Impact of oral problems on daily activities of HIV-infected children.

AIM: Oral manifestations are common in HIV+ children, but the impact of these diseases on their daily life is unknown. So the aim of this study was to assess the impact of oral problems on the daily activities of HIV+ children. METHODS: The Child-OIDP-B was used with 59 10-12 year-old HIV+ children, who were outpatients at two public hospitals for HIV treatment in Rio de Janeiro, Brazil. Caries, biofilm and gingival bleeding indexes were recorded. The Kruskall-Wallis and Mann-Whitney tests as well as the Spearman's correlation coefficient were used for analysis. Statistical evaluation: Replies were analysed using the Statgraphics ® Plus Version 5.0 statistics software system, in order to obtain comparative diagrams and graphs using the ANOVA multifactorial system. RESULTS: The Child-OIDP-B scores ranged from 0 to 30, (mean=6.09) and 71.2% of the children were affected by oral problems. Association was found between oral impact and number of caries (p=0.009). Children receiving HAART therapy had a Child-OIDP-B score (4.87), much lower than those who were not (8.87) (p=0.038). The most reported oral impact of the disease was eating (55.6%), but oral wounds were the most prevalent type of lesions (76.3%). As regards the level of intensity of the impact, moderate severity was prevalent in all 59 children and 66.1% reported that oral impacts affected 1-4 daily activities, 50.8% of all children were not satisfied with their appearance and oral health; 23.7% perceived the impact of HIV-infection on general health. CONCLUSION: Most children suffered the impact of oral problems on their daily activities, mainly functional impacts.

Ectophosphatase activity in Candida albicans influences fungal adhesion: study between HIV-positive and HIV-negative isolates.

OBJECTIVE: This study describes the expression of acidic ectophosphatase activity on twenty isolates of C. albicans from oral cavities of HIV-infected children (HIV+) and compares them with fifteen isolates from HIV-negative children (HIV-), as well as the fungal adhesion to epithelial cells and medical records. METHODS: The activities were measured in intact cells grown in BHI medium for 48 h at 37 degrees C. Phosphatase activity was assayed at pH 5.5 using 4-methylumbelliferyl phosphate. Yeast adhesion was measured using the MA 104 epithelial cell line. RESULTS: Mean values of ectophosphatase activity were 610.27 +/- 166.36 and 241.25 +/- 78.96 picomoles 4-methylumbelliferone/h/10(7) cells for HIV+ and HIV- group, respectively (P = 0.049). No correlation between C. albicans enzyme activity from HIV children with viral load and CD4 percentual was observed. Yeasts with high enzyme activity, isolated from HIV+ children showed greater adherence than yeasts with basal levels of ectophosphatases from HIV- (Spearman correlation, r = 0.8). Surface phosphatase activity was apparently involved in the adhesion to host cells, as the enhanced attachment of C. albicans to host epithelial cells was reversed by pretreatment of yeast with sodium orthovanadate (1 mM), an acid phosphatase inhibitor. CONCLUSION: These results show that C. albicans from HIV+ has an ectophosphatase activity significantly higher than the other isolates. Yeasts expressing higher levels of surface phosphatase activity showed greater adhesion to epithelial cells. So, the activity of acidic surface phosphatases on these cells may contribute to the early mechanisms required for disease establishment.

Cariogenic and erosive potential of the medication used by HIV-infected children: pH and sugar concentration.

OBJECTIVE: The aim of this work was to analyze pH and sugar concentration in seven antiretroviral and three antibacterial medications frequently prescribed to HIV infected paediatric patients. METHOD: Sugars (sucrose, glucose, lactose and fructose) and pH were measured from every one of ten medications with different serial numbers in two samples. The pH was determined by a previously calibrated digital pHmeter (Beckman). Analysis of free sugars was performed using thin-layer chromatography (TLC). The pH results and the amount of sugar originated from the two samples in each lot were added. The arithmetic mean of these results were computed. RESULTS: Two antiretrovirals (Zidovudin and Abacavir Sulphate) had pH below critical level (3.55 and 3.93, respectively). All three antibacterials analyzed had pH above 5.5, and one of them (Azithromycin) had the highest pH level of the ten medications examined (9.28). Sugar was present in seven out of 10 of the medications analyzed. The antibacterials contained the highest concentration of sucrose, ranging from 40% to 54%. Glucose was found in one of the ten, sucrose was present in seven of them and none showed lactose. Fructose was not observed with the technique used. CONCLUSIONS: A number of medications frequently used by HIV-infected children may cause a significant risk of both caries and dental erosion.

Fluoride uptake and release by composites and glass ionomers in a high caries challenge situation.

PURPOSE: To evaluate the behavior of composite resins and glass ionomer cements with regard to the uptake and release of fluoride, in a high caries challenge situation. MATERIALS AND METHODS: Standard test specimens of glass ionomer cement (Chelon Fil), a resin-modified glass ionomer (Vitremer), two polyacid-modified composite resins (VariGlass and Dyract) and a composite resin (Heliomolar), were submitted for 14 days to demineralization and remineralization cycles in order to simulate a high caries challenge, while from the eighth day onward, a fluoridated dentifrice solution was applied for 5 minutes twice a day and the daily fluoride release of those materials to the mediums was quantified and compared. Fifteen test specimens were prepared for each material, making up a total of 75. RESULTS: All materials studied, except for Heliomolar from day 4 to day 7 in the demineralizing solution, were capable of releasing fluoride in measurable quantities during the whole experiment. The fluoride amounts released by Chelon Fil, Vitremer, VariGlass and Dyract were significantly higher in the demineralizing solution (ANOVA, P < 0.05) than in the remineralizing solution, during almost the entire experiment. The fluoride amounts released by Heliomolar were significantly higher in the remineralizing solution (ANOVA, P < 0.05) than in the demineralizing solution, during almost the entire experiment. All materials studied were capable of uptaking fluoride from the dentifrice solution and of later releasing it to the solution, maintaining the release relatively constant and at a higher level than that seen between days 5 and 7.

Gingival status of HIV+ children and the correlation with caries incidence and immunologic profile.

PURPOSE: The aim of this study was to determine gingival health and caries levels in HIV-infected children. METHODS: The modified gingival index (GI) of 43 HIV+ children of both sexes, aged between 2 and 12 years, was measured and correlated with the DMFT/dmf. The children's immunodeficiency level was also established by means of the CD4:CD8 ratio. Pearson's product-moment correlation co-efficient and the Mann-Whitney U test were used. RESULTS: The GI was significantly related to the DMFT/dmf. The children with a GI = 0 presented significantly more DMFT/dmf than the children with a GI > or = 0.1, but there were no significant differences between the GIs of caries-free children and those with DMFT/dmf > or = 1. The children who presented a CD4:CD8 > or = 0.5 ratio presented less DMFT/dmf compared with children who presented a CD4:CD8 < 0.5 ratio. The children who presented a CD4:CD8 < 0.5 ratio presented a statistically significant correlation between their GI and their DMFT/dmf, unlike children who presented a CD4:CD8 > or = 0.5 ratio. Children with a CD4:CD8 < 0.5 who showed a greater DMFT/dmf index also showed greater gingival inflammation. CONCLUSIONS: In this study, children with greater caries experience showed more gingival inflammation. In addition, a greater immunological deficiency might indicate a greater caries experience in children.

Craniometaphyseal dysplasia: case report.

Craniometaphyseal dysplasia is a rare genetic bone remodeling disorder characterized by undertubulation of the long bones, especially in the lower extremities, causing deformities of the metaphyses of the long bones, and sclerosis of the skull base or cranial bone hyperostosis. The authors report a case of craniometaphyseal dysplasia in an 8-year-old Brazilian child, emphasizing the importance of precocious diagnosis of this rare genetic disorder.

Oral manifestations related to immunosuppression degree in HIV-positive children.

Oral manifestations often found in HIV-infected children are frequently the first clinical sign of the infection. This article aims to report the prevalence of oral manifestations in soft tissues and their relationship with the degree of immunosuppression in 80 HIV-infected patients (average age 6.30 +/- 3.32 years old) at the IPPMG-UFRJ. Thirty children (38%) presented some type of oral lesion and the percentage of CD4 was lower than that found in lesion-free children (p < 0.05); 22.5% presented candidiasis, 17.5% gingivitis, 8.8% enlargement of parotids, 1.3% herpes simplex and 1.3% hairy leukoplakia. Of the 30 children with lesions, 70% showed severe immunosuppression, 23.3% moderate immunosuppression and in only 6.7% was immunosuppression absent. Oral manifestations were directly related to the degree of immunosuppression and such lesions can be considered as indicators of the progression of the HIV infection in children.

[Prevalence of caries and its correlation with clinical and immunological classification in HIV-infected children]. / Prevalência de cárie e sua correlação com a classificação clínica e imunológica em crianças infectadas pelo HIV.

This research aims to determine the relationship between the prevalence of caries and clinical and immunological classification in HIV-infected children. Ninety-two outpatients (42 male and 50 female subjects) with definitive diagnosis of HIV infection took part in this research. The patients were examined in order to determine the prevalence of caries (dmf and DMFT indexes), and medical data were collected from their medical records. The mean age of the subjects was 5.77 years. Although no statistical differences were found, young patients (up to 5 years old) had more caries when they were more clinically and immunologically compromised. The same fact was observed regarding older children.

Reliability of two methods for measurement of alveolar bone level in children.

OBJECTIVES: To determine the intra- and interexaminer reliability of two methods (calliper and computerized images) for measuring the alveolar bone level on bitewing radiographs of pre-school children and to determine the extent to which one method can measure more sites. METHODS: Standardized paediatric bitewings were analysed with either an image analysis program (ImageTool) or a digital calliper (Digimatic Caliper). With each method, radiographs were measured three times by three trained examiners. The differences in the number of sites measured with the two methods were assessed with McNemar's tests and kappa statistics. Reliability was assessed with paired t-tests, intraclass correlation coefficients (ICCs), Bland-Altman and survival-agreement plots. RESULTS: The kappa statistics and McNemar's test indicated that examiners measured 14% fewer sites using ImageTool. Paired t-tests also demonstrated a statistically significant bias (range 0.11-0.23 mm) indicating larger measurements for this method, although these observed differences were considered clinically unimportant for the detection of 2 mm of bone loss (which was considered the threshold for periodontal disease). Intra- and interexaminer reliability (ICC range: 0.87-0.97) was considered good for both methods. CONCLUSIONS: Reliable methods to assess alveolar bone loss in primary teeth are important for the diagnosis of incipient periodontal diseases. Both studied methods proved to be reliable. With the Digimatic Caliper, however, more sites were measured.