Orofacial disorders in children with HIV disease

The prevalence of orofacial manifestations differs among geographic regions and is strongly related to the level of medical care. Three different orofacial manifestations are commonly found in most studies of HIV-infected children - oral candidiasis, enlarged parotid glands, and lymphadenopathy. Oral dryness is also a common finding and may be directly associated with parotid dysfunction, other salivary gland disorders, or secondary to medications. There is a significant association between the development of oral lesions and immune suppression. It is yet not clear how HIV viral load influences orofacial manifestations among children. Orofacial manifestations among children with HIV infection, however, serve as early markers for immune deterioration and disease progression. More studies are needed to elucidate this relationship. The revised classification system for pediatric HIVD clearly emphasizes the importance of immunologic and virologic markers as they relate to treatment, disease progression, and survival. The strength of orofacial manifestations as clinical markers for disease progression needs to be appreciated and incorporated in future classification systems. Furthermore, the classification of oral lesions needs to be revisited to reflect not merely epidemiologic findings but rather the relationship between immunologic parameters and the development of orofacial disorders.