HIV positive children are more prone to dental caries, candidiasis
(thrush), leukoplakia (precancerous lesion on the tongue or inside of the
cheeks), herpetic lesions, lymphadenopathy (swelling of the lymph nodes) and
parotiditis than other children.
According to the Bulletin of the
World Health Organization, oral lesions parallel the decline in numbers of CD4+
cells and an increase in viral load and are independent indicators of disease
progression. But little is known about the functional,
emotional and social consequence of poor oral health in these children.
This study was undertaken with an objective to assess the self perception of
oral health by HIV positive children who already manifest AIDS symptoms and to
assess the associated socio-demographic, behavioral and clinical factors of
A total of 88 Brazilian children
in the age group of 10 to 15 years participated in this study. They completed
the Child Perceptions Questionnaire for 11-14-year-old children - CPQ11-14
specifically designed to assess oral health-related quality of life (OHR-QoL).
The questionnaire contained two overall indices on oral health and wellbeing:
1. "Would you say that the health of your teeth,
lips, jaws and mouth is...?" and "How much does the condition of
your teeth, lips, jaws or mouth affect your life overall?"
2. 37 specific questions on oral symptoms, functional
limitations, emotional wellbeing, and social wellbeing.
Parents and guardians answered a
supplementary questionnaire on:
1. Socioeconomic variables where families were
classified according to characteristics of their households such as
ownership, crowding, ratio of inhabitants per room, etc.
2. Behavioral variables such as the caregiver of the
family (mother or other relatives) and toothbrush frequency (twice per
day, greater than 2 per day, less than 2 per day).
Results showed that the girls
reported a higher impact in the first question than boys. Similarly, children
who lived in more crowded households and those who did not brush their teeth at
least twice a day reported a higher impact.
• Higher HIV viral load
associated with poorer ranking in all subscales.
• Having a low CD4+ count (in
comparison to reference values for the corresponding age) associated with
poorer answers for questions that assessed functional limitations.
• An improved socioeconomic
condition associated with better rates in the scale that assessed oral
• Children that could not count
on their own mother as a caregiver scored lower on the social well being
• A lower frequency of brushing
teeth was significantly associated with worse answers in the functional
limitations and emotional well being subscales.
The study reinforced the
importance of having the children's own mothers as caregivers and the
importance of home monitoring as an effective resource in oral health
The investigators of this study
concluded that "AIDS-related clinical
characteristics associated with more severe impacts on OHR-QoL. Children with
more severe AIDS manifestations complained of a poorer status of oral symptoms,
functional limitations, emotional and social well being related to their oral
health. Brushing the teeth two or more
times a day and having their own mother as caretaker associated with improved
oral health related quality of life, which reinforce the importance of the
attention that these children receive in their own household".
They further highlighted the need
to "integrate the dentist in the interdisciplinary health care team that
assists pediatric patients with AIDS, and can instruct health programs that are
intended to improve their overall quality of life".