Periodontal health and HIV infection

There has been debate about whether people with HIV experience unusual or severe periodontal diseases. The research carried out for this thesis comprises 4 epidemiological studies of periodontal health and HIV infection. The first study aimed to develop diagnostic criteria for periodontal changes associated with HIV. Criteria were derived by experienced dentists and tested in a formal experiment. Training with the criteria improved diagnostic reliability. The second study aimed to identify the types, prevalence and severity of periodontal changes seen in HIV infection in a controlled blinded study of 794 homosexual men attending a genito-urinary medicine clinic. Regression analyses associated HIV infection with periodontal pockets, attachment loss, conventional gingivitis, gingival ulceration and erythema of the attached gingiva. HIV disease progression predicted attachment loss but not pocketing. Gingivitis and erythema of the attached gingiva were associated with oral candidiasis. The third study aimed to describe gingival ulceration seen in HIV infection and identify possible aetiological factors. 95 cases were reviewed and compared against 269 controls with HIV. The most common presentation was clinically and microbiologically similar to acute necrotising ulcerative gingivitis. Incidence of this disease was inversely related to age and health and associated with oral candidiasis. Finally, to validate diagnostic criteria for HIV-associated periodontal changes, their predictive values for HIV infection were assessed by applying them post-hoc to data from the cross-sectional study. Criteria sensitive to erythema of the attached gingiva and interdental attachment loss had high predictive values. Three HIV-associated periodontal changes were recognized: erythema of the attached gingiva; necrotising periodontal disease and reverse architecture/interdental craters. A number of periodontal changes are associated with HIV infection. Those specifically associated with the infection are less common than originally suggested. Diagnostic criteria sensitive to the specific and non-specific changes are proposed