Impact of Intensified Dental Care on Outcomes in HIV Infection

To test whether aggressive dental care would improve outcomes among persons with AIDS, the authors designed and carried out a randomized clinical trial with subjects from the Portland, Ore., metropolitan area. Researchers recruited 376 HIV-infected patients, ages 19 to 61, with CD4 counts between 100 and 750. The two-arm randomized control trial provided the control group with professional dental protective treatment and checkups at baseline, 6 months, and 1 year, plus dental care. Enhanced care patients received bimonthly protective treatment and twice-daily chlorhexidine mouth rinses to treat gingivitis. The study period for each subject lasted approximately one year, but the study itself began in December, 1994 and ended in May, 1998. After HAART came into general use, the authors expanded the survey criteria and added another 108 participants to the original group of 268.

The baseline, 6-month and 12-month oral exams gathered data on the presence of oral lesions (candidiasis, Kaposi's lymphoma, herpes, hairy leukoplakia, and RAS), erythema and gingivitis, dental caries, and periodontal disease progression. The study also obtained data through questionnaires that each participant completed before dental exams at their initial, 6-month, and 12-month visits. Questions elicited information about general health, well-being, and functional status; AIDS-related symptoms; socioeconomic status; lesions in the mouth (bleeding gums, toothache, presence of sores); mouth pain; disability resulting from problems in the mouth; and the effect of mouth problems on role and social functioning.

The advent of HAART therapy during the study changed mortality rates, the progression of immune function, and AIDS-related complications in the study subjects, making it impossible to observe results in those areas. The findings focus on changes in dental health, oral/dental symptoms and their impact, and global functional status.

Of the 262 subjects who completed the entire trial, both those in the enhanced care group and the control group showed improvements in active decay, gingivitis, oral pain, impact of oral health on functioning, and global functional status. The mean depth of periodontal pockets decreased in both groups, but the decrease was more substantial in the enhanced care group. Erythema improved among all subjects, but the improvement was greater in the enhanced care group. There was a decrease in gingivitis and active tooth decay in both groups, with no statistically significant difference related to treatment assignment. Mouth pain and tooth pain improved study-wide with no differences in rates of improvement between the groups. The standard care group exhibited a greater trend toward improvement in sleeping, while the enhanced care group reported better overall role functioning.

Now that HAART therapy is preserving immune function and controlling AIDS-related symptoms in most HIV-infected people in industrialized societies, the authors note that the medical threat posed by oral infections is probably much decreased. Still, attention to oral health is important, since patients with HIV and AIDS have much higher than average levels of dental and gingival disease and the attendant pain, loss of function, and other symptoms can impair their overall quality of life.

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