The periodontal health of homosexual men with HIV infection: a controlled study

Abstract

OBJECTIVE Identify types, prevalence and severity of periodontal changes associated with HIV infection. DESIGN: Cross‐sectional controlled blinded study. SETTING: Open access genito‐urinary medicine clinic. PARTICIPANTS: Convenience sample of 794 homosexual men aged 18–65. OUTCOME MEASURES: Prevalence, extent and severity of probing attachment loss (PAL), pocketing, gingival ulceration, gingivitis, bleeding on probing (BOP), gingival red bands and diffuse and punctate erythema of the attached gingiva (selected a priori). RESULTS: Prevalences in men with (n = 312) and without HIV (n = 260) were: PAL (≥l site ≥4 mm), 59.6% and 28.5% respectively (P < 0.001. x2); pocketing (≥1 site ≥4 mm) 51.0% and 31.9% (P < 0.001); BOP, 96.5% and 92.3% (P = 0.038); gingival ulceration. 3.2% and 1.0% (P = 0.031), red banding, 12.2% and 10.0% (P = 0.410); diffuse erythema, 12.5% and 3.1% (P < 0.001) and punctate erythema, 9.6% and 1.1% (P < 0.001). Decreased CD4 lymphocyte counts predicted the presence, extent and severity of PAL (P = 0.023, 0.027 and 0.060) but not pocketing. Oral candidiasis predicted the extent and severity of gingivitis and the presence of diffuse and punctate erythema (P = 0.037, 0.011, 0.002 and <0.001). CONCLUSIONS: Destruction of periodontal attachment is associated with progression of HIV disease whereas pocketing is associated with HIV infection but not disease progression. Gingival ulceration is associated with HIV but gingivitis and erythema of the attached gingiva are most strongly associated with oral candidiasis. Gingival red bands were not associated with HIV infection.

Is human immunodeficiency virus (HIV) stage an independent risk factor for altering the periodontal status of HIV-positive patients? A South African study

“…The epidemiological validity of the Ramfjord teeth in representing the periodontal status of the whole mouth has previously been established [23-28]. Although we are mindful of the limitations of partial mouth measurements such as the underestimation of both the extent and prevalence of periodontal disease reported in some studies [27,31] and the bias reported in others [29,30,32], with measurement of sites on the buccal side of the tooth reported to show better reliability than measurement on the lingual side because of better visibility to the examiner, assessment of the Ramfjord teeth was found to reduce time, cost, patient, and examiner fatigue, while also providing a practical alternative to the 168 measurements for each clinical parameter required to characterise the prevalence and severity of periodontal disease in a single whole mouth using full mouth assessment [27]. …”

“…Moreover only 39 patients were used in their study compared to the present study with a sample size of 120. Robinson et al [32] also reported an association of clinical attachment destruction with progressive HIV infection but not with probing depth. It is generally expected that the lower the immunosuppression of an individual, the higher the severity of periodontal disease detected [21].…”

Periodontal status in HIV-positive individuals and its possible correlation with CD4+T cell count

“…Robinson et al [4] reported a higher prevalence of chronic gingivitis and adult periodontitis in HIV-infected individuals. They also reported an increased risk of periodontal attachment loss and gingival recession without increase in pocket depth.…”

“…The association of between HIV infection and gingivitis, pocket depth, and attachment loss has been shown to be independent of other known risk factors for periodontal diseases, such as age, subgingival biofilm, and smoking. [4] Lamster et al, [5] theorized that persons with different behavioral risk factors, and thus lifestyles, may present with different clinical manifestation of the HIV disease.…”

Oral Cavity: A Mirror to Hiv Manifestations

“…This considerable variation can be due to lack of clear diagnosis standardization and the heterogeneity of the population's studies. The existence of Linear Erythematous Gingivitis as a periodontal disease entity that is strongly associated with HIV has been questioned by someand others suggested that Linear Erythematous Gingivitis is mostly misdiagnosed as gingivitis 11,12,13 .…”