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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists

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Year : 2020  |  Volume : 24  |  Issue : 3  |  Page : 588

Dental caries prevalence among HIV adult population in India: A systematic review

1 Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
2 Department of Public Health Dentistry, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
3 Department of Public Health Dentistry, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission12-Feb-2020
Date of Acceptance18-Aug-2020
Date of Web Publication09-Jan-2021

Correspondence Address:
Shrikanth Muralidharan
Department of Public Health Dentistry, Madha Dental College and Hospital, Kundrathur, Chennai - 600 069, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jomfp.JOMFP_64_20

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Dental caries is a universal disease. Untreated dental caries adds to the existing burden of diseases. It is necessary to have national data on the same, especially in HIV cases, to understand the epidemiological aspects and formulate a treatment plan for the population. Hence, a systematic review was carried out to collectively report the dental caries prevalence among this population. A systematic search for articles was done in PubMed and Google Scholar using the keywords: Dental Caries, India, HIV, AIDS and adults from January 1990 to December 2019. All freely available full-text articles were evaluated based on the inclusion criteria. Only four articles fulfilled the criteria based on qualitative analysis. Decayed, Missing and Filled Teeth index was used to record dental caries. Risk factors related to the same were not specified by any of the authors. Studies were not from different regions of India. More epidemiological studies are needed to understand the prevalence rate and correlated to dental caries among HIV-positive population in India.

Keywords: Dental caries, HIV, India

How to cite this article:
Acharya A, Muralidharan S, Mallaiah P, Geetha S. Dental caries prevalence among HIV adult population in India: A systematic review. J Oral Maxillofac Pathol 2020;24:588

How to cite this URL:
Acharya A, Muralidharan S, Mallaiah P, Geetha S. Dental caries prevalence among HIV adult population in India: A systematic review. J Oral Maxillofac Pathol [serial online] 2020 [cited 2021 Jun 12];24:588. Available from: https://www.jomfp.in/text.asp?2020/24/3/588/306673

   Introduction Top

According to Nouaman et al., “Oral diseases are defined as any morphological or functional abnormalities teeth and supporting structures. These are mainly dental caries resulting from the progressive decalcification of tooth hard tissue, periodontal disease due to inflammation of tooth-supporting tissues and pathologies of the oral mucosa.”[1] The World Health Organization report states that dental diseases are high, especially in marginalized sections of the society due to their inability to afford treatment options.[2] Dental caries is a universally present condition that adds to the disease burden.[3] The last epidemiological data related to nationwide dental caries information came way back in 2002, through the National Fluoride Mapping.[4] The caries prevalence globally varies from 49% to 83% across different nations.[5] Research suggests that the risk for dental caries increases by many folds among people living with HIV. There is infiltration of the salivary glands by CD8 lymphocytes, reducing the salivary secretion.[6] Due to antiretroviral therapy (ART), the microbial flora of the oral cavity also changes, and patients are rendered more prone to caries activity.[7] However, it is not a well-established relationship between ART and increased dental caries. In the Indian context, sparsely studies are reported regarding HIV and oral lesions, and dental caries does not always find a mention among those. Research usually tends to focus on soft tissues. With a lack of national-level data for dental caries, reports on dental caries prevalence in HIV are also missing. It is necessary to understand the disease burden to help assist in the treatment planning and policy administration for the benefit of People living with HIV/AIDS (PLHAV). India has a vast diversity of population and geopolitical influences. The disease patterns are also varied[8] and are highly influenced by sociocultural events. Understanding the prevalence pattern will ensure better deliverance of facilities. Unfortunately, there is no system to systematically report oral diseases in India. Hence, the present meta-analysis was carried out to pool data available on dental caries and HIV/AIDS patients from January 1990 to December 2019 to assist in understanding the present trends.

   Materials and Methods Top

  • Study design – Data analysis of the available literature on dental caries and HV/AIDS adult patients
  • Time period – January 1990 to December 2019.

Data source and search strategy

Data were obtained from PubMed and Google Scholar. The MeSH terms used were Dental Caries, India, HIV, AIDS and Adult. The PRISMA guideline for reporting systematic review was followed. The search for the literature was carried in the month of January 2020, and all the free fully available articles were selected for the review.

Inclusion criteria

  1. Articles on dental caries from January 1990 to December 2019
  2. Studies on adults (above 18 years) only done in India
  3. Only those that are freely available as full texts were included.

No other search engines, unpublished data or gray literature was included in the analysis.

The initial assessment was done based on the title and the abstract by the first author. Then, the total 632 articles were peer-reviewed by all the authors, and finally, 4 were selected fulfilling the qualitative criteria required for the peer review [Figure 1]. The PRISMA guidelines were followed for reporting the review. No risk of bias assessment was done at the start of the article selection. The entire review was completed in 1 month (January 2020).
Figure 1: Search strategy

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Data extraction

The entire text was reviewed independently by the first author for data extraction. Data extraction was done on Microsoft Excel sheet. Eleven parameters were chosen to rate the studies [Table 1]. For the rating, a study ≥5 parameters was considered to be of low quality, a study between 6 and 8 parameters was considered to be moderately good, and if all parameters were satisfactorily reported, it was considered to be high.
Table 1: Parameters for qualitative criteria to rate the studies included in the systematic review

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   Results Top

Of the four studies, three were from Karnataka and only one was from Madhya Pradesh. One study did not mention the overall caries prevalence. The index used for measurement was mentioned in three studies. Mean values of DT, MT, FT and Decayed, Missing and Filled Teeth (DMFT) were not specified by Dongade et al.[9] and Hegde et al. [Table 2].[10] [Table 3] shows the qualitative analysis of the included studies. All the studies mentioned the place, study setting and the aim/objectives involved. Only one study mentioned about the basis for sample size estimation and the sampling method used.[12] Dongade et al. did not mention which index was used for the dental caries recording.[9] Two studies mentioned about calibration of the examiners.[9],[12] Three studies did not state clearly if their data can be generalized or not. Based on the quality of evidence provided and the study types; two studies were in the moderate quality,[9],[10]one was of low[11] and high quality, respectively.[12] None of the studies correlated any specific cause with dental caries. Furthermore, data related to any form of experience with dental treatment was not reported.
Table 2: The study characteristics of the included studies

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Table 3: Qualitative analysis of the included studies

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   Discussion Top

The present study showed that there was a wide variation in the dental caries prevalence. No uniform pattern of reporting was present, as stated earlier. HIV, ART combined with poor oral hygiene, knowledge and maintenance are mainly responsible for dental caries.[13] A higher mean DMFT score of HIV-positive individuals indicates their poor oral health status and warrants the need of special attention toward it.[11] Surprisingly, the North East region of India has no mention in the entire search. Either there are no studies carried out or it is quite possible that they have not reported the prevalence rate. India has a national oral health policy that has been drafted. As yet, it is not under implementation. Norms of the National AIDS Control Organization do not explicitly mention anything about dental caries. In nations like Bangladesh, there is a national oral health policy in execution. Bhutan provides free access to oral health care to its citizens.[14] Among all the studies irrespective of being selected for analysis, almost all of them used the DMFT index. No other indices were used People living with HIV/AIDS (like PUFA). Newer indices have an advantage that they can help to identify and group even the white spot lesions so that preventive therapies such as fluoride application or other demineralizing agents can be used rather than waiting for the lesion to progress to an irreversible form of dental caries. It is essential that studies mention the exact age group, risks factors for dental caries and the associated risk factors of the same. The present review is the first of its kind for reporting HIV and dental caries in the Indian adult population. It has certain limitations. We used only two search engines (PubMed and Google Scholar). We did not access any unpublished data or other gray literature. Hence, we may have missed data from the other regions of India. Furthermore, we had to exclude a lot of studies since they did not fit into the qualitative criteria set by us.

   Conclusion Top

We can conclude from the review that more studies are needed for getting pooled data for dental caries among a special group like HIV. Data in terms of risk groups like sex workers, transgenders and intravenous drug abuse users also need to be presented separately for more tailor-made policies for those groups. A long-term strategic planning can be only them implemented at mass level to provide services for these people.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Nouaman MN, Meless DG, Coffie PA, Arrivé E, Tchounga BK, Ekouévi DK, et al. Oral health and HIV infection among female sex workers in Abidjan, Côte d'Ivoire. BMC Oral Health 2015;15:154.  Back to cited text no. 1
Petersen PE. The world oral health report 2003: Continuous improvement of oral health in the 21st century--the approach of the WHO global oral health programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.  Back to cited text no. 2
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9.  Back to cited text no. 3
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey and Fluoride Mapping; 2002-2003, India. Delhi: Dental Council of India; 2004. [ Last accessed on 2020 Jan 20].  Back to cited text no. 4
Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis a comprehensive review. J Clin Periodontol 2017;44:S94-105.  Back to cited text no. 5
Mandel L, Surattanont F. Regression of HIV parotid swellings after antiviral therapy: Case reports with computed tomographic scan evidence. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2002;94:454-9.  Back to cited text no. 6
Nittayananta W, Talungchit S, Jaruratanasirikul S, Silpapojakul K, Chayakul P, Nilmanat A, et al. Effects of long-term use of HAART on oral health status of HIV-infected subjects. J Oral Pathol Med 2010;39:397-406.  Back to cited text no. 7
Janakiram C, Antony B, Joseph J, Ramanarayanan V. Prevalence of dental caries in India among the WHO index age groups: A meta-analysis. J Clin Diagn Res 2018;12:8-13. DOI: 10.7860/JCDR/2018/32669.11956  Back to cited text no. 8
Dongade S, Sermadi ZW, Manjunath R, Priyadarshini C, Jayapala M. Prevalence of oral manifestations among HIV-positive patients undergoing antiretroviral treatment visiting chamarajanagar district hospital: A cross-sectional study. J Indian Acad Oral Med Radiol 2017;29:288.  Back to cited text no. 9
Hegde V, Shetty P, Alva S, Chengappa Sk. Assessment of dental caries experience, periodontal status, and oral mucosal lesions among human immunodeficiency virus seropositives with and without antiretroviral therapy: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:46.  Back to cited text no. 10
  [Full text]  
Kumar S, Mishra P, Warhekar S, Airen B, Jain D, Godha S. Oral health status and oromucosal lesions in patients living with HIV/AIDS in India: A comparative study. AIDS Res Treat 2014;2014:480247.  Back to cited text no. 11
Muralidharan S, Acharya A, Margabandhu S. Dentition status and treatment needs of human immunodeficiency virus-positive patients on anti retro viral therapy in Raichur taluk, Karnataka, India: A cross sectional study. Eur J Dent 2017;11:238-41.  Back to cited text no. 12
[PUBMED]  [Full text]  
Malhotra A, Ahlawat J, Hegde M, Mahajan A. Dental caries status in human immunodeficiency virus-positive and acquired immunodeficiency syndrome patients. Indian J Oral Sci 2016;7:103.  Back to cited text no. 13
  [Full text]  
Kale S, Kakodkar P, Shetiya S, Rizwan S. Dental caries prevalence among 5 to 15-year-old children from SEAR countries of WHO: A systematic review and meta-analysis. Indian J Dent Res 2019;30:937-47.  Back to cited text no. 14
[PUBMED]  [Full text]  


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  [Table 1], [Table 2], [Table 3]


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