|Year : 2014 | Volume
| Issue : 2 | Page : 117-119
Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study
Beena Javaregowda Parvathy
Department of Pedodontics and Preventive Dentistry, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
|Date of Web Publication||17-Apr-2014|
Beena Javaregowda Parvathy
47, 9th Cross, 29th Main, Ist Phase, J. P. Nagar, Bengaluru - 560 078, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV) infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. Aim: The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Design: Purposive sampling was used. Inclusion criteria: Perinatally infected HIV children screened for oral health status. Exclusion criteria: Patients not screened during the oral health survey. Materials and Methods: Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. Results: The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P < 0.001). The difference in the proportion of patients who completed treatment between mild and advanced group was not statistically significant (P > 0.05). Conclusion: The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.
Keywords: Anti-retroviral therapy, compliance, human immunodeficiency virus
|How to cite this article:|
Parvathy BJ. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study. J Indian Soc Pedod Prev Dent 2014;32:117-9
|How to cite this URL:|
Parvathy BJ. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study. J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2019 Apr 21];32:117-9. Available from: http://www.jisppd.com/text.asp?2014/32/2/117/130785
| Introduction|| |
People with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are living much longer today, thanks to a better understanding of the disease process and the development of effective antiviral drugs and multidrug therapies. Consequently, HIV is now considered a chronic disease, one that affects nearly 40 million people world-wide. Children with HIV and AIDS have longer life expectancy today with the advent of newer successful use of antiviral drugs and multidrug therapy. It is now being considered a chronic disease, which affects millions of children world-wide.
Highly active anti-retroviral therapy, first instituted in 1996, has led to a dramatic reduction in the number of perinatally infected children; however, in 2004, there were still 640,000 children under the age of 15 living with HIV world-wide.  Of significance to the pediatric dentist, children with HIV infection have considerably higher rates of oral diseases, including soft-tissue lesions, salivary gland dysfunction and dental caries, when compared with the general pediatric population. 
Minority and low-income groups have worse oral health status, lower rates of dental service utilization and greater unmet dental treatment needs compared with whites or those of higher socio-economic status , HIV-positive children have high rates of untreated caries, periodontal pockets and oral pain.  Tooth-associated pain, difficulty with nutrition, hampered growth as noted by body height and weight and sleep patterns are adversely altered by severe dental caries in children. It is well-known that children infected with HIV have growth retardation and failure to thrive. This may be further complicated by the presence of severe dental caries in the primary dentition. 
The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey.
| Materials and Methods|| |
A total of 319 perinatally HIV infected children consisting of 178 males and 141 females in the age group of 2-15 years, attending a specialized pediatric out-patient clinic at Indira Gandhi Institute of Child Health were examined for prevalence of dental caries, gingival and periodontal diseases and other associated oral lesions and their relationship to the Absolute CD4 count and CD4 percentages according to the criteria of the World Health Organization. 
Purposive sampling was used. Inclusion criteria: Perinatally infected HIV children screened for oral health status. Exclusion criteria: Patients not screened during the oral health survey.
After their examination the care givers and the patients were counseled about the importance of oral health in maintaining the overall general health and well-being of the child. The screening camps were accompanied by Audio visual aids demonstrating brushing technique and flossing. Furthermore, posters about preventive dental health program consisting of sealants and fluoride application and mode of treatment of oral lesions, deep caries lesions, space maintenance were explained and brochures were made available for patients. Following this, the patients were referred to the Pedodontics and Preventive dentistry dental clinic which was housed in the same hospital building for routine check-up and preventive dental care. Patients who required comprehensive dental care were referred to the Department of Pedodontics and Preventive Dentistry, Vokkaligara Sangha Dental College and Hospital which was situated 3 km from ART center at Indira Gandhi Institute of Child Health. At both these places the treatment provided was free of cost.
Attendance records of the patients referred to the Pedodontics and Preventive dentistry dental clinic at Indira Gandhi Institute of Child Health and to the Department of Pedodontics and Preventive Dentistry, Vokkaligara Sangha Dental College and Hospital were examined to compare treatment compliance rates.
Compliance with treatment was categorized as "completed treatment", "no show", or "not following through with treatment". No show was defined as not showing up for appointments; not following through with treatment was defined as appearing for at least one appointment, but not attending later appointments. 
Dental needs of these patients were predominantly dental decay, gingival and oral lesions. Dental records were documented for over a period of 1 year from the time of their first screening.
HIV infected children were classified depending on the CD4 percentage according into, mild immunosuppression, advanced immunosuppression and severe immunosuppression.
Chi-square was used to analyze the data and compare group differences regarding compliance with dental appointments.
| Results|| |
The number of patients in the severe category who completed treatment was significantly less compared to mild and advanced categories (P < 0.001) [Table 1].
The difference in the proportion of patients who completed treatment between mild and advanced group was not statistically significant (P > 0.05).
| Discussion|| |
Abundant scientific data points toward the importance of oral health in HIV children. Smaller number of data is available regarding the rate of utilization of dental services by these patients. The results of our study show that children with HIV have significantly lower compliance. Though the involvement of these patients during the screening was high, when it came to seeking dental treatment their participation was very poor. Even though, all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.
We conclude from our study, that the reasons for low success rate for seeking dental treatment as:
- Failure on our part to convince the parents and pediatricians about the importance to maintaining good oral health for the overall well-being of these children.
- Failure to convince the care givers and pediatricians that there is more to do for these patients than palliative care and symptomatic treatment of pain due to decay and oral soft-tissue lesions.
- Emphasis on the importance of primary dentition was not enough for them to have it treated.
- Pivotal role of preventive dentistry plays in these children needs to be stressed upon.
- Dealing with anxiety level of the parents and the fearful child and any negative attitude they have about dental treatment.
- Elucidate correlation of diet, sugar based medicines and dental caries.
- Education levels of the parents were low and the majority were from lower socio-economic background.
- Low economic status of the caregivers made it difficult for them to comply with consecutive dental appointments as they would have to miss work and led to loss of pay.
- Overwhelming nature of the disease and the time spent in medical care made it harder for patients as well as the parent to make time for dental appointments.
| Conclusion|| |
Prevention is the key to success in attaining good oral health in these patients with the debilitating disease. This study has been an eye opener for us that we have failed at various levels to instill positive attitude toward dental treatment. Further an in-depth analysis has to be under taken about the attitude and knowledge of the HIV infected patients, care givers and health care providers for failure to seek dental treatment. Of all the things these children have to go through every day for survival it our obligation and ethical duty as Pediatric dentists to intervene and provide preventive and therapeutic treatment measures to aid in a healthy mouth and a pain free smile.
Based on our current results we would like to add these recommendations to improve oral health in these HIV infected children.
- Oral health is an integral part of general health and Pediatric dentists have to be made part of health care providing system when treating these children.
- Consultation by the pediatric dentist along with the medical practitioner should be made absolutely mandatory to keep a check on oral health status.
- Anticipatory guidance and preventive dental treatment must be given to these patients.
- Better communication between the medical and dental staff should be established so that the patient is not lost in follow-up.
- Constant motivation by all the health care providers for better participation of these patients in dental treatment is imperative.
| References|| |
|1.||HIV/AIDS surveillance report. Vol. 18. Available from: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/default.htm. [Last accessed on 2010 May 24]. |
|2.||Flaitz CM, Hicks MJ. Oral manifestations in pediatric HIV infection. In: Shearer WT, Hanson IC, editors. Medical Management of AIDS in Children. Philadelphia, PA: W B Saunders Co.; 2003. p. 249-69. |
|3.||Bolden AJ, Henry JL, Allukian M. Implications of access, utilization and need for oral health care by low income groups and minorities on the dental delivery system. J Dent Educ 1993;57:888-900. |
|4.||Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health 1992;82:1663-8. |
|5.||Jandinski J, Catalanotto F, Murray P, Katz R, Varagiannis E: Oral pathology and pain in pediatric AIDS. J Dent Res 74:Abstract 1003, 1995. |
|6.||Hicks MJ, Flaitz CM, Carter AB, Cron SG, Rossmann SN, Simon CL, et al. Dental caries in HIV-infected children: A longitudinal study. Pediatr Dent 2000;22:359-64. |
|7.||World Health Organization. Oral Health Surveys: Basic Methods. 3 rd ed. Geneva: WHO; 1987. p. 34-9. |
|8.||Broder HL, Catalanotto FA, Reisine S, Variagiannis E. Compliance is poor among HIV-infected children with unmet dental needs. Pediatr Dent 1996;18:137-8. |