The child and adolescent with HIV in resource poor countries.

UNLABELLED: Although sub-Saharan Africa caries the burden of paediatric and adult HIV/AIDS infections, the epidemic is spreading most rapidly in the Middle East and North Africa Region where between 2005 and 2013, AIDS-related deaths increased by 66% in comparison with a worldwide fall of 35%. For the first time, in 2011, more than half of people in need of antiretroviral drugs were receiving them, with coverage reaching 54%; yet only 28% of children have access to HIV treatment. This review sought to provide an update of paediatric and adolescent oral HIV/AIDS issues in resource poor countries. OBJECTIVES: To review the literature on paediatric & adolescent HIV with a focus on oral lesions as predictors of HIV infection; as markers of the efficacy of HAART and quality of life; caries risk; management of oral lesions; and epidemiological tests for clinical significance of oral lesions. METHODS: A search strategy was developed for PubMed to identify papers on paediatric oral HIV. Publications in English were selected on the basis that their titles and abstracts were relevant to the review objectives. The reference lists of included papers were screened for additional articles. The time-search for publications was limited from 2009 to 15 October 2014. RESULTS: Papers on the prevalence of oral lesions lacked standardization in diagnostic criteria and the introduction of HAART had significantly reduced prevalence; oral lesions remain useful predictors for HIV infection and as markers for the efficacy of HAART. Evidence suggest that caries risk is increased with HIV infection; management of oral lesions is inconsistent with available resources and surprisingly little recent information has been published in the past 5 years. Revised case definitions are proposed for large-scale epidemiologic studies with the development of an oral lesion index showing promise. Oral health quality of life indicators for children and adolescents are becoming important as more of these indicators are being developed and their negative oral impacts in individuals with oral lesions are now well established. CONCLUSIONS: Paediatric and adolescent oral HIV research needs to be prioritized as current studies are few and are characterized by poor quality study designs, small study samples and a lack of multicentre collaborations. There is a lack of high quality evidence for a number of interventions available for management of oral lesions.

Paedodontic general anaesthesia and compliance with follow-up visits at a tertiary oral and dental hospital, South Africa.

OBJECTIVES: The study aimed to describe the demographic profile of children receiving dental general anaesthesia (DGA) at the Pretoria Oral-and-Dental Hospital, South Africa, the type of treatment received and the level of compliance with the six-month preventive follow-up visit. METHODS: Retrospective review of records of children treated under DGA between January 2009 and December 2010. RESULTS: The study group contained 78-children. Of these, 79.5% were between one and four years of age (mean 3.7-years; SD: 2.01), and 54% were female. The parents of more than half the sample (56.4%) were unemployed. The majority (55.2%) recorded no medical condition prior to undergoing DGA. Of the treatments performed, 63% were extractions (mean = 4.7 teeth/child), 51% involved placement of composite restorations (mean = 3.4 teeth) and 18% were fitting of stainless steel crowns (mean = 2.1 teeth). No preventive treatment was performed under DGA. Only 14 children (18%) returned within 15-months for follow-ups. Seven returnees were re-booked for a second DGA appointment for severely carious teeth; the rest received preventive treatment. Female children (Odds Ratio (OR): 0.28; p = 0.04) and children with no medical-condition (OR: 0.20; p = 0.03) were less likely to return for a follow-up visit. Children with employed parents were more likely (OR: 3.50; p = 0.09) to return for follow-ups. CONCLUSION: This study highlights the importance of preventive treatment prior to and during DGA, especially in a setting where the caries disease burden and unemployment are high.