Candida species from oral cavity of HIV-infected children exhibit reduced virulence factors in the HAART era.

This study aimed to assess, in vitro, the biofilm viability and the phospholipase and protease production of Candida spp. from the saliva of HIV infected children and healthy controls, and to correlate the results with the use of medical data. A total of 79 isolates were analyzed: 48 Candida albicans isolates (33/15) and 20 Candida parapsilosis sensu lato complex isolates (12/8) (from HIV/control patients, respectively), and 8 Candida krusei, 1 Candida tropicalis, 1 Candida dubliniensis and 1 Candida guilliermondii from HIV patients. The XTT (2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-Carboxanilide) reduction assay analyzed the biofilm viability. Phospholipase and protease assays were performed using the egg yolk and Bovine Serum Albumin agar plate methods, respectively. All isolates were able to form biofilm with cell viability. Quantitatively, Candida isolates from both groups presented a similar ability to form biofilm (p > 0.05). The biofilm viability activity was higher in C. albicans isolates than in non-albicans Candida isolates (p < 0.05) for both groups. Phospholipase activity was detected in 32 isolates (40.5%) and it was significantly higher in the HIV group (p = 0.006). Protease activity was detected in 66 isolates (84.8%) and most of them were relatively/very strong producers. No statistical association with medical data was found in the HIV group. Although Candida spp. isolates from HIV-positive children presented higher phospholipase production, in vitro they exhibited reduced virulence factors compared to isolates from healthy individuals. This finding may enlighten the role played by immunosuppression in the modulation of Candida virulence attributes.

Demineralizing potential of dental biofilm added with Candida albicans and Candida parapsilosis isolated from preschool children with and without caries.

This study aimed to investigate the demineralizing potential of dental biofilm added of Candida albicans (CA) and Candida parapsilosis (CP), isolated from preschoolers with and without caries. Bovine enamel blocks (n = 48), with initial hardness = 341.50 ± 21,83 kg/mm2 were fixed in 24 well plates containing culture media. A pool of children saliva (PHS) was the inoculum for biofilm formation in the presence or absence of isolated CA or CP in accordance with each group (G n = 8): G1 - PHS; G2 - PHS + CA isolated from children with caries; G3 - PHS + CP isolated from children with caries; G4 - PHS + CA isolated from children without caries; G5 - PHS + CP isolated from children without caries; and G6 - blank control. The plates were incubated at 37 °C for 5 days, with daily changes of culture media. The microhardness loss percentage (MHL%) of the blocks was calculated, taking in account the hardness values before and after the experiment. Dental biofilm became more cariogenic, independently of the isolated Candida species. The highest MHL% was observed in G4 (85.90 ± 8.72%) and G5 (86.13 ± 6.74%) compared to the others (p < 0.001): G1 (34.30 ± 14,30%) < G2 (59.40 ± 10.56%) and G3 (65.80 ± 6.36%) < G6 (13.68 ± 4.86%) (p < 0.001). C. albicans and C. parapsilosis isolates induced the demineralization of the dental enamel.

Is dental caries experience increased in HIV-infected children and adolescents? A meta-analysis.

OBJECTIVE: To undertake a systematic review to assess if HIV-infected children and adolescents have an increased dental caries experience. METHODS: A search of MEDLINE, BIREME, EMBASE, GOOGLE SCHOLAR, SIGLE (Grey Literature) and reference lists of included studies was carried out. To be eligible the studies had to present HIV-infected and non-infected children/adolescents between 0-18 years old. To assess the methodological quality, the studies were categorized in scores from 'A' to 'C'. To perform a meta-analysis a random effect model was used with 95% confidence intervals and two distinct sub-group analyses were carried out in terms of caries progression: data for cavitated and non-cavitated lesions (sub-group 1) and data only for cavitated lesions (sub-group 2). RESULTS: Five studies fulfilled the selection criteria. Four studies (two ranked A and two B in the quality assessment) revealed higher caries scores in primary teeth in the HIV-infected patients with mean dmft/dmfs scores of 3.8-4.1/7.8-11.0 compared to the control group 1.5-2.4/3.4-5.1. No differences in caries index were found for permanent dentition. The meta-analysis excluded caries data of permanent teeth and showed a significant association between caries experience in primary dentition and HIV infection considering cavitated and non-cavitated lesions (OR = 2.33, 95% CI = 1.48-3.68) or only cavitated lesions (OR = 2.98, 95% CI = 1.59-5.59). CONCLUSION: Evidence exists that suggests HIV-infected children/adolescents have an increased caries experience in primary dentition.

Autistic spectrum disorder children and adolescents' oral health characteristics - scoping review.

This study aimed to conduct a scoping review to know children and adolescents' main oral health concerns with Autism Spectrum Disorder (ASD) and thus identify any oral characteristic that stands out, aiming at preventive and interceptive clinical conduct. A search was performed in the three electronic databases and the gray literature; in September 2021. A total of 562 studies were identified, and after applying the eligibility criteria, 73 articles were included in the synthesis of this scoping review. The mean decayed, lost, and restored teeth index (DMFT/dfmt) ranged from 0 to 12.37; the mean DMFT index (permanent dentition) from 0.06 to 6.2; and the average dmft index (deciduous dentition) ranged from 0.29 to 9.91. The mean simplified oral hygiene index (OHIS) ranged from 0 to 3.4; gingival index (GI) from 0.29 to 2; and plaque index (PI) from 0.005 to 3.15. Plaque prevalence was 25.9% to 90%; dental calculus from 4.7% to 59.41%; gingivitis from 36.7% to 100%. Bruxism was 10.3% to 73%, and dental trauma was 4.7% to 100%. This disparity in the results shows the heterogeneity of this population, with different degrees of socio-behavioral impairment, which can directly influence oral hygiene and the consequent accumulation of biofilm.

Dental findings and oral health status in patients with mucopolysaccharidosis: a case series.

OBJECTIVE: To present a mucopolysaccharidosis (MPS) case series evaluating oral manifestations (clinical and radiographic), oral health status and discussing its implications. PATIENTS AND METHODS: All patients with MPS attending the Genetics clinic/Brazil were evaluated by means of anamnesis, clinical and radiographic examinations. RESULTS: The final sample consisted of 12 subjects (nine males and three females), with ages ranging from 3-31 years old. Concerning oral health, it was observed high levels of caries and periodontal problems. About oral manifestations, this study clinically observed more cases of delayed tooth eruption, thickness of alveolar process and thick lips. Radiographically, it was observed alterations on condyle, mandibular ramus and joint fossa. CONCLUSION: The dental changes in MPS population are high and consequently it is important to know them for differential diagnoses, early treatment intervention, prevention and education of both patients and parents/caregivers about oral health.

An unusual dentigerous cyst in a young child.

A dentigerous cyst is an odontogenic developmental cyst associated with the crown of an unerupted tooth. This article describes the case of a 7-year-old girl with painful swelling in the left facial region, prolonged retention of tooth No. 9d, and a displaced tooth No. 9 in eruption. Radiographic examination revealed an extensive radiolucent lesion of approximately 28 mm and displacement of teeth No. 10 and 11. Marsupialization was performed, teeth No. 8d and 9d were removed, and the swelling reduced immediately. At a 2-year follow-up, radiographs revealed that teeth No. 10 and 11 had erupted but were displaced. Routine radiographic examinations are important for children during the eruption phase to prevent and detect any alterations that could damage the permanent dentition and occlusion.

Oral Health and Behavioral Management of Children with Autistic Spectrum Disorder: A 30-year Retrospective Study.

PURPOSE: This article aims to determine the oral health status, the dental treatment, the behavioral management techniques, and the follow-up of pediatric autistic spectrum disorder (ASD) patients treated at the Clinic for Pediatric Patients with Disabilities (CPPD) at a public university in Brazil. METHODS: The medical records of all the patients seen between 1990 and 2020 were evaluated. Data were collected on the autistic patients' medical and dental conditions, treatments, behavior during dental visits, behavioral management techniques used, and the entire follow-up period at the clinic. The Student's t-test and chi-square tests were used to perform the statistical analysis (α = 0.05%). RESULTS: Sixty-six records of ASD children were analyzed from a total of 656 dental records. The majority were male (80.3%). The mean age was 7.39 ± 2.75 years. All the children had a cognitive deficit, and 62.5% used medication. Most of the children arrived with caries lesions (56.1%), and the mean number of decayed, missed and filled teeth in both the deciduous (dmft-d) and permanent dentition (DMFT) was 2.45 ± 3.13 and 0.87 ± 1.51, respectively. The restorative technique was the most commonly used procedure (54.5%), and protective stabilization was the most frequently used behavioral management technique (18.2%). Of the children who sought treatment, 86.4% were discharged, and 15.2% abandoned the procedure. The majority (those discharged) continued to undergo regular follow-up at the clinic (86%), and the incidence of new caries lesions observed was 33.33% Conclusions: Although our ASD patients had a high frequency of caries and dental treatment needs, we observed good adherence to the treatment, with a low dropout rate, and high discharge rate.

Human papillomavirus in the oral cavity of children.

OBJECTIVE: The aim of this literature review was to identify studies conducted on the oral Human papillomavirus (HPV) infection in children. METHODS: An electronic database search was performed using the terms 'oral HPV' and 'children'. The studies on the prevalence of oral HPV in children worldwide, descriptive studies, case reports, studies on the association of oral HPV and risk factors and transmission of HPV were included. CONCLUSION: The presence of HPV in oral mucosa of children should be investigated in virtue of the various forms of transmission, and the possibility of sexual abuse eliminated, and also of its possible relation with oral carcinoma pathogenesis in children.

Use of chlorhexidine gel (0.2%) to control gingivitis and candida species colonization in human immunodeficiency virus-infected children: a pilot study.

PURPOSE: The purpose of this study was to evaluate chlorhexidine to control gingivitis and Candida species (spp.) in children infected with the human immunodeficiency virus (HIV) and their acceptance of the therapy. METHODS: Twenty-six HIV+ children were selected, and oral exam-established biofilm, gingival indexes, and stimulated saliva were collected for Candida ssp. identification. The children brushed their teeth for 21 days with chlorhexidine gel (0.2%). Salivary samples, biofilm, and gingival indexes were collected after 21-days and again 35 days after ceasing gel use. The children answered a questionnaire about the therapy. RESULTS: All children tested positive for Candida and gingivitis. After 21 days, Candida counts and gingivitis decreased in 25 and 26 children, respectively. Mean reduction was approximately 68% for Candida spp. and 74% for gingivitis. Thirty-five days after discontinuing gel use, gingivitis and Candida spp. increased in 13 and 16 patients, respectively. Considering the Candida spp., the heavy growth was lower in the first re-evaluation. Candida albicans was the most frequent species. Approximately 85% did not experience inconvenience with the gel, and approximately 48% thought it was good for tooth-brushing. CONCLUSION: Chlorhexidine therapy may be an option to treat and pre- vent gingivitis and reduce yeast counts in children infected with HIV.

Severe oligodontia and dental anomalies in a child with a history of multiple natal teeth: An eight-year retrospective.

This article reports the case of a boy born with 11 natal teeth who had many alterations in his permanent dentition. In this case, 22 teeth were missing and a shape anomaly was detected in eight teeth. The treatment consisted of prosthetic rehabilitation and follow-up of teeth eruption and jaw growth.

Gradual Deprogramming of Self-Inflicted Oral Trauma Habit in a Child with Cerebral Palsy.

The purpose of this paper is to report the successful noninvasive treatment of a self-inflicted traumatic lesion on the lower labial mucosa in a 22-month-old boy with cerebral palsy. An acrylic appliance was cemented on the anterior maxillary region to reduce repetitive self-injury by gradual deprogramming. The wound healed after a few weeks, but four weeks after the appliance was removed new trauma was observed at the site. The appliance was replaced by a new one on the anterior region of the mandibular arch, and complete remission of the habit was achieved after three weeks. In order to prevent relapse, the appliance was gradually reduced in size with carbide drills every two weeks and was removed three weeks after the final reduction. After 24 months of follow-up, the labial mucosa was completely healed and no recurrence of the traumatic habit has been observed.

Oral Candida colonization and its relation with predisposing factors in HIV-infected children and their uninfected siblings in Brazil: the era of highly active antiretroviral therapy.

OBJECTIVES: To evaluate predisposing factors such as orofacial manifestations, immunosuppression status and antiretroviral therapy in relation to oral colonization by Candida spp. in Brazilian HIV-infected children and their uninfected siblings in the era of highly active antiretroviral therapy (HAART). METHODS: Whole stimulated saliva was collected from 65 HIV-infected children (HIV+) and 40 uninfected siblings (HIV-), followed by assessment of orofacial manifestation, caries indexes and the number of cavitated dentinal carious teeth (CDT). The salivary samples were cultured and the colonies were counted. After which they were identified by sugar assimilation and fermentation (API 20C). Data was analyzed using chi-square, Mann-Whitney, Spearman tests and logistic regression. RESULTS: Regarding positive growth, HIV+ presented 80% (52/65) and HIV- 57.5% (23/40) (P = 0.013). Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). Mean CD4%, immune-status and history of recurrent oral candidiasis (OC) had no influence on Candida isolation. Mixed Candida spp. cultures were observed in HIV+ (40%) and HIV- (52%): C. albicans was more frequently found in both groups, with a higher prevalence in HIV+ (P = 0.05); other non-albicans species were isolated in HIV+ and HIV-. Low prevalence of orofacial manifestations was observed in HIV+ (10.7% of OC). There was an association between means of CDT and Candida growth (P < 0.05) and a positive correlation between number of CDT and Candida cfu-counts in HIV+ and HIV-. Mean CD4% and immune-status had no influence on Candida isolation. Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). CONCLUSIONS: The HIV infected children had a significantly higher prevalence of oral Candida spp. compared to their uninfected siblings. Absence of HAART and presence of dentinal carious teeth increased significantly Candida spp. colonization in these children.

Oral manifestations in human immunodeficiency virus infected children in highly active antiretroviral therapy era.

OBJECTIVE: Conducted a literature review to identify studies that reported on the oral manifestations in human immunodeficiency virus (HIV) infected children in highly active antiretrovial therapy (HAART) era. METHODS: A search electronic data base were used and the terms used were 'oral lesions' and 'oral manifestations'. The studies of prevalence of oral manifestation in children with HIV worldwide, descriptive studies, case reports, studies on the association of oral lesions and levels of immune suppression, use of HAART and transmission of HIV were included. RESULTS: There have been substantial changes in the management of HIV disease, especially in the past decade because of the use of HAART. However, children are still being infected and present some peculiarities when compared with adults. Molecular epidemiology, transmission and therapy of the common opportunistic oral infections of HIV disease need to be better understood as a consequence of improved anti-HIV strategies. Treatment with HAART improves the immune function and decreases mortality, morbidity, and opportunistic infections in HIV-infected persons. CONCLUSION: The frequency and severity of oral disease associated with HIV infection have reduced considerably, although the use of HAART may be associated with an increased appearance of oral lesions associated with human papillomavirus and potentially increase the risk of later oral squamous cell carcinoma.

Traumatic lesions from congenital insensitivity to pain with anhidrosis in a pediatric patient: dental management.

Congenital insensitivity to pain with anhidrosis is a rare autosomal-recessive disorder characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and mental retardation. The lack of sensitivity to pain results in traumatic lesions, such as ulcers, fractures, burns, bites, scars, and digital amputations. Several methods have been suggested to treat these patients; however, appropriate management is difficult, especially when the mutilation is particularly severe. This report describes the case of a 2-year-old female patient who had severe self-mutilating injuries to her tongue, hands, lips, and oral mucosa caused by biting. The patient presented digital amputation and also a premature loss of a permanent tooth germ during the treatment. The dental management is described and discussed. It is important to include the dentist on the multidisciplinary team to reduce the frequency and severity of the self-inflicted lesions in these patients, also to prevent complications.

Knowledge and practices of dentists in preventing infective endocarditis in children.

This preliminary study assessed the knowledge and practices of dentists in the prevention of infective endocarditis (IE). The study included 21 dentists working at two public hospitals in Brazil who cared for children with special needs who also have cardiac conditions. The data from a semistructured interview were processed for qualitative and quantitative analysis. All subjects defined IE correctly. Most subjects (81%) said they had treated patients with a previous history of IE and 7 (33%) stated that many guardians seemed to be afraid to mention that their child had a previous history of IE. The main risk of infectivity was the oral cavity according to 16 subjects (76%). Nine subjects (43%) considered a dental procedure involving any amount of bleeding as being a risk, and periodontal/endodontic treatments were mentioned by 5 (24%) as procedures that needed antibiotic prophylaxis. As for prophylactic treatment, only 7 subjects (33%) said they followed the American Heart Association guidelines. The authors concluded that the subjects' knowledge and practices in preventing IE were inadequate.

Comparison of techniques to evaluate the quantification of Candida spp. in HIV-infected children.

This study sought to compare techniques used to make a quantified evaluation of Candida spp. in children infected with HIV. Twenty-four HIV-infected children (age 3 to 13) were selected. Three sterilized swabs were used for each child: one for the dorsum of the tongue, one for the hard palate mucosa, and one for the right jugal mucosa; each swab was rubbed for 10 seconds and transferred to sterilized test tubes containing 1 mL of 0.9% saline solution. Candida spp. growth was observed in 95.8% of all samples, including 95.7% of tongue samples (Group T), 87.0% of saliva samples, 56.6% of hard palate mucosa samples (Group P), and 47.8% of right jugal mucosa samples (Group J). There was no statistical difference in Candida spp. growth between saliva samples and Group T samples, although both had higher growth compared to Groups P and J (p < 0.05; chi(2)). Regarding the sensitivity of each site for positive Candida spp. growth, Group T samples showed 69.5%, while saliva samples showed 52.2%, Group P samples showed 21.7%, and Group J samples showed 13.04%, with no significant statistical difference between Group T and saliva; however, both were more sensitive than Groups J and P (p < 0.05, chi(2)). It was concluded that whole stimulated saliva and swabbing the tongue were considered satisfactory for measuring Candida spp. in HIV-infected children.

Oral healthcare management of a child with phakomatosis pigmentovascularis associated with bilateral Sturge-Weber syndrome.

The aim of this report was to describe an approach for a child with phakomatosis pigmentovascularis Type IIb associated with bilateral Sturge-Weber syndrome and autistic spectrum disorder. A 6-year-old boy was referred to the Special Care Dental Clinic with the main complaints of "damaged teeth and pain." The physical examination revealed bilateral port-wine staining on the face, neck, and upper and lower limbs, congenital dermal melanocytosis on the back, and dilated blood vessels in the sclera. Intraoral examination revealed hypertrophy of the maxillary bone, diffuse and intense redness of the oral mucosa, crowding, anterior open bite, and carious lesions in the left and right upper second primary molars. The medical team was consulted prior to dental treatment to assess the risk of bleeding, and anesthesia was contraindicated. Instruction about brushing technique and procedures for a suitable oral environment were then carried out using a minimally invasive restorative treatment. The patient did not exhibit collaborative behavior, and follow up continues with the patient receiving preventive treatments. Therefore, a multidisciplinary approach to these patients is fundamental to avoid complications during dental intervention. Moreover, regular visits to the dentist reduce the need for invasive treatments and improve the well-being of these individuals.

Salivary microbiota of HIV-positive children and its correlation with HIV status, oral diseases, and total secretory IgA.

AIM: This study aimed to investigate the prevalence and levels of salivary microorganisms in HIV-positive children, and their correlation to HIV status, oral lesions, and salivary IgA levels. DESIGN: Forty-two HIV-positive and 36 control children were clinically examined, had their saliva collected and processed for the microbiological analysis of 38 bacterial taxa by the checkerboard method, and salivary IgA quantification by ELISA. RESULTS: The majority of the species tested were more prevalent in control children than in the HIV group. Mean concentration of total salivary IgA was similar in both groups. High levels of Veillonella parvula were found in children with cheilitis and herpes. Tannerella forsythia, Eikenella Corrodens, and Propionibacterium acnes were prevalent in children with gingivitis, while Fusobacterium periodonticum, Streptococcus gordonii, and Streptococcus oralis were significantly more frequent in children with no oral lesions. Significant negative correlations between salivary IgA levels and Eubacterium nodatum and oral streptococci were observed (P < 0.05). CONCLUSION: HIV-seropositive children presented significantly lower prevalence and levels of several bacterial species in saliva; HIV-positive children are able to mount a mucosal immune response; HIV-seropositive children under highly active antiretroviral therapy presented low prevalence of oral lesions.

Knowledge and practices of pediatric cardiologists concerning the prevention of infective endocarditis of oral origin.

This article sought to identify the knowledge and practices of pediatric cardiologists regarding infective endocarditis (IE), including preventive measures, recommendations offered to guardians, and the importance of antibiotic prophylaxis. Twenty pediatric cardiologists from a national reference hospital in cardiology (Brazil) participated in the study. The data were collected by means of a semi-structured interview. All participants considered oral health directly related to systemic health and 90% considered the mouth to be the main window of infection for IE. Fifteen cardiologists (75%) declared that they performed intraoral examinations at all appointments. Nine cardiologists (45%) recommended that patients undergo a dental examination only before catheterization and/or heart surgery. Twelve cardiologists (60%) offered some orientation on oral health during consultation. Only six of the cardiologists (30%) considered the periodic visit to the dentist to be an effective method of prevention. Although preventing IE of oral origin relies fundamentally on the work of dentists, cardiologists still do not do enough to better promote their patients' health.

Role of Candida species from HIV infected children in enamel caries lesions: an in vitro study.

OBJECTIVES: This study analyzed the capacity of Candida spp. from dental biofilm of HIV infected (HIV+) children to demineralize primary molar enamel in vitro by Transversal Microhardness (TMH), Polarized Light Microscopy (PLM) and the quantity of calcium ions (Ca2+) released from the enamel. MATERIAL AND METHODS: Candida spp. samples were isolated from the supragingival biofilm of HIV+ children. A hundred and forty (140) enamel blocks were randomly assigned to six groups: biofilm formed by C. albicans (Group 1); mixed biofilm formed by C. albicans and C. tropicalis (Group 2); mixed biofilm formed by C. albicans and C. parapsilosis (Group 3); mixed biofilm formed by C. albicans, C. parapsilosis and C. glabrata (Group 4); biofilm formed by C. albicans ATCC (Group 5) and medium without Candida (Group 6). Enamel blocks from each group were removed on days 3, 5, 8 and 15 after biofilm formation to evaluate the TMH and images of enamel were analyzed by PLM. The quantity of Ca2+ released, from Groups 1 and 6, was determined using an Atomic Absorption Spectrophotometer. The SPSS program was used for statistical analysis and the significance level was 5%. RESULTS: TMH showed a gradual reduction in enamel hardness (p<0.05) from the 1st to 15th day, but mainly five days after biofilm formation in all groups. The PLM showed superficial lesions indicating an increase in porosity. C. albicans caused the release of Ca2+ into suspension during biofilm formation. CONCLUSION: Candida species from dental biofilm of HIV+ children can cause demineralization of primary enamel in vitro.