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.

Dental caries prevalence in children attending special needs schools in Johannesburg, Gauteng Province, South Africa.

INTRODUCTION: Anecdotal evidence from clinical data in Johannesburg suggests that there is a high burden of dental caries among children with special health care needs (CSHCN) in Johannesburg. OBJECTIVES: To determine the prevalence of dental caries and Unmet Treatment Needs in children with cerebral palsy, hearing, learning and mental disabilities attending special needs schools in Johannesburg and to compare these with data from the National Children's Oral Health Survey (NCOHS) METHODS: This cross-sectional analytical study comprised of 882 children attending five special needs schools in Johannesburg. Stratified randomised sampling of the participating schools was done and the schools were stratified by disability. Caries status was recorded via the dmft/DMFT index using WHO criteria and guidelines. RESULTS: The mean age of the participants was 10.5 years; with a caries prevalence of 27.55% and 33.56% in the primary and permanent dentition respectively. The highest unmet treatment need of 100% was found in the permanent dentition of the hearing impaired group followed by 90.77% in the primary dentition of the cerebral palsy group. In general no significant difference was found when the dmft/DMFT for CSHCN and NCOHS were compared except in the hearing impaired age groups four to five and six (both primary dentition) where significantly higher dmft scores (3.58 vs. 2.4; 3.85 vs. 2.9; p < 0.05) were found. CONCLUSION: Children with special health care needs had lower caries prevalence compared with the general population and higher unmet treatment needs regardless of the type of disability.

Caries status among children in the West Rand District of Gauteng Province, South Africa.

INTRODUCTION: There is a lack of data about the prevalence and clinical consequences of dental caries in the West Rand. However dental caries does appear to be a substantial public health problem in Gauteng. OBJECTIVE: This study set out to determine the prevalence and clinical consequences of dental caries among school children in the West Rand district of Gauteng. METHODOLOGY: This was a cross-sectional study comprised of 800 pre-school and primary school children six to eight years old. Cluster sampling was used to select the participating schools. The oral health status was determined by using the DMFT/dmft and PUFA/pufa indices. RESULTS: Of the 800 children, 282 were in the four to five year old age group and 518 were six to eight years old. For four to five year olds the mean dmft score was 2.24 and the prevalence of caries 49%. The clinical consequence of caries was scored with a mean pufa index of 2.9 and the percentage of untreated decay was 47%. For six to eight year olds the mean DMFT/dmft scores were 0.1 and 2.4 respectively and the prevalence of caries 46%. The clinical consequence of caries scored with the PUFA/pufa index was 0.0 and 3.4 respectively and the percentage of untreated decay was 44%. CONCLUSION: There are high levels of untreated caries in children in this district. The pufa scores ndicate that children suffer serious consequences of untreated decay.