Oral health improvement helps Cambodian children with HIV

Anisha Hall Hoppe, Dental Tribune International

Thu. 27. July 2023

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PHNOM PENH, Cambodia: Antiretroviral therapy (ART) has increased the life expectancy of children with HIV/Aids, leading to a focus on helping these children have healthy lives, for which oral health has been identified as key. A research team in Cambodia and Japan sought to evaluate to what extent oral health interventions in children with HIV/Aids and receiving ART would impact their health. Their randomised controlled trial determined that oral health education and support provides critical benefit, particularly in poorer settings, and that when oral hygiene outcomes are improved, other aspects of health improve.

The two-year intervention involved oral health education sessions and the provision of toothbrushes, toothpaste and dental floss to support daily home-based oral care. Through a structured questionnaire, medical records and oral examination, the researchers compared the effects between children with HIV/Aids who received the intervention and those who did not and between children with HIV/Aids who received the intervention and those without HIV/Aids who did not.

The researchers assessed the oral health effects according to changes in caries scores, salivary pH, salivary flow rate, debris index, oral health-related quality of life and oral care behaviours. They tracked overall health outcomes through HIV viral load, height for age, BMI for age and overall health-related quality of life.

The intervention improved the oral healthcare behaviours of children with HIV/Aids, particularly toothbrushing duration and frequency. However, there were no significant differences in oral hygiene outcomes. The researchers said that the study duration might not have been sufficient to evaluate changes in oral hygiene, considering that previous research suggests that interventions of less than two years are unlikely to significantly improve oral hygiene.

The study revealed longitudinal associations of the intervention between changes in oral hygiene and overall health. Particularly, dental caries changes in permanent teeth correlated with viral load detection, salivary flow rate was associated with overall quality of life, and changes in caries, salivary pH and debris index had negative interaction effects on BMI. At the end of the study, 16.2% and 14.4% of the children with HIV/Aids who received and did not receive the intervention, respectively, had a detectable viral load.

Additionally, HIV/Aids appeared to have a negative impact on the oral health of children, as children without HIV/Aids exhibited better oral hygiene than those with HIV/Aids. This suggests that HIV-positive children might require a more intensive oral healthcare approach than children without HIV/Aids. The study also found that changes in oral hygiene outcomes due to the intervention were associated with changes in viral load and BMI in children with HIV/Aids. A decrease in caries and plaque and an increase in salivary pH were associated with increased BMI. Increased salivary flow rate was associated with improved quality of life. These findings suggest that poor oral hygiene might lead to health issues and stress the importance of effective oral healthcare interventions for children with HIV/Aids.

The study, titled, “Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: A randomized controlled trial”, was published on 28 April 2023 in BMC Medicine.