cross-sectional epidemiologic study

1. ORAL HYGIENE STATUS AND PREVALENCE OF
PERIODONTITIS IN HIV- SEROPOSITIVE & AIDS
PATIENTS
PRESENTED BY
Dr. BHARGAVI DEVI.VEDULA
PG PERIODONTICS
NARAYANA DENTAL COLLEGE
NELLORE
GUIDED BY
DR.VIJAY. K.CHAVA
PROFESSOR & HOD

2. HIV –AIDS is a debilitating disease characterized by reduced immune
response
susceptible to various diseases.
Oral manifestations of HIV were identified early in the history of the HIV
epidemic. Lesions found to be strongly associated with HIV infection and
its progression to AIDS Scully C et al 1992
• Kaposi’s sarcoma,
• Oral candidiasis, and
• Oral hairy Leukoplakia

3. Chronic gingivitis and periodontitis---- most common forms of gingival
and periodontal disease in HIV infected individuals.
Relationship between periodontal health and the prevalence and severity
of periodontal diseases and CD4+ counts among immune-suppressed
HIV infected individuals remains controversial
(Hofer D 2002, Holmstrup P 2002).
No significant difference in gingival and periodontal status
(Guarinos J1996, Scheutz et al 1997,vastardis SA 2003).

4. Severe attachment loss in more advanced stages of AIDS (Gonçalves 2004).
Prevalence - 0 to 47% (Hofer D 2002, Aguirre-Urízar JM 2004) .
In this study an attempt was made to evaluate their oral hygiene and
periodontal status

6. • Evaluation of oral hygiene and periodontal status in HIV seropositive
and AIDS patients & correlate them with CD4+count
• Determine the prevalence of periodontal diseases
•To educate the patients importance of oral hygiene

7. MATERIALS AND METHODS

8. Cross-sectional epidemiologic pilot study, at Y.R.Gaitonde centre,
(approved by institutional ethical committee)
105 HIV-seropositive subjects,..6 months
63 42
Mean age :42± 20yrs.
Informed consent was obtained from all participants.

9. INCLUSION CRITERIA
• Individuals whose HIV status is confirmed by series of 3 spot tests
• Individuals above 18 yrs
EXCLUSION CRITERIA
• Patients who could not tolerate oral examination
• who underwent recent dental treatment (within 4 weeks of the study)
and who did not give consent

10. Detailed medical, dental, personal and drug histories and duration since
the patient is diagnosed to be HIV-positive and the drugs consumed
(ART) were recorded.
Dental parameters
• Oral Hygiene Index-Simplified (OHI-S –Green & Vermillion 1964)
• Periodontal charting
CAL
Furcation involvment and mobility

11. All the subjects were educated about the brushing techniques and oral
hygiene instructions were given
Based on CD4+ counts according to the WHO criteria 2010,
•People with CD4 cells <350cells/mm3
- 47 subjects ( GROUP I)
•People with CD4 cells >350cells/mm3
- 58 subjects (GROUP II)

12. RESULTS

13. Population with Periodontitis = 37 (GP-I=17; GP-II=20)
Mean OHI-S of Periodontitis patients= 3.7±1.5 (GP-1=3.3;GP-II=4.2)
Significant association between OHI-S AND PERIODONTITIS =p<0.01

14. Prevalence
Parameters Periodontitis patients
Mean CD4+ count 391.8±149.2(SD)
MEAN CAL 4.01±1.31(SD)
Correlation coefficient (r) 0.03(non-significant)

15. DISCUSSION

16. Periodontitis ---progressively destructive leading to loss of bone and PDL
have long been associated with systemic diseases and part of the expected
range of HIV-associated conditions (Robinson P 1992)
The subjects were more representative of HIV positive patients than those
reporting to a dental clinic with oral complaints.

17. No significant difference for OHI-S score, was observed between groups.
While Significant difference in OHI-S was observed in patients with
periodontal problems compared to patients without periodontal
problems P<0.01 ( in both groups)
Immunodeficiency alone does not predispose patients to gingival or
periodontal disease. Thus Importance of adequate oral hygiene and
dental care is emphasized
(Heitz-Mayfield LJ et al 2005, N.W. Johnson 2006)

18. GENDER DISTRIBUTION
High prevalence(59.4%) of periodontitis among males associated with
poor oral hygiene(Mean OHI-S=3.8) (Martinez-Canut et al 1996)
This can be attributed to less medical & dental visits than women, a poor
oral hygiene status & other risk factors like smoking, less patient
compliance to treatment.

19. Lack of statistically significant correlation between CD4+ count and
Periodontal condition
Oral hygiene maintenance in more important in maintaining periodontal
health (John C Greene et al 1963) rather than CD4+ count
(Vastardis SA 2003 , Holmstrup P 2002,, Guarinos j 1996)

20. No typical periodontal findings like linear gingival erythema or
necrotizing periodontitis was observed in any of the subjects.
Other findings like
• Oral pseudomembranous candidiasis : 3 subjects in group I
• HIV-associated Tuberculosis or pneumonia: in 33.3% population

21. SUMMARY & CONCLUSION

22. • Prevalence of periodontal disease ----35%
• Periodontal disease more related to oral hygiene status than to CD4 +
count.
• Further studies with larger sample size and molecular assessment of
Plaque samples and GCF are recommended for evaluating the
correlation and understanding the pathogenesis of periodontitis in
HIV- infected patients

23. ACKNOWLEDGEMENTS:
Dr. Vijay. K. Chava (Prof & HOD)
Dr. Ramesh Reddy. BV (Prof)
Dr. Srinivas.N (Sr. Lecturer)
Dr. Sirisha .K (Sr. Lecturer)
Dr. Jimmly James (Sr. Lecturer)
Dr. Chandan & YRG centre, Nellore
To my parents, sister, Brother &
My colleagues for ENCOURAGEMENT AND SUPPORT