An assessment of adverse effects of antiretroviral therapy on the development of HIV positive children by observation of dental mineralization chronology M. Trigueiro 1 , S. V. Tedeschi-Oliveira 1 , R. F. H. Melani 1 , K. L. Ortega 2 1 Department of Social Dentistry, Faculdade de Odontologia, Universidade de Sa ˜o Paulo, Sa ˜o Paulo, Brazil; 2 Department of Stomathology, Faculdade de Odontologia, Universidade de Sa ˜o Paulo, Sa ˜o Paulo, Brazil BACKGROUND: The difference between dental age (DA) and chronological age (CA) indicates an advance or delay in comparison with the normal standard. Consid- ering that DA has a very close correlation with CA in a developing child, this study aimed to investigate the relationship between the effects of antiretroviral therapy on the development of HIV positive children, by observ- ing the timing of dental mineralization. METHODS: A retrospective examination was made of the medical records and dental panoramic radiographs of 50 HIV-positive pediatric patients, aged 37–168 months of age. Through these radiographs, their DA was esti- mated and compared with their CA. RESULTS: The mean DA was significantly lower than the mean CA in the entire studied sample (P < 0.01). There was a statistical difference between children who received antiretroviral drugs and those who used no drugs (P = 0.02), i.e. the non-treated individuals pre- sented practically no difference between CA and DA, while the treated patients showed a difference of 10.67 months. CONCLUSION: We conclude that the DA of HIV infected children was delayed when compared to the CA, and there was a positive association between the use of antiretroviral therapy and a delay in the chronology of dental mineralization in the sample. J Oral Pathol Med (2010) 39: 35–40 Keywords: dental chronology; HAART; HIV Introduction The history of the HIV / AIDS epidemic over the last two decades has been marked by constant advances in the discovery and development of new antiretroviral (AR) drugs. The new therapies have indisputable positive benefits: they decrease the circulating viral load and increase cellular immunity, which is reflected by an increase in life expectancy for patients. The significant decrease in the incidence of opportunistic diseases also improves the patients’ quality of life (1–4). On the other hand, several adverse effects have been noted in patients who use antiretroviral therapy (ART) such as metabolic, hematologic, liver, heart, neurolog- ical, pancreas and bone disorders, among others (5–16). Regarding children only, HIV has been associated with impaired somatic growth. However, studies that have tried to evaluate the effects of ART on the growth of HIV positive children have shown conflicting findings (17–23). Specifically in the dental field, studies show an increased risk of changes in dental tissue in children with AIDS (24, 25) and delays in tooth eruption (24, 26, 27), sometimes linked to delays in bone development (28). The evaluation of the development phase of a child is an integral part of the processes of diagnosis and treatment of pediatric patients. Dental maturity, based on the degree of dental mineralization, is often expressed as dental age, and is one of the known methods of determining the biological maturity of an individual. It is considered one of the best physical indicators of chronological age, because it is less dependent on the influence of external and internal factors (29). According to Davidson and Rodd (30), dental development is more closely related to chronological age (CA) than skeletal, somatic or sexual maturity indicators. The difference between dental age (DA) and chrono- logical age (CA) indicates an advance or delay in comparison with the normal standard (31). Considering that DA has a very close correlation with CA in a developing child, this study aimed to investigate the relationship between the effects of antiretroviral therapy on the development of HIV positive children, by observing the timing of dental mineralization. Materials and methods The study was carried out at the Center for Special Care Patients of the Faculty of Dentistry at the University of Correspondence: M. Trigueiro, Department of Social Dentistry, Faculdade de Odontologia, Universidade de Sa˜o Paulo, Lineu Prestes, 2227, 05508-000 Sa˜ o Paulo, Brazil. Tel: (55 11) 3091 7891, Fax: (55 11) 3091 7874, E-mail: marianatrigueiro@hotmail.com Accepted for publication September 28, 2009 doi: 10.1111/j.1600-0714.2009.00856.x J Oral Pathol Med (2010) 39: 35–40 ª 2009 The Authors. Journal compilation ª 2009 Blackwell Munksgaard Æ All rights reserved interscience.wiley.com/journal/jop Journal of Oral Pathology & Medicine