dental disease/infection
Dental Management of Adolescents and Young Adults Living with HIV/AIDS Danny A. Kalash, D.M.D., M.P.H.; Kavita P. Ahluwalia, D.D.S., M.P.H.; Burton L. Edelstein, D.D.S., M.P.H.
ABSTRACT HIV, both diagnosed and undiagnosed, remains a significant health problem among U.S. adolescents and young adults. Since HIV/AIDS increases the risk for various oral conditions, it is imperative that dentists become familiar with its presentation and clinical management within this unique population. This brief paper details the occurrence, elevated risk for oral diseases, and clinical management of HIV/AIDS among adolescents and young adults. Epidemiology The prevalence of HIV among U.S. children has declined, since vertical transmission at birth is now rare. Yet, HIV among adolescents and young adults remains persistently high: nearly onein-ten people living with HIV (8.6%) are under age 20, and an additional 29% of HIV-infected persons are ages 20 to 24. The Centers for Disease Control (CDC) also reports that among newly diagnosed HIV cases, one-in-five (21%) occurred between the ages of 13 and 24, with most (87%) in males.1 Among adolescents and young adults, disease incidence is greatest among African-American and Latino males aged 19 to 24.2
28 JUNE/JULY 2020 The New York State Dental Journal ●
Oral Health Adolescents and young adults living with HIV/AIDS present with unique oral health needs. They experience particularly high risk for dental caries, periodontal diseases, and oral soft-tissue pathologies due to compromised immunity and medication side effects that compound poor oral health behaviors. The specific oral effects of long-term, highly active antiretroviral therapy (“HAART”) remain unknown. However, early, as opposed to latelife initiation of antiretroviral therapy, predisposes this population group to greater susceptibility of any long-term systemic and oral side effects. Dentist Engagement Dentists play a leading role in the healthcare of young patients with and at-risk for HIV by providing services, from identification of possible HIV infection, to prevention, diagnosis and management of related oral diseases. The CDC reports that few at-risk youth have been tested for HIV (only 15% of male students who have sexual contact with other males have been tested), and youth with HIV are the least likely of any age group to obtain timely healthcare.1 As adolescents may utilize dental care more Section of Population Oral Health, College of Dental Medicine, Columbia University, New York, NY
