Impact of xerostomia on oral health and quality of life among adults infected with HIV-1

The prevalence and socio-behavioural and clinical covariates of oral health related quality of life in Ugandan mothers with and without HIV-1

Background

There is limited evidence regarding oral health related quality of life of HIV positive populations in sub-Saharan Africa. Focusing HIV positive- and HIV negative Ugandan mothers, this study assessed the influence of HIV status on oral health related quality of life in terms of oral impacts on daily performances, whilst adjusting for clinical- and socio-behavioural factors. We also examined whether any association of clinical and socio-behavioural factors with oral impacts on daily performances vary according to mothers’ HIV status.

Methods

This cross-sectional study used data from a trial (n = 164) and a comparison group (n = 181). The trial comprised of mothers with HIV-1 participating in the ANRS 121741-PROMISE-PEP-trial (NCT00640263) conducted between 2009 and 2013 and from the ANRS 12341-PROMISE-PEP-M&S follow-up study conducted in 2017. The comparison group comprised of HIV negative mothers recruited in 2017. Interviews and clinical oral examinations were performed. The oral health related quality of life was assessed using the oral impacts on daily performances frequency scale. Caries experience and gingival bleeding were assessed using the World Health Organization’s Decayed, Missed and Filled teeth indices and community periodontal index. Logistic and negative binomial regression analyses were performed.

Results

29% of HIV-1 positive and 32% among the comparison reported any oral impact on daily performance. In adjusted logistic regression analysis, HIV status was not significantly associated with oral impacts on daily performances. Mother’s self-reported oral health, caries experience, gingival bleeding and oral health related quality of life of their children were independently associated with oral impacts on daily performances. Corresponding prevalence ratios and 95% confidence intervals were: 0.3 (0.2–0.6), 1.8 (1.0–3.2), 1.1 (1.0–1.1), and 2.1 (1.1–4.3). No significant interaction between HIV status and covariates were observed.

Conclusions

Oral health related quality of life was substantially impaired in Ugandan mothers but did not discriminate between HIV positive and negative participants. Mothers with impaired oral health related quality of life were more likely to have dental caries and children with impaired oral health related quality of life. HIV positive and negative mothers in Uganda deserve special attention regarding their oral disease and quality of life status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01844-3.

Oral health-related quality of life and unmet dental needs among women living with HIV

BACKGROUND

Oral health-related quality of life (OHRQoL) is a multidimensional, perception-based measure of how oral health affects social and physical functioning and self-image. OHRQoL is important for assessing women living with HIV (WLWH) who may have unmet dental needs and experience disparities that impact dental care accessibility.

METHODS

In 2016, the authors conducted an assessment of OHRQoL among a national sample of 1,526 WLWH in the Women's Interagency HIV Study using the Oral Health Impact Profile instrument, which assesses the frequency of 14 oral health impact items. OHRQoL was measured using multivariable linear regression with a negative binomial distribution to assess the association between report of a recent unmet dental need and OHRQoL.

RESULTS

"Fair or poor" oral health condition was reported by 37.8% (n = 576) of WLWH. Multivariable linear regression showed that unmet dental needs had the strongest positive association with poor OHRQoL (difference in Oral Health Impact Profile mean, 2.675; P < .001) compared with not having unmet needs. The frequency of dental care utilization was not associated with higher OHRQoL. Older age, fair or poor dental condition, smoking, symptoms of anxiety and loneliness, and poor OHRQoL were also associated with worse OHRQoL.

CONCLUSION

Self-perceived impact of oral health on social and physical function and self-image, as measured by OHRQoL, may be an easily assessable but underrecognized aspect of OHRQoL, particularly among women aging with HIV.

PRACTICAL IMPLICATIONS

Dentists should implement OHRQoL assessments in their management of the care of patients with HIV to identify those who do have significant oral health impacts.

Salivary flow, amylase, and total protein in hospitalized patients with HIV infection / AIDS complications

BACKGROUND

Saliva is a complex secretion produced daily by the salivary glands. Saliva consists mainly of water, enzymes, ions and amino acids and performs several important functions in oral health.

OBJECTIVE

The aim of this study was to investigate the flow rate and concentrations of amylase and total proteins in the saliva of hospitalized patients due to AIDS complications.

METHODS

Ninety-three men and women (20-64 years of age) were divided into two groups (46 HIV-infected patients and 47 controls) and had salivary flow rate and levels of amylase enzyme and total proteins evaluated.

RESULT

The mean salivary flow rate was lower in individuals with HIV when compared to controls (P < 0.05). No significant difference between amylase enzyme levels and total proteins were observed in the saliva of patients with HIV infection when compared to controls.

CONCLUSION

Individuals with HIV / AIDS infection (in hospital treatment) suffer no interference in levels of amylase and total salivary proteins, but they have significantly reduced salivary flow.

Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults

Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25-50 years of age (mean age 39.9 ± 6.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p < .001). The CA group reported worse oral health (p < .001) and general health (p < .01), more xerostomia (p < .001) and lower salivary flow rate (p < .01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p < .01). There were no differences between groups in quality of life.Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.

Relation between Clinical Oral Dryness Score and Denture Satisfaction among Patients' in a Tertiary Care Centre, India

INTRODUCTION

Xerostomia is a subjective feeling of dryness commonly seen in elderly populations which impairs the quality of life. Due to loss of lubricating property of saliva the buccal mucosa, tongue and lips tend to stick leading to dry, freckled, ulcerated and sore mucosa which is of major concern to the patient to use complete denture.

AIM

The aim of the study was to assess the relation between oral dryness score and denture satisfaction among elderly patients.

MATERIALS AND METHODS

A cross-sectional study was conducted in prosthodontics department of a dental institution. Patients wearing dentures for at least six months were invited to participate in study. Visual Analogue Scale (VAS) with scores ranging from 0-100 was used to assess patient's satisfaction and clinical oral dryness score was assessed using the criteria described by Osailan SM et al., with scores ranging from 0-10. Data was analysed with SPSS software (version-20) and Kendall's tau-b correlation was used to determine the relationship between mean denture satisfactions and mean clinical oral dryness scores.

RESULTS

A total of 220 participants were included in the study based on inclusion criteria. Mean dryness score of the participants was 1.8±0.6 and mean VAS-score for denture satisfaction was 74.32±21.20 for aesthetics, for chewing ability the mean score was 62.31±19.64 and for phonetics it was 67.82±30.60. Strong negative correlation between VAS-scores and oral dryness scores was observed.

CONCLUSION

Clinical oral dryness score is one of the important factors which influence denture satisfaction. Dentist should consider in predicting prognosis.

The Burden of Oral Disease among Perinatally HIV-Infected and HIV-Exposed Uninfected Youth

Objective

To compare oral health parameters in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected youth (PHEU).

Methods

In a cross-sectional substudy within the Pediatric HIV/AIDS Cohort Study, participants were examined for number of decayed teeth (DT), Decayed, Missing, and Filled Teeth (DMFT), oral mucosal disease, and periodontal disease (PD). Covariates for oral health parameters were examined using zero-inflated negative binomial regression and ordinal logistic regression models.

Results

Eleven sites enrolled 209 PHIV and 126 PHEU. Higher DT scores were observed in participants who were PHIV [Adjusted Mean Ratio (aMR) = 1.7 (95% CI 1.2–2.5)], female [aMR = 1.4 (1.0–1.9)], had no source of regular dental care [aMR = 2.3 (1.5–3.4)], and had a high frequency of meals/snacks [≥5 /day vs 0–3, aMR = 1.9 (1.1–3.1)] and juice/soda [≥5 /day vs 0–3, aMR = 1.6 (1.1–2.4)]. Higher DMFT scores were observed in participants who were older [≥19, aMR = 1.9 (1.2–2.9)], had biological parent as caregiver [aMR = 1.2 (1.0–1.3)], had a high frequency of juice/soda [≥5 /day vs 0–3, aMR = 1.4 (1.1–1.7)] and a low saliva flow rate [mL/min, aMR = 0.8 per unit higher (0.6–1.0)]. Eighty percent had PD; no differences were seen by HIV status using the patient-based classifications of health, gingivitis or mild, moderate, or severe periodontitis. No associations were observed of CD4 count and viral load with oral health outcomes after adjustment.

Conclusions

Oral health was poor in PHIV and PHEU youth. This was dismaying since most HIV infected children in the U.S. are carefully followed at medical health care clinics. This data underscore the need for regular dental care. As PHIV youth were at higher risk for cavities, it will be important to better understand this relationship in order to develop targeted interventions.

Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report

In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.

Update knowledge of dry mouth- A guideline for dentists

BACKGROUND

Dry mouth is usually caused by a reduced salivary flow or by changes in the biochemical composition of saliva.

OBJECTIVE

The aim of this paper is a review of the update literature of dry mouth.

METHODS

We search in pubmed in the past 10 years using the words «dry mouth», «causes», «symptoms», «treatment» and «dentistry». A large number of papers have been identified. Papers not relevant to the issue were removed reducing the entries to 56 only.

RESULTS

There are no clearly established protocols for the treatment of dry mouth in the literature. Most of identified papers were systematic reviews, non-systematic reviews, and observational studies. The most studied patients were Sjögren's syndrome and the irradiated patients. Treatments are focused on the etiology, prevention, symptomatic, local salivary stimulation and systemic treatments.

CONCLUSION

It can be concluded that there is no clear evidence for the causes and treatment of dry mouth, therefore the majority of the general dental practitioners refer most of the cases to appropriate specialist. Treatment must be individualized, salivary substitutes and mechanical stimulation techniques can be applied.