Discussion
infections, HIV exhibited better oral hygiene
DENTAL CARIES, INFECTIONS
To the best of our knowledge, this was the first randomized controlled trial that evaluated the effectiveness of oral health interventions in improving oral health outcomes among children living with HIV. We compared outcome indicators between children living with HIV receiving and not receiving the intervention and between children living with HIV receiving the intervention and children without HIV not receiving any intervention.Oral health intervention improved the oral health care behaviors of children living with HIV compared to the control groups’ children. However, the differences in oral hygiene did not significantly differ between them. Those were similar even after stratification by mixed or permanent dentition type. The results are consistent with previous systematic reviews and meta-analyses of intervention studies involving the general child and adolescent populations [We found that children without HIV exhibited better oral hygiene, as assessed via the DMFT/dmft scores and salivary flow rate, than children living with HIV receiving the intervention. A similar association was observed in our cross-sectional analysis using this trial’s baseline data [Longitudinal changes in oral hygiene outcomes due to the intervention were associated with changes in viral load and BMI for age in children living with HIV. Specifically, greater dental caries in permanent teeth was associated with viral load detection. Although this relationship has been known in a cross-sectional study [This study had certain limitations. The endline survey was delayed for 10 months because of the COVID-19 pandemic. The time gap and COVID-19 prevention and intervention measures might have influenced the direct impact of the intervention (e.g., oral healthcare behaviors, including oral hygiene for preventing infections, and interruptions in dental services in the study site and community). The children without HIV who dropped out from the study during the follow-up were older and moved elsewhere for higher schooling. Older children are likely to have higher DMFT scores in permanent teeth and better oral hygiene care skills, which might have affected our results. Despite these limitations, our study demonstrated a robust design involving children living with and without HIV recruited from a large health facility and comparable community. Hence, our results have critical implications for HIV care services for children and research on oral hygiene, development, and overall health.