into consideration.
The increase in dental caries may be attributed to the decreased immune-competence of the HIV infected individual as has been found in other immuno-compromised conditions. 
The various studies showed changes in saliva and increase in dental caries in systemic diseases, hence the study was done in subjects with the absence of systemic diseases affecting saliva which would have acted as confounding factors. 
Candida albicans being the opportunistic organism in oral cavity is well known.  The dentinal carious lesions in HIV infection harbor the causative organisms for oral candidal infection, so it is important to study the load of dental caries in HIV population. ,,
The influence of saliva on the caries process is fundamental; in some way, saliva affects all three components of Keye's classic Venn diagram of caries etiology (that is, tooth, plaque, and substrate). Salivary flow rates, clearance, pH, buffer capacity, calcium phosphate homeostasis, effects on bacterial metabolism, adsorption to oral tissues and elimination from the oral cavity are all obvious manifestations of the saliva/caries interaction. Many studies have attempted to relate certain aspects of salivary output and composition to caries susceptibility. ,,
Dry mouth, or xerostomia, is a common condition in HIV disease that may have a variety of causes. HIV disease may cause dry mouth because of swollen salivary glands leading to reduced amount of saliva in the mouth. ,,
The change in salivary volume, and alteration of various salivary factors could have caused increased dental caries in HIV +ve individuals which still need to be studied in detail in future.
| Conclusion|| |
There is an increase in dental caries in HIV +ve patients. The increase in dental caries was found to be very highly significant in HIV infected patients as compared to HIV free group but the increase was not significant with the increase in severity of disease. The usual interval of 6 months for routine dental visit should be reviewed for HIV patients as they are more prone to oral infections.
The authors would also like to acknowledge the ART centre, Wenlock Hospital and Nitte University, Mangalore.
Financial support and sponsorship
This study was supported by research grant from the Indian Council of Medical Research, New Delhi, India.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hegde MN, Malhotra A, Hegde ND. Salivary pH and buffering capacity in early and late human immunodeficiency virus infection. Dent Res J (Isfahan) 2013;10:772-6.
Cavasin Filho JC, Giovani EM. Xerostomy, dental caries and periodontal disease in HIV patients. Braz J Infect Dis 2009;13:13-7.
Phelan JA, Mulligan R, Nelson E, Brunelle J, Alves ME, Navazesh M, et al.
Dental caries in HIV-seropositive women. J Dent Res 2004;83:869-73.
Rask PI, Emilson CG, Krasse B, Sundberg H. Dental caries and salivary and microbial conditions in 50-60-year-old persons. Community Dent Oral Epidemiol 1991;19:93-7.
Khan AA, Jain SK, Shrivastav A. Prevalence of dental caries among the population of Gwalior (India) in relation of different associated factors. Eur J Dent 2008;2:81-5.
Everhart DL, Grigsby WR, Carter WH. Human dental caries experience related to age, sex, race and certain salivary properties. J Dent Res 1973;52:242-7.
Dahlén G, Björkander J, Gahnberg L, Slots J, Hanson LA. Periodontal disease and dental caries in relation to primary IgG subclass and other humoral immunodeficiencies. J Clin Periodontol 1993;20:7-13.
Timonen P, Niskanen M, Suominen-Taipale L, Jula A, Knuuttila M, Ylöstalo P. Metabolic syndrome, periodontal infection, and dental caries. J Dent Res 2010;89:1068-73.
Junqueira JC, Fuchs BB, Muhammed M, Coleman JJ, Suleiman JM, Vilela SF, et al
. Oral Candida albicans
isolates from HIV-positive individuals have similar in vitro
biofilm-forming ability and pathogenicity as invasive Candida
isolates. BMC Microbiol 2011;11:247.
Jacob LS, Flaitz CM, Nichols CM, Hicks MJ. Role of dentinal carious lesions in the pathogenesis of oral candidiasis in HIV infection. J Am Dent Assoc 1998;129:187-94.
Greenspan D, Gange SJ, Phelan JA, Navazesh M, Alves ME, MacPhail LA, et al.
Incidence of oral lesions in HIV-1-infected women: Reduction with HAART. J Dent Res 2004;83:145-50.
De Carvalho FG, Parisotto TM. Presence of Candida
in infants oral cavity and its association with early childhood caries.
Braz J Oral Sci 2007;6:1249-
Varma S, Banerjee A, Bartlett D. An in vivo
investigation of associations between saliva properties, caries prevalence and potential lesion activity in an adult UK population. J Dent 2008;36:294-9.
Dodds MW, Johnson DA, Yeh CK. Health benefits of saliva: A review. J Dent 2005;33:223-33.
Giovani EM. The relationship between salivary flow and oral manifestations in patients who are HIV +ve. Spec Care Dentist 2005;24:141.
Lin AL, Johnson DA, Stephan KT, Yeh CK. Alteration in salivary function in early HIV infection. J Dent Res 2003;82:719-24.
Navazesh M, Mulligan R, Komaroff E, Redford M, Greenspan D, Phelan J. The prevalence of xerostomia and salivary gland hypofunction in a cohort of HIV-positive and at-risk women. J Dent Res 2000;79:1502-7.
[Table 1], [Table 2]