Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report.

In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.

Factors influencing oral cancer screening preferences in patients attending Tertiary Care University Oral Health Clinic.

BACKGROUND: Understanding factors that influence patients' preferences towards oral cancer (OC) screening is imperative to provide high-quality evidence-based OC screening interventions that can be targeted for population-level uptake. This study determined adult patients' knowledge and awareness of OC, and how health behaviours influenced their preferences towards OC screening. METHODS: This cross-sectional study used a 42-point questionnaire, between February and May 2020 using a combination of in-person and telephone interviews. Chi-square test and multiple logistic regression analysis were applied to confounding factors that returned statistical significance against OC knowledge and awareness. Significance of P < 0.05 was accepted. RESULTS: Sixty-eight (38.6%) participants out of a total 176 had good knowledge of OC and 89 (50.6%) had good awareness. A total of 31.8% reported preference for OC screening by a general dental practitioner (GDP) over a general medical practitioner (GMP). Majority (72.7%) reported acceptance of OC screening at their next GDP visit. Ages 56-70 (OR = 0.357, 95% CI) and previous smokers (OR = 0.336, 95% CI) significantly influenced screening preferences. Knowledge of risk factors did not significantly influence OC screening preferences (χ2 = 3.178, P = 0.075). CONCLUSIONS: Significant gaps in OC knowledge, screening and role of GDPs exist with smoking history and age influencing OC screening preferences.

Coinfections associated with human immunodeficiency virus infection: workshop 1A.

The importance of opportunistic pathogens in HIV disease has been demonstrated from the onset of the epidemic. This workshop aimed to review the evidence for the role of oral microorganisms in HIV-related periodontal disease and HIV transmission and the effect of HIV therapy on periodontal disease. Despite being a common copathogen, tuberculosis seems to have limited oral presentation. The oral manifestations seem to have little impact on the individual and, once diagnosed, are responsive to chemotherapy. The participants debated the available evidence on the role of microorganisms and whether further research was warranted and justified. Although the effects of lipodystrophy on facial aesthetics may be profound and may markedly affect quality of life, there is no evidence to suggest a direct effect on the oral cavity. Though of interest to oral health care workers, lipodystrophy and associated metabolic syndromes were thought to be further investigated by other, more appropriate groups.

The effect of oral commensal bacteria on candidal adhesion to denture acrylic surfaces. An in vitro study.

The effect of four different species of oral bacteria (Streptococci (X 2); Escherichia; Porphyromonas) on the adhesion of Candida albicans and Candida krusei to denture acrylic surfaces was studied using a previously described in vitro adhesion assay. Clear acrylic strips immersed in known concentrations of bacterial suspensions and incubated for 45 min to 1 h, at 37 degrees C, were transferred to yeast suspensions of known concentrations and incubated for a similar period, and the adherent yeasts were quantified using an image analysis system. Pre-exposure to different bacterial concentrations resulted in suppression of candidal adhesion to varying degrees. Of three selected concentrations, exposure to the highest bacterial concentration (10(6) organisms/ml) resulted in a consistent reduction in candidal adhesion, except for E. coli-C. albicans and S. salivarius-C. albicans combinations. Candidal adhesion was significantly reduced on pre-exposure to S. sanguis and P. gingivalis, but not E. coli. There were also significant differences in relative adhesion between C. albicans and C. krusei. Taken together, these results indicate that the adhesion of yeasts to acrylic strips is modulated both by the quantity and the quality of pre-existing bacterial flora on acrylic surfaces.

The effect of oral bacteria on Candida albicans germ-tube formation.

A total of eight bacterial isolates belonging to six species, and a select group of 12 oral Candida albicans isolates, were used to study the effect of bacteria on germ-tube formation. Briefly, each bacterial suspension (10(5-6) cells/ml) was mixed with a C. albicans suspension (10(7) cells/ml) and incubated at 37 degrees C for 90 min with bovine serum, and the percentage germ-tube-positive Candida cells was quantified using a haemocytometer, under light microscopy. In general, out of eight bacteria, Streptococcus sanguis SK21A, Streptococcus salivarius SK56, Escherichia coli ATCC 25922, and S. salivarius OBU3 suppressed germ-tube formation to varying degrees, with different C albicans isolates. Porphyromonas gingivalis Pg 50, Lactobacillus casei ATCC 7469 and Prevotella intermedia OBU4 elicited significant enhancement of germ-tube formation, whereas S. sanguis OBU 2 had no effect. E. coli ATCC 25922 was the only organism to show statistically significant suppression of germ-tube formation (p=0.0312). A significant increase in the germ tube production of C. albicans isolated from HIV-infected compared with HIV-free individuals was also noted. The current results tend to suggest that commensal and transient oral bacterial populations may selectively influence the differential expression of germ-tube-forming ability of C. albicans isolates.

The effect of oral commensal bacteria on candidal adhesion to human buccal epithelial cells in vitro.

The effect of Streptococcus sanguis, S. salivarius, Escherichia coli and Porphyromonas gingivalis on the adhesion of Candida albicans and C. krusei to human buccal epithelial cells (BEC) was investigated with a modified membrane filter system. The filters (12 microns diameter pores) acted as a support for the BEC which were pre-exposed to known concentrations of bacterial suspensions (for 45 min-1 h), and then re-incubated with standardised concentrations of yeast suspensions for various periods. The BEC with adherent yeasts were then transferred on to a glass slide, gram-stained and counted by light microscopy. Three of the four bacterial species significantly suppressed adhesion of C. albicans to BEC; S. sanguis had no effect. Both S. sanguis and S. salivarius suppressed adhesion of C. krusei to BEC pre-exposed to three different bacterial concentrations, although variable results were obtained with P. gingivalis and E. coli. Significant differences in the relative adhesion of C. albicans and C. krusei to BEC were also recorded. These results indicate that the adhesion of yeasts to BEC is modulated both by the composition and the quantity of the pre-existing bacterial flora on the BEC.

Prevalence of oral lesions in a selected Vietnamese population.

Clinical examination of the oral and peri-oral regions of a cohort of 550 Vietnamese living in a refugee camp in Hong Kong was conducted. They comprised 216 (39 per cent) males and 334 (61 per cent) females and their age ranged from 2 to 60 years. A positive clinical finding was observed in 14 per cent, 35 males and 43 females. The most common condition observed was periapical infection (36 per cent), either with an abscess or a sinus. Other lesions noted include mucocele (10 per cent), traumatic ulcers (9 per cent), tori, either palatal (6 per cent) or mandibular (3 per cent), lymph node enlargement (7 per cent), pulp polyp (6 per cent), angular cheilitis (4 per cent), papillomas (3 per cent), cellulitis (3 per cent) and herpes lesions (2 per cent), 7 out of 9 (78 per cent) mucoceles were found in females. No malignant lesions were noted.

Gingival enlargement as a diagnostic indicator in leukaemia. Case report.

The acute leukaemias are a group of neoplastic diseases that are characterized by proliferation of immature white cells in the bone marrow and/or blood and are often associated with severe leukopenia, anaemia and thrombocytopenia. Oral manifestations are more common in patients with acute leukaemia. Oral bleeding, gingival enlargement, ulceration and infection in patients with leukaemia have been described. Leukaemic infiltrates in the gingivae are commonly seen in acute monocytic leukaemia. A case of acute monocytic leukaemia in a 34-year-old female who reported with gingival enlargement is presented here. The role of oral lesions as a diagnostic indicator is discussed.

Squamous cell carcinoma of the gingiva in an HIV-positive patient: a case report.

This article presents a case of gingival squamous cell carcinoma in a patient who was HIV positive but who had no history of pan chewing, smoking, alcohol consumption or nutritional deficiency. Investigations also revealed the presence of superimposed pseudomembranous candidiasis. The case reported reveals that squamous cell carcinoma of the gingiva may occur as an oral manifestation of AIDS.

Detection of HIV antibodies in saliva and its implications.

Human immunodeficiency virus has been detected in almost all body fluids. With a silent disease such as HIV infection, testing for HIV antibodies currently is the most cost effective means for determining the incidence and prevalence of HIV infection in the community and for identifying HIV infection in the individuals. HIV antibodies are found in human saliva and can be detected by sensitive ELISA. Saliva collection is easy to perform, non-invasive, safe to use and thus provides alternative method to blood collection. Research is underway to develop a low-cost saliva assay, thus saliva could become the HIV antibody testing medium of choice for much of the developing countries.

Immunoglobulins in the saliva of diabetic patients with periodontitis.

The study was conducted to estimate the concentration of immunoglobulins in the saliva of diabetic and nondiabetic patients with periodontitis. The salivary immunoglobulins G, A and M (IgG, IgA, IgM) were determined in 50 patients with type II or noninsulin dependent diabetes mellitus (NIDDM) and 50 non diabetic patients with periodontitis. The values were compared with that of 50 age and sex matched controls. IgG, IgA were found to be significantly increased in diabetic patients with periodontitis, compared to nondiabetic patients and controls. Though an increase in IgM was found in diabetic patients it was not significant. The altered immune response observed may be due to the response to a greater antigenic challenge which in turn may be responsible for the increased incidence of periodontitis in diabetic patients. Further studies in this field may help to establish this association.

Effects of fluoridated milk on artificial enamel carious lesions: a pH cycling study.

OBJECTIVE: To investigate the relationship between concentration of fluoride in milk and its re-mineralizing efficacy, and to test whether increasing the volume of fluoridated milk has any effect on its re-mineralizing efficacy. METHODS: Third molars were painted leaving a 1 mm window on the buccal and/or lingual surfaces. Artificial carious lesions were induced using a de-mineralizing solution. The teeth were then sectioned longitudinally. Specimens were randomly assigned to 15 groups according to different concentrations and volume; i.e., 2.5 ppm, 5 ppm, 7.5 ppm, 10 ppm, 15 ppm, 20 ppm, and 250 ppm of fluoride with 25 ml/section and 50 ml/section. De-ionized water and plain milk were used as controls. Sections were subjected to pH cycling for 20 days. Polarized light microscopy and micro-radiography were utilized to record the lesion characteristics before and after pH cycling. RESULTS: Mean lesion depths decreased significantly in all the fluoride groups, and increased significantly in the control groups. There were no differences in percentage of lesion depth decrease when the volume was doubled for the same fluoride concentration. There were also no statistically significant differences between percentages of decrease in lesion depth when the concentration of fluoride in milk was increased. CONCLUSION: Fluoridated milk demonstrated a remineralization efficacy on early enamel carious lesions. A 2.5 ppm fluoride milk concentration provided similar remineralization potential to that of higher fluoride concentration in milk.