The effect of antiretroviral therapy initiation on vitamin D levels and four oral diseases among Kenyan children and adolescents living with HIV.

OBJECTIVES: The impact of antiretroviral treatment (ART) on the occurrence of oral diseases among children and adolescents living with HIV (CALHIV) is poorly understood. The aim of this study was to determine the effect of ART timing on vitamin D levels and the prevalence of four oral diseases (dry mouth, dental caries, enamel hypoplasia, and non-herpes oral ulcer) among Kenyan CALHIV from two pediatric HIV cohorts. METHODS: This nested cross-sectional study was conducted at the Kenyatta National Hospital, Nairobi, Kenya. CALHIV, 51 with early-ART initiated at <12 months of age and 27 with late-ART initiated between 18 months-12 years of age, were included. Demographics, HIV diagnosis, baseline CD4 and HIV RNA viral load data were extracted from the primary study databases. Community Oral Health Officers performed oral health examinations following standardized training. RESULTS: Among 78 CALHIV in the study, median age at the time of the oral examination was 11.4 years old and median ART duration at the time of oral examination was 11 years (IQR: 10.1, 13.4). Mean serum vitamin D level was significantly higher among the early-ART group than the late-ART group (29.5 versus 22.4 ng/mL, p = 0.0002). Children who received early-ART had a 70% reduction in risk of inadequate vitamin D level (<20 ng/mL), compared to those who received late-ART (p = 0.02). Although both groups had similar prevalence of oral diseases overall (early-ART 82.4%; late-ART 85.2%; p = 0.2), there was a trend for higher prevalence of dry mouth (p = 0.1) and dental caries (p = 0.1) in the early versus late ART groups. The prevalence of the four oral diseases was not associated with vitamin D levels (p = 0.583). CONCLUSIONS: After >10 years of ART, CALHIV with early-ART initiation had higher serum vitamin D levels compared to the late-ART group. The four oral diseases were not significantly associated with timing of ART initiation or serum vitamin D concentrations in this cohort. There was a trend for higher prevalence of dry mouth and dental caries in the early-ART group, probably as side-effects of ART.

Survival of Zirconia Crowns in Primary Maxillary Incisors at 12-, 24- and 36-Month Follow-Up.

Purpose: The purpose of this study was to assess the survival probability of zirconia crowns (ZCs) on primary maxillary incisors placed in children diagnosed with severe early childhood caries at 12-, 24-, and 36-month follow-up visits in a university pediatric dental clinic. Methods: Ninety-four teeth in 30 healthy 24- to 60-month-olds who received ZCs under general anesthesia participated in this study (N equals 94). Data included children's demographics, dental-related variables, appointment dates, survival of crown, and type of failure (defined as replacement of lost ZCs or extraction of the treated tooth due to evidence of apical periodontitis prior to natural exfoliation). Descriptive statistics were performed to examine demographics, while Kaplan-Meier survival curves were used to estimate survival probabilities of ZCs over time. Unadjusted and adjusted hazard ratios (HR) from Cox proportional hazard regression with robust standard errors were used to compare risk of ZC failure by patient and tooth characteristics. Results: The overall survival probabilities for ZCs at 12, 24, and 36 months were 93 percent, 85 percent, and 76 percent, respectively. Conclusion: With esthetic characteristics and high survival probabilities, zirconia crowns present as a suitable alternative for reconstruction of primary maxillary incisors in young children. (Pediatr Dent 2019;41(5):385-90).