Medical Professionals Treating Children with HIV

Oral Health Fact Sheet for Medical Professionals Treating Children with Human Immunodeficiency Virus (HIV)

Human immunodeficiency virus (HIV) disease is a syndrome resulting from the acquired deficiency of cellular immunity caused by a complex family of lentiviruses. These are composed of 2 sub types HIV-1 and HIV-2. It is characterized by the reduction of the Helper T-lymphocytes in the peripheral blood and the lymph nodes (ICD 9 code 042)

Oral Manifestations and Considerations

Oral

Oral lesions may be among the first manifestations of disease; generally oral manifestations are less common among children than adults

• Candidiasis of the oral mucosa (most common oral manifestation)
  • Pseudomembranous type most common in children, followed by erythematous type and angular cheilitis
• Aphthous lesions
• HIV-associated periodontal diseases
  • Linear gingival erythema
  • Necrotizing ulcerative gingivitis (NUG) and Necrotizing Ulcerative Periodontitis (NUP)
• Viral Infection: Herpes Virus Family – HSV, CMV, EBV, Varicella-zoster, Human Papilloma Virus
• Necrotizing Stomatitis
• Hairy leukoplakia (primarily on the lateral border of the tongue, can involve other areas)
• Salivary gland enlargement
• Kaposi’s sarcoma
• Intraoral, head and neck lymphomas
• Facial palsy
• May exhibit delayed dental development
• Increased caries risk with xerostomia that can be heightened by the use of sugar containing medicines

Other Potential Disorders/Concerns

• Progressive wasting and diarrhea if not well managed
• Nausea and vomiting

Medication Management and Side Effects

Highly Active Antiretorviral Therapy (HAART) to suppress viral load and delay immune suppression, can include:

• Protease inhibitors (PI)
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Non Nucleoside reverse transcriptase inhibitors (NNRTIs)
• Integrase inhibitors
• Fusion inhibitors

Side Effects

• Peripheral neuropathy
• Salivary gland enlargement
• Dysgeusia (taste alteration)
• Melanotic pigmentation and skin rashes
• Hepatotoxicity, Hyperglycemia, Hyperlipidemia, Lactic Acidosis, Lipodystrophy,
• Osteonecrosis, Osteoporosis, Osteopenia
• Neutropenia, Thrombocytopenia, which can cause an increase in the potential for bleeding
• Stevens-Johnson Syndrome/ Erythema multiformae

Parent/Caregiver Support and Guidance

• Communicate with dentist and dental hygienist for helpful information regarding the child’s special oral health needs. Plan to coordinate medical and dental care whenever necessary.
• Discourage consumption of cariogenic foods and beverages.
• Prescribe sugar-free medications, if available.
• Recommend preventive measures, such as topical fluoride and sealants.
• Advise the use of fluoridated toothpaste twice daily and support the family in following dental care instructions.
• Instruct caregiver on appropriate protocol following dental trauma (locate/preserve missing tooth and put in cold milk; seek immediate professional care).
• Review safety issues appropriate to the age of the child, such as mouth guards to prevent oral-facial trauma.
• Recommend rinsing with water thoroughly after taking each dose of sugar containing medication and frequent water intake for patients taking xerostomic medication.
• Discuss habits that may harm the child’s teeth, such as propping baby bottles, putting child to bed with bottle.
• Refer to dentist any oral developmental abnormalities.

References

• Little, J., Falace, D., Miller, C., Rhodus, N., (2008) Dental Management of the Medically Compromised Patient. 7th edition
• dos Santos Pinheiro R, França TT, Ribeiro CM, Leão JC, de Souza IP, Castro GF, Oral manifestations in human immunodeficiency virus infected children in highly active antiretroviral therapy era. J Oral Pathol Med. 2009 Sep;38(8):613-22. Epub 2009 Jul 15.
• Holderbaum RM, Veeck EB, Oliveira HW, Silva CL, Fernandes A. Comparison among dental, skeletal and chronological development in HIV-positive children: a radiographic study. Braz Oral Res. 2005 Jul-Sep;19(3):209-15. Epub 2005 Nov 21.
• Church, JA. HIV disease in children. The many ways it differs from the disease in adults. Postgrad Med. 2000 Apr;107(4): 163-6, 169-71, 175-7 passim.
• 5 Minute Clinical Consult

Additional Resources

• NIH Institute for HIV
• Special Care: an Oral Health Professionals Guide to Serving Young Children with Special Health Care Needs
• Bright Futures Oral Health Pocket Guide
• American Academy of Pediatric Dentistry: 2011–2012 Definitions, Oral Health Policies and Clinical Guidelines
• MCH Resource Center
• ASTDD – Special Needs
• Block Oral Disease, MA
• Free of charge CDE courses: MCH Oral Health CDE (4 CDE hours) NIDCR CDE (2 CDE hours)