Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 19017

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Advertise Contacts Login 
     

  Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 53  |  Issue : 3  |  Page : 150-154  

Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients


1 Department of Dental and Maxillofacial Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Paediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Oral and Maxillofacial Surgery, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria

Date of Web Publication6-Dec-2012

Correspondence Address:
Otasowie Daniel Osunde
Department of Dental and Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0300-1652.104385

Rights and Permissions
   Abstract 

Background: The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART. Materials and Methods: All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant. Results: A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm [3] , 913 cells/mm [3] and 629 cells/mm [3] for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06). Conclusion: HIV-related Oral lesions are frequently seen in HIV-infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis.

Keywords: HIV/AIDS, Nigeria, oral manifestations, paediatrics


How to cite this article:
Adebola AR, Adeleke SI, Mukhtar M, Osunde OD, Akhiwu BI, Ladeinde A. Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients. Niger Med J 2012;53:150-4

How to cite this URL:
Adebola AR, Adeleke SI, Mukhtar M, Osunde OD, Akhiwu BI, Ladeinde A. Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients. Niger Med J [serial online] 2012 [cited 2024 Mar 28];53:150-4. Available from: https://www.nigeriamedj.com/text.asp?2012/53/3/150/104385


   Introduction Top


The HIV/AIDS pandemic has become a human, social, and economic disaster, with far reaching implications for individuals, communities, and countries. Of the 40 million people estimated to be infected with HIV by the end of 2004, children accounted for over 3 million of the total population. [1] The progression of the disease is faster and more severe in children due to their developmental stage and to the immaturity of their immune system. [2] Several manifestations including those of the oral tissues have been reported. [3] The early diagnosis of these lesions as well as their complications should be viewed as important components in the management and treatment of affected children. [3],[4] Most published work on oral manifestations of HIV/AIDS is from the developed world with very little information from Africa where about 70% of HIV-infected persons reside. [5] The prevalence of oral lesions varies among different authors from different parts of the globe, with figures as high as 63.0% in South African children [6] , Thailand [7] (50.0%) and 41.7% among Nigerian children. [8] Candidiasis has been consistently found to be the most common oral lesions associated with paediatric HIV/AIDS. [8],[9],[10] Candidiasis in the paediatric age group range from 11.0% in Uganda [11] to 63% in South Africa. [6] The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART.


   Materials and Methods Top


Patients attending the Aminu Kano Teaching Hospital (AKTH) paediatric specialist out-patient clinic and diagnosed with HIV infection between January 2005 and December 2006 were the subjects of this study. Referred patients from screening centers in the adjoining states, who were confirmed sero-positive in AKTH, within the same period, were also recruited into the study. Approval for this study was obtained from the ethics committee of the hospital. The study protocol was adequately explained to the parents or guardian after which a written informed consent was obtained for selected participants. All patients whose parents or guardian refused participation were withdrawn from the study. HIV sero-positive status was determined by a repeatedly reactive sample on ELISA screening in addition to a positive confirmatory test by the Western immunoblot. Information on risk factors such as history of blood transfusion, circumcision, scarification, and sero-positive status of parents were also recorded. Examination of the orofacial tissues for each patient was carried out by two dental surgeons pretrained in the diagnosis of oral manifestations of HIV/ AIDS. The criteria described by Greespan et al. [12] for diagnoses of oral lesions in HIV/AIDS were adopted. Information collected was captured on the WHO [13] recording form for oral HIV/AIDS. Statistical analysis was carried out using SPSS version 13 software (Chicago, IL). Mean, standard deviation, range, and percentages were used to describe quantitative and qualitative data respectively. Comparative statistics was done using the Student t-test, ANOVA, and odd ratio as appropriate. A P-value of less than 0.05 was considered significant.


   Results Top


A total of 105 patients were seen over this period of study. Of these, male accounted for 63 (60%) and female 42 (40%), giving a M:F of 1.5:1. Their age ranged from 2 to 156 months with an overall mean age of 53.3±42.2 (3.40±2.2 for male and 2.8±1.8 for female). About half the patients (47.61%), were up to 40 months or below followed by the 41-60 months age group (15.24%), [Table 1]. There was no statistical significant difference in the mean age for males and females (t=1.481, df=103, P=0.142). When considering the potential risk factors for the transmission of HIV/AIDS, child circumcision accounted for 19.0%, previous surgery (1.0%), blood transfusion (6.7%) and 90.5% of the mothers were positive for HIV while 67.6% of the fathers were positive. HIV sero-negative status was 21.0% and 5.7% for fathers and mothers respectively [Table 2].
Table 1: Distribution of subjects by age–grouping and sex

Click here to view
Table 2: Demographic, risk factors, and treatment characteristics of subjects

Click here to view


The distribution of oral lesions is shown in [Table 3]. Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesions. The most common lesion was candidiasis (79.1%) and the angular cheilitis (43.8%) variant was most frequent. Other lesions were HIV gingivitis (21.9%), apthous ulcer (14.3%), extraoral herpes (8.6%), HIV periodontitis (4.8%), parotid enlargement (3.8%), Kaposi sarcoma (1.9%), and oral wart (2.9%). There were no oral lesions in 38.1% of the patients. The mean CD4 counts were 1138 cells/mm [3] , 913 cells/mm [3] and 629 cells/ mm [3] for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831).
Table 3: Distribution of oral lesion in patients

Click here to view


Of the 105 patients, 65 (61.9%) were on HAART. The duration of use of HAART ranged from 1 to 12 months, with about 60.0% having been on treatment for 1-6 months. Patients on HAART had reduce risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). Use of HAART showed some beneficial but insignificant effect on the prevalence of HIV periodontitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06; P=0.25) [Table 4].
Table 4: Effect of HAART on prevalence of oral lesions

Click here to view


The HAART regimen in this study was combinations of stavudine, lamivudine, and nevirapine.


   Discussion Top


Majority of the parents were HIV-positive highly suggestive that mother-to-child transmission was the dominant mode of transmission of the virus to infected children. This agrees with earlier reports in the literature. [12],[13],[14] Other presumed modes of transmission were child circumcision and blood transfusion.

The prevalence of oral lesion in the present study (61.9%), while comparable to the 63.0% reported among South African children [6] was a little higher than that of Thailand [7] (50.0%) and American children (53.6%), [15] and much higher than a previous study from Nigeria. [8] These varying prevalence values could be attributed to racial, social, and geographical variations in disease presentations. [8] Candidiasis has been consistently found to be the most common oral lesions associated with HIV/AIDS. [9],[10],[16],[17],[18] Candidiasis in the paediatric age group range from 11.0% in Uganda [11] to 63% in South Africa [6] which is lower than the prevalence rate of 79.1% obtained from the present study. Our prevalence value for oral candidiasis also differ sharply from the result of a similar study from North Central Nigeria which reported 45.0% prevalence value among their study population. [8]

In contrast to most reports where the pseudomembranous variant was the most frequently seen candida infection, [2],[11],[17],[18],[19],[20] angular cheilitis was most common in this study, accounting for 43.8% compared with pseudomembranous candidiasis which accounted for 26.7%. The presence of HIV infection is also associated with increased prevalence of gingival/periodontal diseases which accounted for 26.7% of oral lesions in the present study. This value is higher than that reported by Bosco and Birman [2] in Brazillian children, but comparable to those of Leggott [21] and Fonseca et al. [22]

Gingival/periodontal lesions were previously reported from our environment, including Kano in northwest Nigeria, as the second most common oral lesions in adult Nigerian HIV infected patients. [23],[24] Interestingly, gingival/periodontal lesion was also the most common after candidiasis among children examined in the same centre. Periodontal lesions and gingivitis have been reported to be more prevalent in Africa and Asia due to poor nutrition and inadequate oral hygiene practices. [18] This result contrast sharply from other studies in which HIV-salivary gland disease was second to candididal infection. [10],[16] Hamza et al. [25] found parotid enlargement to be the most common presentation followed by candidiasis in HIV infected children in Tanzania. Salivary gland disease in the present study accounted for only 3.8% which is lower than the 7% in Ugandan Children [17] and the 50% in South Africa. [18] Ulcerations, which are commonly observed in AIDS, have received numerous nomenclatures. Recurrent apthous ucerations, nonspecific ulcers, unidentified ulcerations and ghost ulcerations are some of the terms used in description of oral ulcers. [2],[22] Reported prevalence rates of recurrent oral ulcerations in HIV infection varies partly because accurate definitive diagnosis and classification is difficult due to its varied etiology. [2],[22] The prevalence of 14.3% for aphthous ulceration in the present study is comparable with the 14% reported in South Africa [18] and much higher than the 1% reported in Brazil. [22] Less common oral lesions in HIV infected children include Kaposi sarcoma, non- Hodgkin lymphoma and oral hairy leukoplakia. [25] In the present study Kaposi sarcoma was found in only 2 (1.9%) out of the 105 children examined. No case of non-Hodgkin lymphoma and hairy leukoplakia was reported in this series. The prevalence of these lesions in children differs sharply from that reported in adult populations where a higher prevalence is the normal finding. [21],[26] The differences may be explained in terms of geographical variations in the clinical presentations of oral lesions in both children and adults infected with HIV/AIDS.

Patients of different age groups have been reported to respond differently to highly active antiretroviral therapy (HAART) with respect to prevalence of oral lesions. In adults, there has been a decrease in the prevalence of oral candidiasis, oral hairy leukoplakia, and HIV-associated periodontal disease [27],[28] In children variable effects of HAART on oral lesions have been observed. While some authors reported significant reduction in prevalence of oral lesions, [8],[29],[30] others did not observe any changes in the occurrence of HIV-related oral lesions in children receiving HAART. [23],[31],[32] The result of the present study shows that HAART in HIV infected children significantly reduces the prevalence of angular cheilitis, psuedomembranous candidiasis, and HIV gingivitis. These lesions may possibly be used as prognostic indicators of response to HAART in children.


   Conclusion Top


Oral lesions are frequently seen in HIV-infected Nigerian children. Candidiasis is the most common oral lesion associated with HIV/AIDS in the paediatric population in this environment. The clinical picture, however, differs from those reported from other parts of Africa as well as other regions of the world in that parotid enlargement is not as prominent as it is in these regions. Early recognition of these lesions and institution of appropriate treatment will go a long way in reducing the high mortality associated with HIV/AIDS in children. Children on HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis.

 
   References Top

1.UNAIDS/Who Health Organization. AIDS epidemic update. December 2004, Geneva: UNAIDS/WHO.  Back to cited text no. 1
    
2.Bosco VL, Birman EG. Oral manifestations in children with AIDS and in controls. Pesqui Odontol Bras 2002;16:7-11  Back to cited text no. 2
    
3.dos Santos Pinheiro R, França TT, Ribeiro CM, Leão JC, de Souza IP, Castro GF. Oral manifestations in human immunodeficiency virus infected children in highly active antiretroviral therapy era. J Oral Pathol Med 2009;38:613-22.  Back to cited text no. 3
    
4.Chigurupati R, Raghavan SS, Studen-Pavlovich DA. Pediatric HIV infection and its oral manifestations: a review. Pediatr Dent. 1996;18:106-13.  Back to cited text no. 4
[PUBMED]    
5.Dixon S, McDonald S, Roberts J. The impact of HIV and AIDS on Africa's economic development. BMJ 2002;324:232-4.  Back to cited text no. 5
[PUBMED]    
6.European Collaborative Study. Children born to women with HIV-1 infection: Natural history and risk of transmission. Lancet 1991;327:253-60.  Back to cited text no. 6
    
7.Akpede GO, Ambe JP, Rabasa AI, Akuhwa TR, Ajayi BB, Akoma MA, et al. Presentation and outcome of HIV-infection in hospitalized infants and other children in north-eastern Nigeria. East Afr Med J 1997;74:21-7.  Back to cited text no. 7
[PUBMED]    
8.Olaniyi TO, Sunday P. Oral Manifestations of HIV infection in 36 Nigerian children. J Clin Pediatr Dent 2005;30:89-92.  Back to cited text no. 8
[PUBMED]    
9.Ramos-Gomez F. Dental consideration for the pediatric AIDS/HIV patient. Oral Dis 2002;8:49-54.  Back to cited text no. 9
[PUBMED]    
10.Naido S, Chikte U. Oro-facial manifestations in paediatric HIV: A comparative study of institutionalized hospital outpatients. Oral Dis 2004;10:13-8.  Back to cited text no. 10
    
11.Coogan MM, Greeenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ 2005;83:700-6.  Back to cited text no. 11
    
12.Greenspan JS, Barr CE, Sciubba JJ, Winkler JR. Oral manifestations of HIV infection: Definitions, diagnostic criteria and principles of therapy. Oral Surg Oral Med Oral Pathol 1992;73:142-4.  Back to cited text no. 12
    
13.Krammer IR, Pindborg JJ, Bezrouukov V, Infirri JS. Guide to epidemiology and diagnosis of oral mucosal diseases and conditions. World Health Organization. Community Dent Oral Epidemiol 1980;8:1-16.  Back to cited text no. 13
    
14.Scott GB, Hutto C, Makuch RW, Mastrucci MT, O'Connor T, Mitchell CD, et al. Survival in children with perinatally acquired human immunodeficiency virus type 1 infection. N Engl J Med 1989;321:1791-6.  Back to cited text no. 14
[PUBMED]    
15.Holmes HK, Stephen LX. Oral lesions in developing countries. Oral Dis 2002;8:40-3.  Back to cited text no. 15
[PUBMED]    
16.Reichart PA, Khongkhunthian P, Bendick C. Oral manifestations in HIV-infected individuals from Thailand and Cambodia. Med Microbiol Immunol 2003;192:157-60.  Back to cited text no. 16
[PUBMED]    
17.Ramos-Gomez FJ, Flaitz C, Catapano P, Murray P, Milnes AR, Dorenbaum A. Classification, diagnostic criteria and treatment recommendation for orofacial manifestations in HIV-infected paediatric patients. Collaborative Workshop on Oral Manifestations of Paeditric HIV infections. J Clin Pediatr Dent 1999;23:85-96.  Back to cited text no. 17
[PUBMED]    
18.Chen JW, Flaitz CM, Wullbrandt B, Sexton J. Association of dental health parameters with oral lesions prevalence in human immunodeficiency virus-infected Romanian children. Pediatr Dent. 2003;25:479-84.  Back to cited text no. 18
[PUBMED]    
19.Ranganathan K, Hemalatha R. Oral Lesions in HIV infection in developing countries: An overview. Adv Dent Res 2006;19:63-8.  Back to cited text no. 19
[PUBMED]    
20.Bakaki P, Kayita J, Moura Machado JE, Coulter JB, Tindyebwa D, Ndugwa CM, et al. Epidemiologic and clinical features of HIV-infected and HIV-uninfected Ugandan children younger than 18 months. J Acquir Immune Defic Syndr2001;28:35-42.  Back to cited text no. 20
[PUBMED]    
21.Leggott PJ. Oral manifestations of HIV infection in children. Oral Surg Oral Med Oral Pathol 1992;73:187-92.  Back to cited text no. 21
[PUBMED]    
22.Fonseca R, Cardoso AS, Pomarico IP. Frequency of oral manifestations in children with human immunodefiency virus. Quintessence Int 2000;31:419-22.  Back to cited text no. 22
    
23.Arotiba JT, Adebola RA, Iliyasu, Babashani M, Shokunbi WA, Ladipo MMA Z et al. Oral manifestations of HIV/AIDS infection in Nigerian patients. Nig J Surg Research 2005; 7 (12): 176-181.  Back to cited text no. 23
    
24.Taiwo OO, Okeke EN, Otoh EC, Danfillo IS. Oral manifestations of HIV/AIDS infection in Nigerian patients. Niger J Med 2005;7:176-81.  Back to cited text no. 24
    
25.Hamza OJ, Matee MI, Simon EN, Kikwilu E, Moshi MJ, Mugusi F, et al. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salam, Tanzania. Oral Health 2006,6:12  Back to cited text no. 25
    
26.Santos LC, Castro GF, de Souza IP, Oliveire RH. Oral manifestations related to immunosuppression degree in HIV-positive children. Braz Dent J 2001; 12:135-138.  Back to cited text no. 26
    
27.Greenspan JS, Greenspan D. The epidemiology of the oral lesions of HIV infections in developed world. Oral Dis 2002;8(suppl 2):34-9.  Back to cited text no. 27
[PUBMED]    
28.Ramírez-Amador V, González M, de la Rosa E, Esquivel L, Volkow P, Ochoa FJ, et al. Oral findings in Mexican AIDS patients with cancer. J Oral Pathol Med 1993;22:87-91.  Back to cited text no. 28
    
29.Greenwood I, Zakrzewska JM, Robinson PG. Changes in the prevalence of HIV- associated mucosa disease at a dedicated clinic over 7 years. Oral Dis 2002;8:90-4.  Back to cited text no. 29
    
30.Bendick C, Scheifele C, Reichart PA. Oral Manifestations in 101 Cambodian patients with HIV infection and AIDS. J Oral Pathol Med 2002;31:1-4.  Back to cited text no. 30
    
31.Patton LL, McKaig R, Strauss R, Rogers D, Eron JJ. Changing prevalence of oral manifestations human immune-deficiency virus in the era of protease inhibitor therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:299-304.  Back to cited text no. 31
    
32.Schmidt-Westhausen AM, Priepke F, Bergmann FJ, Reichart PA. Decline in the rate of oral opportunistic infections following introduction of highly active anti-retroviral therapy. J Oral Pathol Med 2000;29:336-41.  Back to cited text no. 32
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


This article has been cited by
1 Prevalence of oral mucosal lesions in human immunodeficiency virus-infected children attending the Pediatric Infectious Diseases Clinic in Cape Town
Riaan Mulder, Nadia Mohamed, Olorato Mathiba
Clinical and Experimental Dental Research. 2022; 8(1): 160
[Pubmed] | [DOI]
2 Oral candidiasis in human immunodeficiency virus-infected patients under highly active antiretroviral therapy
Madhura Shekatkar,Supriya Kheur,Archana A Gupta,Aavishi Arora,A. Thirumal Raj,Shankargouda Patil,Samar Saeed Khan,Ami Desai,William B. Carroll,Kamran Habib Awan
Disease-a-Month. 2021; : 101169
[Pubmed] | [DOI]
3 The Prevalence, Etiological Agents, Clinical Features, Treatment, and Diagnosis of HIV-Associated Oral Candidiasis in Pediatrics Across the World: A Systematic Review and Meta-Analysis
Zahra Rafat, Elahe Sasani, Yahya Salimi, Samaneh Hajimohammadi, Mohammad Shenagari, Davoud Roostaei
Frontiers in Pediatrics. 2021; 9
[Pubmed] | [DOI]
4 Oral Manifestations in HIV-Positive Children: A Systematic Review
Dorina Lauritano,Giulia Moreo,Luca Oberti,Alberta Lucchese,Dario Di Stasio,Massimo Conese,Francesco Carinci
Pathogens. 2020; 9(2): 88
[Pubmed] | [DOI]
5 Holistic dermatology: An evidence-based review of modifiable lifestyle factor associations with dermatologic disorders
Sophia Hu,Pratibha Anand,Melissa Laughter,Mayra B.C. Maymone,Robert P. Dellavalle
Journal of the American Academy of Dermatology. 2020;
[Pubmed] | [DOI]
6 The child and adolescent with HIV in resource poor countries
V Yengopal,Y Kolisa,MD Thekiso,MP Molete
Oral Diseases. 2016; : n/a
[Pubmed] | [DOI]
7 The global burden of oral diseases in pediatric HIV-infected populations: a workshop report
E Arrive,D Meless,G Anaya-Saavedra,M Gallottini,LM Pinzon,V Ramirez-Amador
Oral Diseases. 2016; : n/a
[Pubmed] | [DOI]
8 Prevalence of oral candidiasis in HIV/AIDS children in highly active antiretroviral therapy era. A literature analysis
Luis Alberto Gaitán-Cepeda,Octavio Sánchez-Vargas,Nydia Castillo
International Journal of STD & AIDS. 2015; 26(9): 625
[Pubmed] | [DOI]
9 Baseline burden and antimicrobial susceptibility of pathogenic bacteria recovered from oral lesions of patients with HIV/AIDS in South-Western Uganda
Ezera Agwu,John C. Ihongbe,Joseph O. Ezeonwumelu,Moazzam M. Lodhi
Oral Science International. 2015; 12(2): 59
[Pubmed] | [DOI]
10 Knowledge of Nairobi East District Community Health Workers concerning HIV-related orofacial lesions and other common oral lesions
Lucina N Koyio,Wil JM van der Sanden,Elizabeth O Dimba,Jan Mulder,Andre JAM van der Ven,Matthias AW Merkx,Jo E Frencken
BMC Public Health. 2014; 14(1): 1066
[Pubmed] | [DOI]
11 Programme guidelines for promoting good oral health for children in Nigeria: a position paper
Morenike O Folayan,Abiola A Adeniyi,Nneka M Chukwumah,Nneka Onyejaka,Ayodeji O Esan,Oyinkan O Sofola,Omolola O Orenuga
BMC Oral Health. 2014; 14(1): 128
[Pubmed] | [DOI]
12 Oral lesions among HIV-infected children on antiretroviral treatment in West Africa
David Meless,Boubacar Ba,Malick Faye,Jean-Serge Diby,Serge Næzoré,Sébastien Datté,Lucrèce Diecket,Clémentine NæDiaye,Edmond Addi Aka,Kouadio Kouakou,Abou Ba,Didier Koumavi Ekouévi,François Dabis,Caroline Shiboski,Elise Arrivé
Tropical Medicine & International Health. 2014; : n/a
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed6979    
    Printed247    
    Emailed1    
    PDF Downloaded267    
    Comments [Add]    
    Cited by others 12    

Recommend this journal