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 Table of Contents  
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 38-41

Oral health status among human immunodeficiency virus-positive patients visiting ART center in Chennai: A cross-sectional study

Department of Epidemiology, The Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India

Date of Submission02-Aug-2020
Date of Acceptance28-Aug-2020
Date of Web Publication31-Oct-2020

Correspondence Address:
Dr. T K Sivabakya
Department of Epidemiology, The Tamil Nadu Dr MGR Medical University, No. 69, Anna Salai, Guindy, Chennai - 600 032, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijohr.ijohr_19_20

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Background: Oral health status of human immunodeficiency virus (HIV)-positive individuals is in poor condition which may be a sequela of variety of factors. Aim and Objective: The aim of this pilot study was to assess the oral health status of HIV-positive patients visiting the Chennai antiretroviral therapy center. Materials and Methods: A total of 43 people who were HIV positive were recruited for the study. Oral health status was recorded using the World Health Organization oral health assessment form (2003). Data were analyzed using Chi-square test. Results: Majority (62.8%) of the people suffering from HIV belonged to upper lower class. The mean for decayed, missing, and filled teeth score in HIV-positive individuals was found to be 12.56 ± 4.14. Nearly 75% of HIV-positive individuals showed oromucosal lesions, with candidiasis (30.2%) being the most common. Nearly 50% of HIV-positive individuals had community periodontal index and loss of attachment score >2. It was more than a year since 83.5% of the participants had made a visit to the dentist. Conclusion: In conclusion, HIV-positive people have poor oral health status and poor periodontal condition. To take care of this high-risk group's oral health, effective policies must be drafted.

Keywords: Dentistry, human immunodeficiency virus, oral health

How to cite this article:
Sivabakya T K, Srinivas G. Oral health status among human immunodeficiency virus-positive patients visiting ART center in Chennai: A cross-sectional study. Indian J Oral Health Res 2020;6:38-41

How to cite this URL:
Sivabakya T K, Srinivas G. Oral health status among human immunodeficiency virus-positive patients visiting ART center in Chennai: A cross-sectional study. Indian J Oral Health Res [serial online] 2020 [cited 2022 Jun 28];6:38-41. Available from: https://www.ijohr.org/text.asp?2020/6/2/38/299704

  Introduction Top

Human Immunodeficiency infection is caused by Human Immunodeficiency virus (HIV). Based on HIV sentinel surveillance 2017, it is estimated that India has an adult prevalence of 0.22% with 21.4 lakh people infected with HIV. The total number of people living with HIV in Tamil Nadu is about 1.43 lakhs.[1] The condition gradually destroys the immune system which makes it harder for the body to fight infections. Not only does it destroy the immunity of the infected person, but also it results in an elevated tendency to acquire and manifest diseases that are considered usually resistible by the normal human body.[2] With the inclusion of depletion in health, such a state also depletes the quality of living, which results in further complications as far as oral disease states are concerned. In general, HIV progression is faster and more severe due to the immaturity of the immune system. Oral lesions are among the earliest and most common clinical signs of infection with HIV.[3] Oral lesions are important indicators and can predict the progression of HIV stages. The early diagnosis of these lesions will help in assessing disease progression, especially in low-income countries, where limited resources hamper disease-specific interventions.[4]

According to the World Oral Health Report, priority is given to effective prevention of oral manifestations of HIV/acquired immunodeficiency syndrome (AIDS) through additional action. Studies show that HIV patients are more likely to have heavier oral burdens of lactobacilli and streptococci than others.[5] Oral manifestations occur in 30%–80% of people with HIV, with considerable variations depending on the situations such as affordability of standard antiretroviral therapy (ART). Oral manifestations include fungal, bacterial, or viral infections, of which oral candidiasis is the most common and often the first symptom early in the course of the disease. Oral HIV lesions cause pain, discomfort, dry mouth, and eating restrictions and are a constant source of opportunistic infection.[6] Early detection of HIV-related oral lesions can be used to diagnose HIV infection, monitor the disease's progression, predict immune status, and result in timely therapeutic intervention. The treatment and management of oral HIV lesions can considerably improve oral health, quality of life, and well-being. In developed countries, oral lesions in HIV infection have been well documented, but in developing countries like India, there are fewer reports on oral lesions that have been documented.[7] Thus, the implication of this study may help assess the various oral manifestations of HIV-positive patients. Many studies have shown a higher prevalence of dental disease among HIV-positive patients, of which candidiasis is the most common. Hence, this study is taken as a step in assessing the oral health status of HIV-positive patients.

  Methods Top

This cross-sectional study was carried at ART center at Rajiv Gandhi Government Hospital, Chennai. A total of 43 HIV-positive individuals fulfilled the inclusion criteria and were included in the pilot study. All individuals who were more than 15 years of age and above, present on the day of the survey, and willing to participate were included in the study. Those patients who were not willing to participate were excluded from the study. Before the study, a well-informed consent was taken from the participants and ethical clearance to conduct the study was taken from the Institutional Review Board. A questionnaire was prepared that collected information on sociodemographic data, oral hygiene practices. To eliminate interviewer's bias, data collection, questionnaire, and visual examination were carried out by the same examiner. Socioeconomic status was calculated according to the modified Kuppuswamy scale.[8] Based on patient's education, occupation, and monthly income, the socioeconomic status of the patient was tabulated and compiled into upper, middle, and lower classes.

Dentition status, oral-mucosal condition, and periodontal status were assessed using the World Health Organization (WHO) oral health pro forma (2013). Caries was assessed as per the WHO guidelines under natural daylight by a single calibrated examiner using a mouth mirror and community periodontal index (CPI) probe. Buccal, lingual, occlusal, mesial, and distal surfaces of all teeth were examined for signs of caries. The number of decayed teeth (DT), missing teeth (MT), and filled teeth (FT) was identified based on dentition status, and decayed, missing, and filled teeth (DMFT) score was obtained by adding DT, MT, and FT. Oral mucosa was checked using mouth mirror and the oral conditions were categorized as per the WHO oral health survey assessment form. CPI was used to assess periodontal status as recommended by the WHO oral health assessment form.[9] After the clinical findings were recorded, an oral health talk was given to the patients suffering from HIV for duration of 15 min with the help of pictures containing toothbrushing techniques. The health talk primarily focused on oral hygiene maintenance. All statistical analyses were performed using R software, and P ≤ 0.05 was taken as statistically significant. Chi-square test was used to see the difference in categorical data between the two groups.

  Results Top

The mean age of HIV-positive individuals was 37.58 ± 10.44 years. Among the patients suffering from HIV, 62.8% were males while 37.2% were females. Majority (62.8%) of the people suffering from HIV belonged to upper lower category in socioeconomic class. Eighty-six percent were using toothbrush and paste for oral hygiene maintenance. The mean number of DT, MT, and overall DMFT score was calculated. The mean score of DT, MT, and FT was 5.14 ± 2.503, 4.84 ± 2.329, and 2.58 ± 2.32, respectively. The overall mean DMFT scoring was 12.56 ± 4.14 [Table 1].
Table 1: Dentition status of the human immunodeficiency virus-positive participants

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About 81.4% of the people who were suffering from HIV showed some form of oromucosal conditions. Candidiasis was the most common condition seen in 30.2% of the patients, followed by angular cheilitis (16.2%) [Table 2]. Nearly 50% of the patients living with HIV had CPI score and loss of attachment (LOA) score >2 [Table 3] and [Table 4].
Table 2: Oromucosal lesions in human immunodeficiency virus patients

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Table 3: Community periodontal index scores of human immunodeficiency virus-positive participants

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Table 4: Loss of attachment scores of human immunodeficiency virus-positive participants

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The participants were also examined for other parameters such as fluorosis, dental erosion, and dental trauma. Majority (62.8%) of the participants had no dental fluorosis. Only 20.9% of the HIV patients had questionable fluorosis, followed by 7% with very mild and 7% with moderate dental fluorosis. About 2.3% of the study participants had severe fluorosis. While examining dental erosion, 60.5% of the participants had no signs of erosion, followed by 20.9% with enamel erosion. About 11.6% of the HIV participants had dentinal erosion and 7% of the participants had erosion at the pulpal level. About 90.7% of the study population had no traces of dental trauma. However, 9.3% of them had enamel fracture [Table 5].
Table 5: Other findings in human immunodeficiency viruspositive participants

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Chi-square analysis was done to check any correlation between the DMFT score, CPI score, LOA score, and oral manifestations to age, gender, education, and socioeconomic status. There was no statistical significance between the variables [Table 6]. Moreover, when enquired about their visit to dentist, 83.5% of the participants had not gone for a checkup in the past 1 year. About 6.5% of the remaining participants had made a visit to the dentist in <1 year.
Table 6: Chi-square analysis of variables

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  Discussion Top

In this study, the oral health status of 43 patients suffering from HIV/AIDS was examined. The study showed that nearly 62.8% of the patients suffering from HIV/AIDS belonged to lower socioeconomic status and were having less awareness about oral health maintenance. The lack of awareness and effect of antiretroviral drugs could be responsible for depleted oral health of HIV-positive individuals. A higher mean DMFT score of HIV-positive individuals indicates their poor oral health status and warrants the need of special attention toward it. A higher MT component of DMFT and lower FT component indicate that the extraction was the treatment that has been carried out mostly as compared to the restorative care. Progression of HIV infection is associated with a range of oral manifestations. Oral lesions have been widely studied and some were found to have diagnostic and prognostic values.[10],[11]

Nearly 75% of the people suffering from HIV presented with some form of oromucosal condition. Candidiasis was the most common condition observed in HIV patients. Similar findings were reported by Gillespie and Mariño and[12] Patton et al.[13] They also found candidiasis as the most common oral lesion affecting HIV people. Nearly 50% of people suffering from HIV had CPI score and LOA score >2. This indicates poor periodontal health in patients suffering from HIV. Similar to our study, Ranganathan et al.[14] found greater severity and extent of periodontal breakdown in 136 South Indian HIV-seropositive patients than in normal controls. ART has changed the course of HIV disease and improved quality of life in HIV patients, but the patients may also experience adverse effects.[15] The orofacial adverse effects of highly active ART including oral ulcers, xerostomia, mucositis, hyperpigmentation, erythema multiforme, cheilitis, perioral paresthesia, angioedema, and taste alteration have been reported.[16] The prevalence of high oromucosal lesion and poor oral health including periodontal disease may be an attribute to the prolonged consumption of antiretroviral drugs.


Our study has some limitations. First, this is a pilot study with short sample size. Then, we used a cross-sectional design that has inherent methodological limitations, such as the difficulty to establish the correct temporal sequence of exposure and effect. Our patients were recruited from a single reference center for HIV-infected patients. We did not take the exposure duration to ART into consideration in our analysis. We did not have an HIV-uninfected population to compare the frequency of comorbidities. However, this is a well-characterized sample for a pilot study that was fair enough to provide insights on significant associations between oral health factors, with scarce data and especially in less-developed settings.

  Conclusion Top

The study shows that HIV-positive patients have poor oral health status compared to the HIV-negative individuals. Majority of the people living with HIV belong to lower socioeconomic status and also have less awareness about oral health. The use of antiretroviral drugs further depletes their oral health and is responsible for development of oromucosal lesions. Candidiasis was the most common oral lesion found in HIV-positive patients. Effective policies need to be drafted to take care of the oral health of this high-risk group. The need for government intervention, nongovernmental organizations, and public–private partnership is required for oral health promotion of this high-risk group.

Ethical approval and consent to participate

Ethical approval and consent to participate have been obtained by the Institutional Review Committee.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

HIV Estimations 2017 Report – Naco. Available from: http://naco.gov.in. [Last accessed on 2020 Jul 17].  Back to cited text no. 1
Quinn TC. “Epidemiology of human immunodeficiency virus infection and acquired immunodeficiency syndrome,” in Cecil Medicine. In: Golden L, Schafer A, editors. 24th ed. Philadelphia, Pa, USA: 2011. p. 392.  Back to cited text no. 2
Pakfetrat A, Falaki F, Delavarian Z, Dalirsani Z, Sanatkhani M, Zabihi Marani M. Oral manifestations of human immunodeficiency virus-infected patients. Iran J Otorhinolaryngol 2015;27:43-54.  Back to cited text no. 3
Leao JC, Ribeiro CM, Carvalho AA, Frezzini C, Porter S. Oral complications of HIV disease. Clinics (Sao Paulo) 2009;64:459-70.  Back to cited text no. 4
Department of AIDS Control, Ministry of Health & Family Welfare, Annual Report, 2010-2011, Available from: http://www.nacogov.in/upload/REPORTS/NACO%20Annual%20Report%202010-11.pdf. [Last accessed on 2020 Jul 21].  Back to cited text no. 5
Ranganathan K, Hemalatha R. Oral lesions in HIV infection in developing countries: An overview. Adv Dent Res 2006;19:63-8.  Back to cited text no. 6
Sandeep K, Prashant M, Shilpa W, Bhuvnesh A, Deepika J, Shaijal G. Oral health status and oromucosal lesions in patients living with HIV/AIDS in India: A comparative study. AIDS Res Treat 2014;2014:480247.  Back to cited text no. 7
Sheikh S. Modified Kuppuswamy socioeconomic scale updated for the year 2019. Indian J Forensic Com Med 2019;6:2019.  Back to cited text no. 8
Petersen, Erik P, Baez, Ramon J. World Health Organization. Oral health surveys: basic methods, 5th ed. World Health Organization. 2013. Available from: https://apps.who.int/iris/handle/10665/97035. [Last accessed on 2020 Jul 15].  Back to cited text no. 9
Kolokotronis A, Kioses V, Antoniades D, Mandraveli K, Doutsos I, Papanayotou P. Immunologic status in patients infected with HIV with oral candidiasis and hairy leukoplakia. Oral Surg Oral Med Oral Pathol 1994;78:41-6.  Back to cited text no. 10
Schmidt-Westhausen A, Grünewald T, Reichart PA, Pohle HD. Oral manifestations in 70 German HIV-infected women. Oral Dis 1997;3 Suppl 1:S28-30.  Back to cited text no. 11
Gillespie GM, Mariño R. Oral manifestations of HIV infection: A Panamerican perspective. J Oral Pathol Med 1993;22:2-7.  Back to cited text no. 12
Patton LL, Phelan JA, Ramos-Gomez FJ, Nittayananta W, Shiboski CH, Mbuguye TL. “Prevalence and classification of HIV-associated oral lesions.” Oral Dis 2002;8(suppl 2):98-109.  Back to cited text no. 13
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.  Back to cited text no. 14
[PUBMED]  [Full text]  
Arirachakaran P, Hanvanich M, Kuysakorn P, Thongprasom K. Antiretroviral drug-associated oral lichenoid reaction in HIV patient: A case report. Int J Dent 2010;2010:291072.  Back to cited text no. 15
Scully C, Diz Dios P. Orofacial effects of antiretroviral therapies. Oral Dis 2001;7:205-10.  Back to cited text no. 16


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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