Caries in HIV-infected children and adolescents

shutterstock_34500700 - caries sign

HIV infection has become a chronic condition since the development of antiviral therapy (ART) increasing survival for people living with HIV. It has been estimated that worldwide some 2.7 million children and adolescents are living with HIV with a number of studies reporting a higher risk of caries in these individuals. However, some studies have suggested that there is no difference in those with HIV.

The aim of this review was to assess whether the caries severity is higher in HIV-infected children and adolescents than in those who uninfected.


A protocol for the review was registered in the PROSPERO database. Searches were conducted in the Medline/PubMed, LILACS, Scopus, Web of Science, ProQuest and databases with no language restrictions. Observational studies including cohort, case–control, or cross- sectional studies involving HIV-infected and HIV- unexposed children and adolescents aged 0–19 years with a minimum of 20 participants per group reporting caries experience using the DMFT/dmft or DMFS/dmfs index were considered. Two reviewers independently searched and selected studies with a single author extracting data for validation by a second reviewer.  Study quality was assessed by a single author using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Observational Studies and meta-analyses undertaken.


  • 16 studies ( 9 cross-sectional, 7 case-control) involving 3231 child and adolescent patients (1701 HIV-infected, 1530 HIV-uninfected) were included.
  • 7 studies were conducted in Brazil, 4 in India, 2 in the USA and one each in Cambodia, Nigeria and West Africa
  • 13 of the 16 studies reported higher caries severity in HIV-infected children.
  • 11 studies contributed a meta-analysis of DMFT in the permanent dentition demonstrating a higher caries severity in those with HIV-infection SMD = 0.32 (95%CI: 0.11 to 0.53).
  • 12 studies contributed to the meta-analysis for primary teeth also showing a higher caries severity in those with HIV-infection SMD = 0.34 (95%CI: 0.10 to 0.57).
  • Higher DMFS and dmfs scores were also seen in HIV-infected children and adolescents,
    • DMFS, SMD = 1.78 (95%CI: 1.03 to 2.54) [2 studies].
    • dmfs, SMD = 0.37 (95%CI: 0.14 to 0.59) [4 studies].


The authors concluded: –

The caries severity in permanent and deciduous teeth was higher among HIV-positive children and adolescents than among uninfected children and adolescents. However, the certainty of the evidence regarding the outcomes is low.


We last looked at a review on this topic by Oliveira et al in 2015 (Dental Elf – 14th Apr 2015). The Oliveira review included 5 case-controlled suggesting a link between HIV-infected children and caries risk in the primary dentition.  This new review searched a good range of databases including 16 studies three of which were included in the earlier Oliveira review.  A number of potential reasons for HIV-infected children have been suggested, immunosuppression leading to increased risk of bacterial colonisation, high sugar content medications and hypernutrition therapy. Although most of the included studies were rated as moderate to good most did not report on confounding factors such as diet or socioeconomic status. Consequently, the findings should be interpreted cautiously as the evidence is of low certainty. In a previous review by Lam et al., (2022) which looked more broadly at the oral health of children and adolescents undergoing ART suggests no significant difference in relation to caries prevalence.  Both the Lam review and this review highlight lack of high quality studies on this topic and larger well-conducted and reported studies that include data on relevant potential confounders are needed.


Primary Paper

Faé DS, de Aquino SN, Verner FS, Lemos CAA. Dental caries in HIV-infected children and adolescents: A systematic review with meta-analysis. Oral Dis. 2023 Jun 25. doi: 10.1111/odi.14637. Epub ahead of print. PMID: 37357361.

Review protocol in PROSPERO

Other references

Dental Elf – 14th Apr 2015

Caries: review suggests a higher risk in HIV-infected children


Lam PPY, Zhou N, Wong HM, Yiu CKY. Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Oct 8;19(19):12864. doi: 10.3390/ijerph191912864. PMID: 36232165; PMCID: PMC9564723.





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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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