Sir, I would like to bring to the notice of all that the world has never seen a comparably complex public health hazard as that which it is currently experiencing in dealing with the effects of the AIDS epidemic on children.1 HIV infection was first recognised in children in 1983.2 It has now assumed the proportions of a major public health challenge. Oral lesions are frequently among the first symptoms of HIV-infected children. Certain clinical findings typical of the disease in the paediatric age group are: salivary gland enlargement, pyogenic bacterial infections, developmental delay and dysmorphic craniofacial features.

Recognition of these early oral signs during routine examinations and in surgical procedures may allow for early intervention and a reduction in morbidity in the population.3 Clinicians involved with examination and treatment of the oral cavity must be aware of the potential for oral presentation of a wide variety of disseminated bacterial, parasitic and fungal infections in children who have AIDS or who are at high risk of contracting HIV.4

Three of the most common oral and extra-oral problems seen in children infected with HIV are thrush, cervical lymphadenopathy and parotitis.5 Oral manifestations should be considered the earliest clinical sign of HIV infection and a good indicator of the progression of HIV in children. Oral lesions can be asymptomatic or can present with pain, discomfort and eating restrictions. Oral examination is simple, quick and inexpensive.6 Early detection of HIV-related oral lesions can be used to diagnose HIV infection, elucidate progression of the disease, predict immune status, and provide a basis for more aggressive and appropriate treatment of HIV that may considerably improve the child's well being.1

Early and accurate diagnosis of oral lesions in children is an important component in their clinical management, as oral manifestations have been found to be the earliest indicators of HIV infection. Oral lesions are the source of substantial HIV-associated morbidity in both adults and children. In addition, certain oral lesions are markers for progressive immunologic dysfunction and HIV disease progression. For these reasons, careful and continuous assessment of oral health is an integral part of comprehensive HIV disease treatment.

In developing countries, where the techniques to diagnose and the drugs to treat HIV infection are not uniformly available, the use of oral lesions as predictors of disease progression could be of immense importance. Primary dental care for HIV infected children should include a careful oral examination at regular intervals to ensure early detection and intervention. Preventive oral health measures especially where treatment is unavailable, can improve a child's overall health.

Though such measures cannot stop the progression of HIV disease in the absence of medications, improved diagnosis of the oral manifestations of HIV infection can enhance case management, ensure better oral health outcomes and improve quality of life for HIV infected children.3 The treatment and eradication of HIV infection in children require major contributions from disciplines of nursing, social work and medicine.

Thus, all of us must develop at least a basic familiarity with this illness.