Prevalence of tooth wear and associated risk factors among People Living with HIV/AIDS in Rwanda: a cross-sectional study

Prevalence of tooth wear and associated risk factors among People Living with HIV/AIDS in Rwanda: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of tooth wear and associated risk factors among People Living with HIV/AIDS in Rwanda: a cross-sectional study Julienne Murererehe, Franҫois Niragire, Jeannine Ahishakiye, Dorcus Dorée Nishimwe, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7215743/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Nov, 2025 Read the published version in BMC Oral Health → Version 1 posted 17 You are reading this latest preprint version Abstract Background Tooth wear has been reported to be on an increasing prevalence repeatedly. More importantly, tooth wear was found to be considerably higher and severer among People Living with HIV/AIDS (PLWHA) compared to HIV negative counterparts. There is scarce of information on tooth wear and associated factors in general. Specifically, no single study done in Rwanda to provide baseline data on this topic. Aim The aim of this study was to determine the prevalence of tooth wear and associated risk factors among PLWHA in Rwanda Methods A cross-sectional study was conducted among 237 PLWHA aged 18 years and above attending HIV clinics outside Kigali city (Nyamata and kagayi hospitals) and within Kigali city (Muhima hospital) in Rwanda. Oral examination was done by calibrated examiners and tooth wear was assesses using Tooth wear index (TWI). Descriptive statistics, Chi square, and multiple binary logistic regression analysis were used for data analysis using Stata version 15 software. Results Overall, the results revealed a higher prevalence of tooth wear among PLWHA 220 (92.83%) in Rwanda. Among them, more than a half 133 (56.12%) had dentinal wear up to 1/3 of the crown, a considerable number 33(13.92%) had excess tooth wear that extends to more than 1/3 of the crown. Only 54 (22.78%) had enamel wear to dentine in a single spot. Regarding the location and categories of teeth affected, a big number 142 (60%) of participants had tooth wear in 4 to 6 sextants. More participants had tooth wear in both anterior and posterior teeth 160 (67.51%) and majority of PLWHA had tooth wear in both upper and lower jaws 219 (81.02%). The Predictors of tooth wear were older age of 55+ (OR: 20.872; 95% CI:1.704-255.733), longer duration on HIV medication (OR: 6.594; 95%CI:1.053-40.719); and horizontal brushing technique. Although not statistically significant, males were 3.547 more like to have tooth wear than females. In addition, PLWHA who grind teeth were 2 times more likely to have tooth wear than those who do not grind teeth. Conclusion According to study results, tooth wear is a highly prevalent and a notably severe condition generalized to all teeth in the oral cavity among PLWHA in Rwanda. Longer duration on HIV medication, older age, horizontal brushing techniques were strongly associated with tooth wear. Therefore, there is a need of efforts from multidisciplinary health workers (dental professionals, nurses/ physicians in HIV services to raise awareness on tooth wear and its risk among this high risk group of people. In addition, tooth wear in PLWHA are left untreated. Hence the need to integrate oral health services to HIV cervices to provide oral health care to this high risk group of PLWHA. Clinical trial number not applicable. Tooth wear HIV risk factors Rwanda Introduction Oral health is a vital to general health. The burden of oral diseases and problems associated to them have remained a major public health concern worldwide [ 1 ]. In particular, tooth wear has been reported to be on an increasing prevalence repeatedly. Even though the literature underlines the scarce of research that specifies the prevalence of tooth wear among people living with HIV/AIDS (PLWHA), tooth wear was found to be considerably high (more than 90%) among PLWHA [ 2 ]. PLWHIV have also been reported to be at risk of severe tooth wear compared to HIV-negative counterparts [ 2 ]. Further, the literature highlights that patients with severe tooth wear experience difficulties with mastication, swallowing, speaking, sleeping and social interaction [ 3 ]. There is no single published research in Rwanda that investigated the prevalence and risk factors of tooth wear. According to the existing literature, thorough diagnosis of tooth wear and identification of its etiological factors are essential for developing preventative measures and successful tooth wear treatment [ 4 ]. In addition, the successful management of tooth wear require a holistic multidisciplinary management approach that consider dental, medical and mental involvement [ 5 ]. Several studies in various context have reported different risk factors for tooth wear including dietary factors such as excessive consumption of acidic foods and beverages, sweets, soft drinks, acidic snacks, and drinking habits like swishing or holding drinks in the mouth [ 6 ], [ 7 ] as well as mechanical factors such as oral hygiene practices, tooth grinding, anterior contact [ 6 ], [ 7 ], [ 8 ], [ 9 ]. In sub-Saharan Africa, there is still little and weak documented information regarding oral diseases, especially among PLWHA [ 10 ]. In particular, there is lack of research about the tooth wear status and risk factors among PLWHA in Rwanda. This knowledge gaps constitutes a major problem for prevention and treatment of tooth wear among PLWHA in Rwanda. Therefore, this study seeks to determine the prevalence and identify risk factors associated with tooth wear among PLWHA in Rwanda. This information will constitute reliable evidence to inform policy making and intervention programmes aimed to improve the oral health and wellbeing of PLWHA in Rwanda. Materials and methods Study setting The study was conducted at HIV clinics in three selected hospitals of Rwanda. These include the Muhima, Nyamata and Kabwayi hospitals. Muhima hospital is a district hospital in City of Kigali and it is considered as urban area. Muhima receives a considerable number of PLWHA. The district hospitals outside Kigali city were Kabgayi and Nyamata hospitals and they were selected because they are at a sufficiently large distance from the City of Kigali and patients from those hospitals are less likely to be referred to Muhima hospital. According to record, Muhima Hospital have a total of 1900 cases of PLWHA. Kabwayi hospital have a total of 1385 PLWHA and the total number of PLWHA followed at Nyamata hospital is 846. Thus, the total population of PLWHA is 4131 persons for these 3 hospitals. Study design and participants This study used a prospective cross-sectional study design. The study population were adults PLWHA attending 3 randomly selected hospitals from within Kigali City of Rwanda (Kabgayi) and outside Kigali City of Rwanda (Nyamata Hospital). All known PLWHA (aged 18 years and older) were considered eligible for the study. Sample size and sample size calculation The sample size for the present study was calculated using the Cochran formula for the sample size calculation for proportions (Bartlett EJ, Kotrlik WJ, Higgins CC., 2001). The proportion of tooth wear in the population is currently unknown. Thus, a proportion of p = 50% was considered to maximize the sample size n, and a confidence interval of 7% (we expect the true proportion is within 7 units below or above the estimated proportion (margin error of 7%), thus CI width = 14%). To draw inference at 95% level of confidence, the minimum sample size for the study is given by: where N is the population size and the sample size for each hospital clinic was then proportionate to its population size by the time of data collection. This study sample also takes into consideration a design effect of 1.2 as the similarities in the responses provided between patient from the same facility is expected to be very small given the nature of research design and tools. This suggested a minimum sample size of 225 patients. Also, we expect that PLWHA will be more likely to respond to our oral health study given that they have already crossed the HIV stigma barrier to health seeking behavior. They care much about their health as they have been adhering to HIV treatment visits. Thus, the minimum sample size will be augmented by five percent to allow for non-response. Thus, this study will target to achieve the sample size of 236 PLWHA. Data collection tools and procedures Participants was selected from PLWHA who daily visit the HIV clinics in the 3 selected hospitals. To recruit them, we collaborated with nurses and physicians who received PLWHA daily and they were ones to first inform participants about the study. PLWHA who voluntarily showed interests were oriented to data collectors for informed consent procedures. To determine the prevalence of tooth wear, all consenting participants were examined for tooth wear. Clinical examination was done by calibrated experienced dental professionals using Tooth wear index (TWI). The TWI is the most frequently used index to identify tooth wear [ 11 ]. The clinical examination was done in a research room at the HIV clinics of selected hospitals. Participants were seated in semi-supine position and then examined under natural light using mouth mirror and explorer. (0) was recorded for “no wear or negligible wear of the enamel” (1) was scored for “Obvious wear through the enamel to dentin in single spots”, (2) was recorded for “wear of dentin up to 1/3 of the crown height”, (3) was recorded for “wear of dentin more than 1/3 of the crown height and or excessive wear of tooth restorative materials. To be able to calculate the overall tooth status among our participants, people who scored 0 were considered as not having tooth wear. Those who scored 1, 2 and 3 were combined and considered as having tooth wear To identify risk factors for tooth wear, the structured interviewer-administered questionnaire on potential risk factors for tooth wear were developed based on items of a tool developed by National Association of Community Health Centers (NACHC) and factors from the Protocol for Responding and Assessing Patients ‘Assets, Risks, and Experiences (PREPARE) (U.S. Department of Health and Human Services et al., 2000; Masovic, 2018) the questionnaire was piloted prior to data collection to improve its clarity and quality. Statistical analysis Descriptive statistics comprising frequencies, percentages of tooth wear were calculated. Multiple binary logistic regression tests were done to determine the relationships between the tooth wear (dichotomous outcomes) with different factors. Stata version 15 was used to analyze data. Results Demographic characteristics of People Living with HIV/AIDs (PLWHA) in selected hospitals in Rwanda. The results in Table 1 displays participants’ characteristics. According to participants age, a big number were aged between 45–54 years 87(36.71%) and 55 + years 94(39.66%). Females The. Majority of study participants 219 (92.41%%) had medical insurance and a bigger number of study participants were females 137 (57.81%) than males 100 (42.19%). Table 1 Demographic characteristics of People Living with HIV/AIDs (PLWHA) in Rwanda. Variables Frequency (n) Percentage (%) Age 23–34 12 5.06 35–44 44 18.57 45–54 87 36.71 55+ 94 39.66 Sex Males 100 42.19 Females 137 57.81 Insurance Yes 219 92.41 No 18 7.59 Residence Within Kigali City 106 44.73 Outside Kigali City 131 55.27 Distribution of tooth wear among PLWHA in Rwanda Overall, the results revealed a higher prevalence of tooth wear among PLWHA 220 (92.83%) in selected areas of Rwanda as shown in Table 2 . Among them, more than a half 133 (56.12%) had dentinal wear up to 1/3 of the crown, a considerable number 33(13.92%) had excess tooth wear that extends to more than 1/3 of the crown. Only 54 (22.78%) enamel wear to dentine in a single spot. Regarding the location and categories of teeth affected, a big number 142 (60%) of participants had tooth wear in 4 to 6 sextants, more participants 160 (67.51%) had tooth wear in both anterior and posterior teeth and majority of PLWHA 2192 (81.02%) had tooth wear in both upper and lower jaws. Table 2 Distribution of tooth wear among PLWHA in Rwanda Tooth wear categories Frequency (n) Percentage (%) Overall tooth wear 220 92.83 Dentinal wear up to 1/3 of the crown 133 56.12 Excessive tooth wear: (more than 1/3 wear of the crown) 33 13.92 Enamel wear to dentine in a single spot 54 22.78 No tooth wear or negligible wear 17 7.17 Location of tooth wear within the mouth Number of sextants affected 4 to 6 sextants 142 60 2 to 3 sextants 66 27.80 1 or none 29 12.20 Jaws affected Tooth wear in upper and lower jaws 192 81.01 Lower jaw only 15 6.33 Upper jaw only 13 5.49 Teeth affected Tooth wear in anterior and posterior teeth 160 67.51 Anterior teeth 30 12.66 Posterior teeth 30 12.66 Binary logistic regression analysis of factors associated with tooth wear among PLWHA in Rwanda. According to results in Table 3 below, the predictors of tooth wear were older age of 55+ (OR: 20.872; 95% CI:1.704-255.733), longer duration on HIV medication (OR: 6.594; 95%CI:1.053–40.719); and horizontal brushing technique. Although not statistically significant, middle aged (35–44) participants were 4,905 times more likely to have tooth wear OR :1.99; 95%CI: 0.209–17.05 than young (23–24) aged ones. Also, males were 3.547 more like to have tooth wear OR: 3.547; 95%CI:0.831–15.137 than females. Participants living with HIV for 1–5 year were 7.095 times more likely to have tooth wear than those living with HIV for 6–10 years. Also PLWHA who reported to grind teeth were 2 times more likely to have tooth wear than those who said that they do not grind teeth. Table 3 Binary logistic regression of factors associated with tooth wear among HIV positive people in Rwanda Variables Subcategories OR ( 95% CI) P value Age 23–34 1 35–44 1.997(0.209–17.052) 0.548 45–54 4.905 (0.581–41.392) 0.144 55+ 20.872 (1.704-255.733) 0.017* Sex Females 1 Males 3.547 (0.831–15.137) 0.087 Residence location Within the capital city of Rwanda 1 Outside the capital city of Rwanda 1.317 (0.346–5.016) 0.687 Education High school 1 Primary or less 4.452 (0.997–19.864) 0. 0.50 University or others 11..553 (0.854-156.299) 0.066 Duration on HIV medication 6–10 years 1 1–5 years 7.095 (0.565–89.061) 0.129 10 + years 6.549 (1.053–40.719) 0.044* Duration of brushing 3–5 minutes 1 Less than 3 minutes 1.267 (0.269–5.974) 0.765 Frequency of brushing 2–3 times a day 1 Less than 2 times a day 1.507 (0.415–5.477) 0.533 Brushing Method Vertical or circular 1 Horizontal 5.671 (1.496–21.506) 0.011* Type of toothbrush bristles Medium bristles 1 Soft bristles 2.291 (0.456–11.519) 0.314 Hard bristles 3.814 (0.815–17.849) 0.089 Frequency of changing toothbrush After more than 3 months 1 After less than 3 month 4.360 (0.803–23.677) 0.088 After 3 months 12.337 (0.996-152.856) 0.050 Grinding teeth Never 1 Sometimes or often 2.075 (0.259–16.595) 0.491 Taking acidic means Low (Less than once a week) 1 High (once or more daily) to medium (less than 3 times a week) 1.082 (0.084–12.663) 0.980 Dry mouth Yes 1 No 0.452 (0.100-2.023) 0.299 * indicates statistically significant P value Discussion According to findings of this study, tooth wear is at high prevalence 220 (92.83%) and it is a remarkably severe condition (dentinal wear up to 1/3 of the crown and excess tooth wear than extends to more than 1/3 of the crown) generalized in the oral cavity among People Living with HIV/AIDs (PLWHA) in Rwanda. Longer duration on HIV medication, older age, horizontal brushing techniques were significantly associated with tooth wear. These results are similar to previous findings in the literature that revealed a high prevalence of tooth wear among PLWHA and highlighting duration of HIV medication, older age and brushing technique among predictors of tooth wear [ 2 ][ 9 ]. Overall, this study revealed a high prevalence of tooth wear (more than 92%) among PLWHA. the results of this study are in line with the finding of a study done in Saudi Arabia by Sehgal and colleagues. In their study, more than 90% of PLWHA had tooth wear [ 2 ]. The findings in this study also revealed that more study participants had severe tooth wear (Dentinal wear up to 1/3 of the crown (more than 56%) and excess tooth wear than extends to more than 1/3 of the crown (about 14%)). This results support the previous argument in the literature highlighting that PLWHA live with severe and untreated oral health problems including tooth wear [ 14 ] [ 2 ]. Severe tooth wear has an impact on oral pain levels, dental appearance and function [ 14 ][ 15 ]. Thus, as emphasized by previous researchers, medical interventions that consider involvement of dental providers and health professionals in HIV services are essential to comprehensively and successfully prevent and treat tooth wear among PLWHA [ 2 ]. According to the localization of tooth wear in the oral cavities, the findings of this study showed a generalized tooth wear in the oral cavity where most respondents had tooth wear in 4 up to 6 sextants (60%), in both upper and lower teeth (80.01%) and within both anterior and posterior teeth (67.51%). Having many teeth, in various sextants and jaws affected by tooth wear can lead to functional impairment, tooth sensitivity or pain, and aesthetic problems (7).In addition, tooth wear can affect a person's ability to live comfortably, work successfully, enjoy life, form relationships, and can have a negative impact on one's quality of life [ 16 ]. Hence, the results of this study show how tooth wear condition among PLWHA is a severe generalized problem. Hence the need for effective and contextual oral health promotion interventions among this high risk group of PLWHA in Rwanda. The literature has highlighted that tooth wear-related early diagnosis and intervention are vital because the treatment of tooth wear is very challenging (12). At the same time, there is a limited access to oral health services mostly due to shortage of dental personnel and infrastructures in Rwanda [ 17 ]. This context can amplify the problem of tooth wear among Rwandans especially among PLWHA. Therefore, Oral health advocacy is essential to help timely diagnosis and management of tooth wear and to ensure good oral health and better quality of life of PLWHA in Rwanda. After performing logistic binary regression analysis, the predictors of tooth wear were older age longer duration on HIV medication and horizontal brushing technique. These findings are in line with previous studies reports in the literature. For an instance older age were shown to be associated with tooth wear by diverse researchers [ 18 ][ 19 ][ 20 ] [ 9 ]. Tooth wear increases during a person’s life course, and its severity increases with age [ 21 ]. As the life expectancy of PLWHA increases, the prevalence and severity of tooth wear among this high risk group also increases. Therefore, it is essential for oral health care professionals in collaboration with medical care professionals in HIV services to ensure early tooth wear risk assessment and a clinical examination to avoid complex restorative procedures which are complex and difficult especially among older people The results of this study has shown that longer duration on HIV medication to be significantly associated with tooth wear. similar results were reported in the literature [ 2 ]. These findings are explained by the fact that many oral health issues experienced by PLWHA are related to the side effects of the medications themselves, including dry mouth or xerostomia which is highlighted as a significant complication of HIV and/or side effect of ART medications [ 22 ]. Also, mood and sleeping disturbances are reported among side effects of taking antiretroviral therapy [ 23 ]. The combination of insomnia and moody increases the likelihood of clenching and grinding teeth leading to increased risk of tooth wear among PLWHA[ 2 ]. Although not statistically significant the results have shown that PLWHA were more likely to have tooth wear within their first 5 years than within their 6 to 10 years of HIV infection. This may be explained by increased psychological problems in recent years after being informed about HIV infection results which may decrease with time while PLWHA cope with this issues and then increases again with longer time due to HIV treatment side effects. This study has also shown that participants who used horizontal brushing movements were more likely to develop tooth wear. These results are similar to the findings of a study done by Kan sun and colleagues in Beijing [ 19 ]. In general, improper rushing techniques accelerate dental hard tissue defects [ 24 ]. For example, horizontal brushing movement is known to be one of the most important reasons for wedge-shaped defects in teeth [ 19 ]. At the same time Keeping good oral hygiene is very central to prevent different oral diseases including tooth wear. Thus, educating PLWHA on how to properly brush their teeth is paramount to reduce the risk of tooth wear development in this high risk group. Though not statistically significant, participants who reported to grind teeth were more likely to have tooth wear than the ones who were not grinding teeth. These results are in line with previous studies done [ 2 ]. Scholars have reported that most PLWHA on antiretroviral therapy experience dry mouth, bruxism and teeth grinding that all result in tooth wear [ 6 ] [ 2 ]. Others researchers have highlighted that Antiretroviral medicine can expose to xerostomia, mood, and sleeping difficulties [ 25 ]. Insomnia and medicines increase the likelihood of clenching and grinding teeth, which exacerbates tooth wear among PLWHA [ 25 ]. Also, the results of a study done in Brasil by Pomarico and colleagues highlighted that HIV medication can have a significant risk of tooth wear among PLWHA [ 26 ]. In addition to HIV medication side effects, PLWHA are prone to psychological disorders [ 24 ]. The presence of psychological disorders is known to result in various oral health problems [ 22 ] including as bruxism which in turn leads to tooth wear [ 6 ]. Moreover, there findings in this research have shown that males were more likely to develop tooth wear than females. Similar results were reported in previous studies [ 20 ] [ 9 ] [ 2 ]. For instance, in a study done by Khalifa S Al-Khalifa in Saudi Arabia, males were reported with higher prevalence of tooth wear than females [ 25 ]. Bernhardt and colleagues has reported that men are more likely show bruxism behavior than females [ 27 ] which may explain why greater amounts of tooth wear is found in this group of people. Conclusion According to study results, tooth wear is a highly prevalent and a notably severe condition among PLWHA in Rwanda. Longer duration on HIV medication, older age, horizontal brushing techniques were strongly associated with tooth wear. Therefore, there is a need of efforts from multidisciplinary health workers (dental professionals, nurses/ physicians in HIV services to raise awareness on tooth wear and its risk among this high risk group of people. In addition, tooth wear in PLWHA are left untreated. Hence the need to integrate oral health services to HIV cervices to provide oral health care to this group of people. educating providers about the potential harmful impact of HIV medications on patients’ dentition and oral health and intervening with night guard therapy at the time a patient is diagnosed with HIV by prescribing night guard therapy at the time of diagnosis was recommended in the literature. This intervention would protect PLWHA from many negative effects associated with chronic bruxism and decrease tooth wear in this group. Abbreviations AIDs Acquired Immunodeficiency Syndrome CMHS College of Medicine and Health Sciences HIV Human Immunodeficiency Virus IRB Institutional Review Board OR Odd Ratio PLWHA People Living with HIV/AIDs Declarations Ethics approval and consent to participate This study has been performed in accordance with the Declaration of Helsinki. The ethical clearance was obtained from Institutional Review Board (No 548/ CMHS IRB/2023) from University of Rwanda. In addition, the permission to conduct the study were received from all studies cite. The informed written consents were given to all participants before data correction. To get informed consent, we provided adequate information to participants through information sheet to the nature and processes involved in the study, the reason for the study, and the intended outcomes. We ensured participants comprehended the provided information before signing the consent form. Then, participants who agreed to participate in our study voluntarily signed the consent form. The confidentiality of patients was observed by using an anonymous questionnaire Consent for publication Not applicable Competing interests The authors declare no competing interests. Julienne Murererehe Julienne Murererehe is a PhD CARTA graduate Funding This study received funding from the University of Rwanda-Sweden collaboration program (UR Seed Grant) under the grant No. (VC/1284/2022). Author Contribution JM, FN, JA and YMC participated in the study conception and design. JM and FN analyzed data. JM, GT, DDN, NP, EN, corrected the data and drafted the manuscript. JM, YMC, reviewed the manuscript and supported data analysis, data interpretation, and discussions. All authors revised and approved the final version of the manuscript. Acknowledgement We thank Mrs Aurelie Uwamahoro, Mr. Manirakiza Jonathan and Mr. Joseph Mwiza for their guidance and support during data collection process. We also acknowledge Associate Professor Peace Uwambaye for her contribution during the research conceptualization. Julienne Murererehe is a PhD CARTA graduate Availability of data and materials All data generated or analyzed during this study are included in this published article and its supplementary materials. References Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR et al. Oral diseases: a global public health challenge. Lancet [Internet]. 2019;394(10194):249–60. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673619311468 Sehgal HS, Kohli R, Pham E, Beck GE, Anderson JR. Tooth wear in patients treated with HIV anti-retroviral therapy. 2019;1–7. Sterenborg BAMM, Bronkhorst EM, Wetselaar P, Lobbezoo F, Loomans BAC, Huysmans MDNJM. The influence of management of tooth wear on oral health-related quality of life. 2018;2567–73. Sartawi S, Salim NA, Taim D. Awareness and Treatment Decisions on Tooth Wear among Jordanian Dentists and Prosthodontists: A Cross-Sectional Survey Study. 2020;2020. Ahmed KE, MANAGEMENT OF TOOTH WEAR: MENTAL HEALTHCARE APPROACH. 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Cite Share Download PDF Status: Published Journal Publication published 28 Nov, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 03 Sep, 2025 Reviews received at journal 29 Aug, 2025 Reviews received at journal 29 Aug, 2025 Reviews received at journal 26 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers agreed at journal 08 Aug, 2025 Reviews received at journal 06 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 05 Aug, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviewers invited by journal 04 Aug, 2025 Editor invited by journal 02 Aug, 2025 Editor assigned by journal 30 Jul, 2025 Submission checks completed at journal 30 Jul, 2025 First submitted to journal 25 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7215743","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496204745,"identity":"d5368fdc-b015-42ba-95ed-39a2e392825d","order_by":0,"name":"Julienne Murererehe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYBACxgYYS4KB8QGYwXyA4QCxWpgNwBRbAn4tCABUKwHTghcwTztj9uHjHpt8funmYxU/au7V8bfxPjzwo4ZBzrx/AXaHzc4xnjnjWZrlzDnH0m72HCuWkDjGbnCw5xiDscyNBzi1MPMcOGxgcCPH7DbQURIM99sYDjOwMSTOkMDuJbCWPwf+G9jfyP9WzPAvQUL+GBtQyz8CWhgOHDAwkMhhY2ZsS5AwAGlhbANq4W/AoSWtmLHnQLKBxI00Y8nevgTJjUAtB3v7JIwlJLCHmOHs5M0MPw7YGfDPSH744ce3BH65Y2zMQIaNnAQ/docZYrccFD8MEglYZeRx6AABHLaMglEwCkbBiAMA58ddKGkPnnQAAAAASUVORK5CYII=","orcid":"","institution":"University of Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Julienne","middleName":"","lastName":"Murererehe","suffix":""},{"id":496204747,"identity":"c991e83d-065a-4594-b87a-9d6347f681e2","order_by":1,"name":"Franҫois Niragire","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Franҫois","middleName":"","lastName":"Niragire","suffix":""},{"id":496204750,"identity":"d95723ea-3fa9-4dc3-b408-47ed159f79bc","order_by":2,"name":"Jeannine Ahishakiye","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Jeannine","middleName":"","lastName":"Ahishakiye","suffix":""},{"id":496204756,"identity":"fb642669-b4ec-4950-a5a3-108f88fe0180","order_by":3,"name":"Dorcus Dorée Nishimwe","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Dorcus","middleName":"Dorée","lastName":"Nishimwe","suffix":""},{"id":496204757,"identity":"d14fe5cb-5611-4044-8f8d-c577fbc0f5fe","order_by":4,"name":"Eliane I Harelimana","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Eliane","middleName":"I","lastName":"Harelimana","suffix":""},{"id":496204758,"identity":"bc99860e-48a5-4e37-b0d5-c45582d21fe4","order_by":5,"name":"Gabriel Tuyishime","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Gabriel","middleName":"","lastName":"Tuyishime","suffix":""},{"id":496204759,"identity":"9a60aead-ffdc-4dac-a950-8d904611fa87","order_by":6,"name":"Pierre Nkundimfura","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Pierre","middleName":"","lastName":"Nkundimfura","suffix":""},{"id":496204760,"identity":"1472b055-ebe4-4adb-b1cd-dc1a3d1ba6e4","order_by":7,"name":"Eustache Ntigura","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Eustache","middleName":"","lastName":"Ntigura","suffix":""},{"id":496204761,"identity":"f9d3d93d-4954-4b64-a0f9-a1e66c4ba0d2","order_by":8,"name":"Ineza Marie Claire","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Ineza","middleName":"Marie","lastName":"Claire","suffix":""},{"id":496204762,"identity":"decac879-e2fa-4f0c-a9fd-8bda0572cd4c","order_by":9,"name":"Sifa Nayihiki","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Sifa","middleName":"","lastName":"Nayihiki","suffix":""},{"id":496204763,"identity":"2657e3d5-198f-4d80-b268-966cc95c6263","order_by":10,"name":"Yolanda Malele-Kolisa","email":"","orcid":"","institution":"University of Witwatersrand","correspondingAuthor":false,"prefix":"","firstName":"Yolanda","middleName":"","lastName":"Malele-Kolisa","suffix":""}],"badges":[],"createdAt":"2025-07-25 15:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7215743/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7215743/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-07261-y","type":"published","date":"2025-11-28T15:57:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97178342,"identity":"f9a83b0f-2565-43aa-b082-f2b55a9c9839","added_by":"auto","created_at":"2025-12-01 16:08:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":942286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7215743/v1/8b8bd228-0da1-4115-a7d2-a8b4a8d40da6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of tooth wear and associated risk factors among People Living with HIV/AIDS in Rwanda: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOral health is a vital to general health. The burden of oral diseases and problems associated to them have remained a major public health concern worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In particular, tooth wear has been reported to be on an increasing prevalence repeatedly. Even though the literature underlines the scarce of research that specifies the prevalence of tooth wear among people living with HIV/AIDS (PLWHA), tooth wear was found to be considerably high (more than 90%) among PLWHA [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. PLWHIV have also been reported to be at risk of severe tooth wear compared to HIV-negative counterparts [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Further, the literature highlights that patients with severe tooth wear experience difficulties with mastication, swallowing, speaking, sleeping and social interaction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. There is no single published research in Rwanda that investigated the prevalence and risk factors of tooth wear.\u003c/p\u003e\u003cp\u003eAccording to the existing literature, thorough diagnosis of tooth wear and identification of its etiological factors are essential for developing preventative measures and successful tooth wear treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, the successful management of tooth wear require a holistic multidisciplinary management approach that consider dental, medical and mental involvement [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Several studies in various context have reported different risk factors for tooth wear including dietary factors such as excessive consumption of acidic foods and beverages, sweets, soft drinks, acidic snacks, and drinking habits like swishing or holding drinks in the mouth [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] as well as mechanical factors such as oral hygiene practices, tooth grinding, anterior contact [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn sub-Saharan Africa, there is still little and weak documented information regarding oral diseases, especially among PLWHA [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In particular, there is lack of research about the tooth wear status and risk factors among PLWHA in Rwanda. This knowledge gaps constitutes a major problem for prevention and treatment of tooth wear among PLWHA in Rwanda. Therefore, this study seeks to determine the prevalence and identify risk factors associated with tooth wear among PLWHA in Rwanda. This information will constitute reliable evidence to inform policy making and intervention programmes aimed to improve the oral health and wellbeing of PLWHA in Rwanda.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at HIV clinics in three selected hospitals of Rwanda. These include the Muhima, Nyamata and Kabwayi hospitals. Muhima hospital is a district hospital in City of Kigali and it is considered as urban area. Muhima receives a considerable number of PLWHA. The district hospitals outside Kigali city were Kabgayi and Nyamata hospitals and they were selected because they are at a sufficiently large distance from the City of Kigali and patients from those hospitals are less likely to be referred to Muhima hospital. According to record, Muhima Hospital have a total of 1900 cases of PLWHA. Kabwayi hospital have a total of 1385 PLWHA and the total number of PLWHA followed at Nyamata hospital is 846. Thus, the total population of PLWHA is 4131 persons for these 3 hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used a prospective cross-sectional study design. The study population were adults PLWHA attending 3 randomly selected hospitals from within Kigali City of Rwanda (Kabgayi) and outside Kigali City of Rwanda (Nyamata Hospital). All known PLWHA (aged 18 years and older) were considered eligible for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sample size calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size for the present study was calculated using the Cochran formula for the sample size calculation for proportions (Bartlett EJ, Kotrlik WJ, Higgins CC., 2001). The proportion of tooth wear in the population is currently unknown. Thus, a proportion of p\u0026thinsp;=\u0026thinsp;50% was considered to maximize the sample size n, and a confidence interval of 7% (we expect the true proportion is within 7 units below or above the estimated proportion (margin error of 7%), thus CI width\u0026thinsp;=\u0026thinsp;14%). To draw inference at 95% level of confidence, the minimum sample size for the study is given by:\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"145\" height=\"93\" src=\"data:image/wmf;base64,iVBORw0KGgoAAAANSUhEUgAAANkAAACLCAYAAADs+DyKAAAAAXNSR0ICQMB9xQAAAAlwSFlzAAAWJQAAFiUBSVIk8AAAABl0RVh0U29mdHdhcmUATWljcm9zb2Z0IE9mZmljZX/tNXEAAAsQSURBVHja7Z29bt1GGobZbKqUKWTAYyCFgSCdzaMyQSqaEdykESITBylspAoICKkFyp2BXV/AunNnX4GL9RX4Dlyk38LILexqSA3PnCNyyCGH5AzPU7yALcGyZs4839/8fNHLly8jhNB0YhIQAjKEgAwhBGQIAdkqdZ3FT6Mo+l+p+Nlb5gTIkEMVefpIxM9e13+Ooi8i+eNP5gbIkCPl2+0Pv7969bX6+x+J+DO6n37Uv4aADLkOHYEMyNB0kp7M53Dx1avfv87S08s4yV8EGz0k8YvTNLv0zZABQAcYdeGiQyaAimJ7L37w5I2vXkz+fo9F9EnmkOp3vM7zk+02Od9sxLsoEl/SvHjk++clDcWzWLz2LWIAJsMHlt6PPsqFl+fXJ23f71M5zOK42BbFPa8B04yELNRshPggVRmRMCDbM47i8Sdf5hyg2hbfzUIzhU7P4uhtuQA7rKb8wOPs+qmv4yzH0WIkSg8cRX+FBlnXuIDMm/g+OW+zhLsw0rz4ZLFD9xDy7z4BV+3jtY9h563Dg0xtm/gw3wA18MOTkJk+wOZ8Lv7LlxCmBshg7UOGrP7dPcjPAMcyf6nCJ3OhYxGvlOcnWZo+l3mU/N3kInsSP3ijPO6hQVCnUUzj8AEy23E1GbqlvRnw2FpGD49I7R3full4yXZ7nqbZc2nBd55334uqnNK0AJeGbMi4Gv/9wp8XANkk0p6FfG1GQB3nagOqLzw+eDKbcbWG9guHjABkZVGnX2yqpG5bgjZZ9sPFuAt7zQbDB8hsxtUe3i9rGIHIUaFjihDJ5v9T+cdhjtUEimvIbDbtbfNZm3EBGYWOyTzZbsHdXUxNIVMonsx2XEAWcqHD84O99YJrSPCbKmyhQGY7LiALTLsQyFy9Si+KH33JGQ8XXL3IDoxEKIUP23FR+FhZoaPILx5uxOadD5XGqgCwbwy6AAmhhD9kXI2fIyX8cAod8gPO84tHcjO0LYxZLm+8WXRZfqYMQNdC7LMZXZ7fvM1J574CM3RctiElkC1Y6OgjH87F6V5X37jVr60YvVRDKLWXj+5pPo82dFx3PCHHqpCbkGrY4u86IBzquPSIhAPCyI3nHWGtfboSstZxsVhXUKAZs4dXX0716MDz2HFxaRM5kV5lGxsS6bfAl85fxoyrfn7AI8CALOg87KAo4SDBlw/RLPmQzthx8ZAOQkcqJgEhIEMIyBBCQNZjIizuQ6FwBWQI4ckQQkCGEJAhBGToyETbXSBDE4q2u0CGJhZtd4EMLRE6AhmQoenke9tdIENh52eet90FMhS8fG67C2RoFWGiz213gQwFLd/b7gIZ8l55dvqrENHnesNZewPD97a7QIa8lnxxV3WIuciLh9XX2ps4ICBDVoDtYNKrhUAGZMiBTH29xr7Mi4AMvWxutFC/SThjQ0MEZKv3YjIPk11okiS+KkPEm9wMDwZkyFUuprqgiM2HOEmuVOEDARkaKV8a3yEgW78nazlJX+6ZefDmPZChoKXelNdhkntmZYdQAAMyNF56JVHlZg/iJ2/IyzyDTFalsvT0ciPEB9XpQ3548mtVYs1eC0KDIdtvYVPBVJaG4/if0hryFgRCDjyZ3lI0v85Pkji5UrF8n06IzQdP2wWw6PggU94qzYrDy3zK03EdAqERkFWeSHzZbDb/1mGqPdzM1yFoloBCbWjRWp2qjuZUZWD9e2x2IuTAk+2O5rSd4iZURGgUZG2FDb0Y0rWhSeEDIQNklbe668V0+K7z/ISTAwgNgKz2Vg05l7rwl2y353GcFUxgpTxLz07T7BKjsz5VBzDS52mWnzmDTHmrppxLQaZOgPABVMeXmI/1q3xZ+aAIOCpcRP0AS4V4P1cuSXsjf0CzjViYvIGSHmwuwGhvFLZHY+IGTvScnU9ob+RZBHM/+mizhcXE2XqVYnvvcSQWfSuD9kYLr4Eymtg9EAtkzsPE6O3SoZrv7Y3Ulag1F4TKImDP3BhwJrRgd0JMBxvzvrc3Kj29iD7pBQK5p7rdJuebjXi3lnuINmsBeGxBGVDZU3G8XHh5fn3S9v0+lUOf2xvVgGlGQi5GefFXSr+feExRDfBMmPDqC80UOtWXZDvyLN/bG5lCqN3tjfVA1jc3BqAZQsU8Sc7b/t0ujDQvPt/bG1X7eO1j2Hnr9UBWFcEe/6drTQCQY6tlD271EKkJGN/bG9UAGULdNULWN7oBoInzMWMBowyf/LuBIAsV8ryezKPk7yYXk3xOTnncw0XV5zkKHyCzHZervAyAHCe5VpbfwyNSe8e3bg+Dp2n2XHrwtnuGfe4YLg3ZkHG5Mr4ANHHRw1jo8LSjpelm/CFQfeHxwZPZjMtlGgFEvUK7n77/Jvrq7+9+K35xZ1HnWWyqrK63sO2fK3bfjO/75osPkE1x47/47btf/hGJ/z4tim+BzAPI+hY6pgqT+v6fqtByGB43gTIFZFPdqrcZlw1kX0Xf/P1TUXwPZAtDtlShw9aTmbp0NjWzCMWT2Y4LyAKDbK/Q4fnBXlNP6aYOnqFAZjsuIAsMsl34074QZViXXhQ/Lj3WtpvxbY8ohVL4sB0XkAUEWZ9Ch2xrtBGbdz5UGpseUeoCJIQS/pBxAVkAkJkKHfIDlp1zyp5hLWHM/OPUzhfePhwjDUDXQuyzGV2e37zNSee+AjN0XEcL2RLXJoZAphc6+siHc4i619U3brvetag9QkPItZeP7mk+jzZ0XEcJ2VLXJlzuk/ks9RrZkDntOiAc6riONlyc+9qED08OzDanI6qfNreFQxpXd0pg3h4JckGM2jwcAMwxeLI+eVXfz8WnA88uxnWUngzIppvPsbmhfgt86f1Al+MCMiAbma8cFCUchFZ5Er9Y8iGdqcYFZECG5s75gAzIEJABGQKykCGzvTLR/tISkCEg88qT0aB8vU3WgYxwEeHJgAwBGZABGQKycdcmgAwBWS8PNvzaBJD1Fy10j9iTzT6RRwgZLXSBbGbI1n/V5VC00LUwRmu86gJkC4WOQAZkhIvTqauFbtNzC03XS9ryap/7rhEuAtksnrxvC93dAzXmYknZb03meWlWhOwdgQzInMi2he7uLpfpGbzhTRWBDMhWFybahHKq+2T1mlj7tX/X/d6ADMiCLXbYttBVpX/T+/KuW1EBGZB5qzw7/VWI6HNdgNCaUgxtoasKJKajb2sJFYEMyIzFCdXp5SIvHu4W/riXjEuwhHivoGprVbSWUBHIgKw9nLuFSQ/jXEBW/gyRvq/bKjU03VtTqAhkTiFbx2a0qUeXi1d2m/bS7nTmXFGo2GRYgGzk4gzd+jb14ZJjexaL104eNtVCRb1You+ZrSlUrMdHz2g3khY5ZMh0LybzMNlRJkniqzKcu8nNxnrpNouuNwm8KPKHawoV+xoNABoRCgWZi6mOJmLzIU6SK1X4mHJ+VMgofv75X3IPbS2hohpb17oAIIdhgfe//4T3wmTIaT7dcQv4ikLFvmkEAFl5gnAT9q7m4+We2cD367vmRj8UvKZQUZ1u6VoTAHRExY86bNNgkntmZbfPgYBVhZObnyvMBqgqunRvZq8xugEgx0mu74ZCVRJVbvYgfvJmSF5me2WlfJclzoo1rYc++RiQDQqLxOdjvryJ7NMHJmwi64WIaoAMb4Zm8GJANsaK8d7FUWpIAYyJGxw2iteEjcdpYNVTeUA2h0UT4j2gHR9gthEMkzcSNOnRluyNjPwGDMgcKc/Ss9M0uyRHW6chzdL0eZrlZ0N/BhOJ0MRiEhACMoSADCEEZAgtp/8DUaUd72jlzsoAAAAASUVORK5CYII=\" alt=\"image\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003ewhere N is the population size and the sample size for each hospital clinic was then proportionate to its population size by the time of data collection. This study sample also takes into consideration a design effect of 1.2 as the similarities in the responses provided between patient from the same facility is expected to be very small given the nature of research design and tools. This suggested a minimum sample size of 225 patients. Also, we expect that PLWHA will be more likely to respond to our oral health study given that they have already crossed the HIV stigma barrier to health seeking behavior. They care much about their health as they have been adhering to HIV treatment visits. Thus, the minimum sample size will be augmented by five percent to allow for non-response. Thus, this study will target to achieve the sample size of 236 PLWHA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants was selected from PLWHA who daily visit the HIV clinics in the 3 selected hospitals. To recruit them, we collaborated with nurses and physicians who received PLWHA daily and they were ones to first inform participants about the study. PLWHA who voluntarily showed interests were oriented to data collectors for informed consent procedures.\u003c/p\u003e\n\u003cp\u003eTo determine the prevalence of tooth wear, all consenting participants were examined for tooth wear. Clinical examination was done by calibrated experienced dental professionals using Tooth wear index (TWI). The TWI is the most frequently used index to identify tooth wear [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. The clinical examination was done in a research room at the HIV clinics of selected hospitals. Participants were seated in semi-supine position and then examined under natural light using mouth mirror and explorer. (0) was recorded for \u0026ldquo;no wear or negligible wear of the enamel\u0026rdquo; (1) was scored for \u0026ldquo;Obvious wear through the enamel to dentin in single spots\u0026rdquo;, (2) was recorded for \u0026ldquo;wear of dentin up to 1/3 of the crown height\u0026rdquo;, (3) was recorded for \u0026ldquo;wear of dentin more than 1/3 of the crown height and or excessive wear of tooth restorative materials. To be able to calculate the overall tooth status among our participants, people who scored 0 were considered as not having tooth wear. Those who scored 1, 2 and 3 were combined and considered as having tooth wear\u003c/p\u003e\n\u003cp\u003eTo identify risk factors for tooth wear, the structured interviewer-administered questionnaire on potential risk factors for tooth wear were developed based on items of a tool developed by National Association of Community Health Centers (NACHC) and factors from the Protocol for Responding and Assessing Patients \u0026lsquo;Assets, Risks, and Experiences (PREPARE) (U.S. Department of Health and Human Services et al., 2000; Masovic, 2018) the questionnaire was piloted prior to data collection to improve its clarity and quality.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eDescriptive statistics comprising frequencies, percentages of tooth wear were calculated. Multiple binary logistic regression tests were done to determine the relationships between the tooth wear (dichotomous outcomes) with different factors. Stata version 15 was used to analyze data.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDemographic characteristics of People Living with HIV/AIDs (PLWHA) in selected hospitals in Rwanda.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays participants\u0026rsquo; characteristics. According to participants age, a big number were aged between 45\u0026ndash;54 years 87(36.71%) and 55\u0026thinsp;+\u0026thinsp;years 94(39.66%). Females The. Majority of study participants 219 (92.41%%) had medical insurance and a bigger number of study participants were females 137 (57.81%) than males 100 (42.19%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of People Living with HIV/AIDs (PLWHA) in Rwanda.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e55+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsurance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin Kigali City\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutside Kigali City\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDistribution of tooth wear among PLWHA in Rwanda\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOverall, the results revealed a higher prevalence of tooth wear among PLWHA 220 (92.83%) in selected areas of Rwanda as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among them, more than a half 133 (56.12%) had dentinal wear up to 1/3 of the crown, a considerable number 33(13.92%) had excess tooth wear that extends to more than 1/3 of the crown. Only 54 (22.78%) enamel wear to dentine in a single spot. Regarding the location and categories of teeth affected, a big number 142 (60%) of participants had tooth wear in 4 to 6 sextants, more participants 160 (67.51%) had tooth wear in both anterior and posterior teeth and majority of PLWHA 2192 (81.02%) had tooth wear in both upper and lower jaws.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of tooth wear among PLWHA in Rwanda\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTooth wear categories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall tooth wear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e220\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e92.83\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDentinal wear up to 1/3 of the crown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcessive tooth wear: (more than 1/3 wear of the crown)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnamel wear to dentine in a single spot\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo tooth wear or negligible wear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation of tooth wear within the mouth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of sextants affected\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 to 6 sextants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e142\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e60\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 to 3 sextants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 or none\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eJaws affected\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTooth wear in upper and lower jaws\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e192\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e81.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower jaw only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper jaw only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTeeth affected\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTooth wear in anterior and posterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e160\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e67.51\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosterior teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBinary logistic regression analysis of factors associated with tooth wear among PLWHA in Rwanda.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to results in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below, the predictors of tooth wear were older age of 55+ (OR: 20.872; 95% CI:1.704-255.733), longer duration on HIV medication (OR: 6.594; 95%CI:1.053\u0026ndash;40.719); and horizontal brushing technique. Although not statistically significant, middle aged (35\u0026ndash;44) participants were 4,905 times more likely to have tooth wear \u003cem\u003eOR\u003c/em\u003e:1.99; 95%CI: 0.209\u0026ndash;17.05 than young (23\u0026ndash;24) aged ones. Also, males were 3.547 more like to have tooth wear OR: 3.547; 95%CI:0.831\u0026ndash;15.137 than females. Participants living with HIV for 1\u0026ndash;5 year were 7.095 times more likely to have tooth wear than those living with HIV for 6\u0026ndash;10 years. Also PLWHA who reported to grind teeth were 2 times more likely to have tooth wear than those who said that they do not grind teeth.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinary logistic regression of factors associated with tooth wear among HIV positive people in Rwanda\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubcategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR ( 95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.997(0.209\u0026ndash;17.052)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.548\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.905 (0.581\u0026ndash;41.392)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.872 (1.704-255.733)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.017*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.547 (0.831\u0026ndash;15.137)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.087\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eResidence location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithin the capital city of Rwanda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOutside the capital city of Rwanda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.317 (0.346\u0026ndash;5.016)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.687\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.452 (0.997\u0026ndash;19.864)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0. 0.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity or others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11..553 (0.854-156.299)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDuration on HIV medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.095 (0.565\u0026ndash;89.061)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.549 (1.053\u0026ndash;40.719)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.044*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDuration of brushing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u0026ndash;5 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 3 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.267 (0.269\u0026ndash;5.974)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.765\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFrequency of brushing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;3 times a day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 2 times a day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.507 (0.415\u0026ndash;5.477)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.533\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBrushing Method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVertical or circular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHorizontal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.671 (1.496\u0026ndash;21.506)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of toothbrush bristles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium bristles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSoft bristles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.291 (0.456\u0026ndash;11.519)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHard bristles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.814 (0.815\u0026ndash;17.849)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFrequency of changing toothbrush\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter more than 3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter less than 3 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.360 (0.803\u0026ndash;23.677)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter 3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.337 (0.996-152.856)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGrinding teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSometimes or often\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.075 (0.259\u0026ndash;16.595)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.491\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTaking acidic means\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (Less than once a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (once or more daily) to medium (less than 3 times a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.082 (0.084\u0026ndash;12.663)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.980\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDry mouth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.452 (0.100-2.023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.299\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003e*\u003c/b\u003e \u003cem\u003eindicates statistically significant P value\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to findings of this study, tooth wear is at high prevalence 220 (92.83%) and it is a remarkably severe condition (dentinal wear up to 1/3 of the crown and excess tooth wear than extends to more than 1/3 of the crown) generalized in the oral cavity among People Living with HIV/AIDs (PLWHA) in Rwanda. Longer duration on HIV medication, older age, horizontal brushing techniques were significantly associated with tooth wear. These results are similar to previous findings in the literature that revealed a high prevalence of tooth wear among PLWHA and highlighting duration of HIV medication, older age and brushing technique among predictors of tooth wear [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOverall, this study revealed a high prevalence of tooth wear (more than 92%) among PLWHA. the results of this study are in line with the finding of a study done in Saudi Arabia by Sehgal and colleagues. In their study, more than 90% of PLWHA had tooth wear [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The findings in this study also revealed that more study participants had severe tooth wear (Dentinal wear up to 1/3 of the crown (more than 56%) and excess tooth wear than extends to more than 1/3 of the crown (about 14%)). This results support the previous argument in the literature highlighting that PLWHA live with severe and untreated oral health problems including tooth wear [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Severe tooth wear has an impact on oral pain levels, dental appearance and function [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e][\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Thus, as emphasized by previous researchers, medical interventions that consider involvement of dental providers and health professionals in HIV services are essential to comprehensively and successfully prevent and treat tooth wear among PLWHA [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the localization of tooth wear in the oral cavities, the findings of this study showed a generalized tooth wear in the oral cavity where most respondents had tooth wear in 4 up to 6 sextants (60%), in both upper and lower teeth (80.01%) and within both anterior and posterior teeth (67.51%). Having many teeth, in various sextants and jaws affected by tooth wear can lead to functional impairment, tooth sensitivity or pain, and aesthetic problems (7).In addition, tooth wear can affect a person's ability to live comfortably, work successfully, enjoy life, form relationships, and can have a negative impact on one's quality of life [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Hence, the results of this study show how tooth wear condition among PLWHA is a severe generalized problem. Hence the need for effective and contextual oral health promotion interventions among this high risk group of PLWHA in Rwanda.\u003c/p\u003e\u003cp\u003eThe literature has highlighted that tooth wear-related early diagnosis and intervention are vital because the treatment of tooth wear is very challenging (12). At the same time, there is a limited access to oral health services mostly due to shortage of dental personnel and infrastructures in Rwanda [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This context can amplify the problem of tooth wear among Rwandans especially among PLWHA. Therefore, Oral health advocacy is essential to help timely diagnosis and management of tooth wear and to ensure good oral health and better quality of life of PLWHA in Rwanda.\u003c/p\u003e\u003cp\u003eAfter performing logistic binary regression analysis, the predictors of tooth wear were older age longer duration on HIV medication and horizontal brushing technique. These findings are in line with previous studies reports in the literature. For an instance older age were shown to be associated with tooth wear by diverse researchers [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e][\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e][\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Tooth wear increases during a person\u0026rsquo;s life course, and its severity increases with age [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As the life expectancy of PLWHA increases, the prevalence and severity of tooth wear among this high risk group also increases. Therefore, it is essential for oral health care professionals in collaboration with medical care professionals in HIV services to ensure early tooth wear risk assessment and a clinical examination to avoid complex restorative procedures which are complex and difficult especially among older people\u003c/p\u003e\u003cp\u003eThe results of this study has shown that longer duration on HIV medication to be significantly associated with tooth wear. similar results were reported in the literature [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These findings are explained by the fact that many oral health issues experienced by PLWHA are related to the side effects of the medications themselves, including dry mouth or xerostomia which is highlighted as a significant complication of HIV and/or side effect of ART medications [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Also, mood and sleeping disturbances are reported among side effects of taking antiretroviral therapy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The combination of insomnia and moody increases the likelihood of clenching and grinding teeth leading to increased risk of tooth wear among PLWHA[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although not statistically significant the results have shown that PLWHA were more likely to have tooth wear within their first 5 years than within their 6 to 10 years of HIV infection. This may be explained by increased psychological problems in recent years after being informed about HIV infection results which may decrease with time while PLWHA cope with this issues and then increases again with longer time due to HIV treatment side effects.\u003c/p\u003e\u003cp\u003eThis study has also shown that participants who used horizontal brushing movements were more likely to develop tooth wear. These results are similar to the findings of a study done by Kan sun and colleagues in Beijing [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In general, improper rushing techniques accelerate dental hard tissue defects [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. For example, horizontal brushing movement is known to be one of the most important reasons for wedge-shaped defects in teeth [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. At the same time Keeping good oral hygiene is very central to prevent different oral diseases including tooth wear. Thus, educating PLWHA on how to properly brush their teeth is paramount to reduce the risk of tooth wear development in this high risk group.\u003c/p\u003e\u003cp\u003eThough not statistically significant, participants who reported to grind teeth were more likely to have tooth wear than the ones who were not grinding teeth. These results are in line with previous studies done [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Scholars have reported that most PLWHA on antiretroviral therapy experience dry mouth, bruxism and teeth grinding that all result in tooth wear [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Others researchers have highlighted that Antiretroviral medicine can expose to xerostomia, mood, and sleeping difficulties [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Insomnia and medicines increase the likelihood of clenching and grinding teeth, which exacerbates tooth wear among PLWHA [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Also, the results of a study done in Brasil by Pomarico and colleagues highlighted that HIV medication can have a significant risk of tooth wear among PLWHA [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition to HIV medication side effects, PLWHA are prone to psychological disorders [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The presence of psychological disorders is known to result in various oral health problems [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] including as bruxism which in turn leads to tooth wear [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, there findings in this research have shown that males were more likely to develop tooth wear than females. Similar results were reported in previous studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For instance, in a study done by Khalifa S Al-Khalifa in Saudi Arabia, males were reported with higher prevalence of tooth wear than females [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Bernhardt and colleagues has reported that men are more likely show bruxism behavior than females [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] which may explain why greater amounts of tooth wear is found in this group of people.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to study results, tooth wear is a highly prevalent and a notably severe condition among PLWHA in Rwanda. Longer duration on HIV medication, older age, horizontal brushing techniques were strongly associated with tooth wear. Therefore, there is a need of efforts from multidisciplinary health workers (dental professionals, nurses/ physicians in HIV services to raise awareness on tooth wear and its risk among this high risk group of people. In addition, tooth wear in PLWHA are left untreated. Hence the need to integrate oral health services to HIV cervices to provide oral health care to this group of people.\u003c/p\u003e\u003cp\u003eeducating providers about the potential harmful impact of HIV medications on patients\u0026rsquo; dentition and oral health and intervening with night guard therapy at the time a patient is diagnosed with HIV by prescribing night guard therapy at the time of diagnosis was recommended in the literature. This intervention would protect PLWHA from many negative effects associated with chronic bruxism and decrease tooth wear in this group.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAIDs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCMHS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCollege of Medicine and Health Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInstitutional Review Board\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdd Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePLWHA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePeople Living with HIV/AIDs\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003e This study has been performed in accordance with the Declaration of Helsinki. The ethical clearance was obtained from Institutional Review Board (No 548/ CMHS IRB/2023) from University of Rwanda. In addition, the permission to conduct the study were received from all studies cite. The informed written consents were given to all participants before data correction. To get informed consent, we provided adequate information to participants through information sheet to the nature and processes involved in the study, the reason for the study, and the intended outcomes. We ensured participants comprehended the provided information before signing the consent form. Then, participants who agreed to participate in our study voluntarily signed the consent form. The confidentiality of patients was observed by using an anonymous questionnaire\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eJulienne Murererehe\u003c/h2\u003e\u003cp\u003eJulienne Murererehe is a PhD CARTA graduate\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study received funding from the University of Rwanda-Sweden collaboration program (UR Seed Grant) under the grant No. (VC/1284/2022).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJM, FN, JA and YMC participated in the study conception and design. JM and FN analyzed data. JM, GT, DDN, NP, EN, corrected the data and drafted the manuscript. JM, YMC, reviewed the manuscript and supported data analysis, data interpretation, and discussions. All authors revised and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank Mrs Aurelie Uwamahoro, Mr. Manirakiza Jonathan and Mr. Joseph Mwiza for their guidance and support during data collection process. We also acknowledge Associate Professor Peace Uwambaye for her contribution during the research conceptualization. Julienne Murererehe is a PhD CARTA graduate\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePeres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR et al. Oral diseases: a global public health challenge. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jpmsonline.com/article/systematic-review-on-toothbrushing-and-cervical-abrasion-a-comprehensive-analysis-of-the-evidence-714/\u003c/span\u003e\u003cspan address=\"https://jpmsonline.com/article/systematic-review-on-toothbrushing-and-cervical-abrasion-a-comprehensive-analysis-of-the-evidence-714/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Khalifa KS. The Prevalence of Tooth Wear in an Adult Population from the Eastern Province of Saudi Arabia. Clin Cosmet Investig Dent 2020. 2020;12:525\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePomarico L, Czauski G, Portela MB, de Souza IPR, Kneipp L, de Ara\u0026uacute;jo Soares RM et al. Cariogenic and erosive potential of the medication used by HIV-infected children: pH and sugar concentration. Community Dent Heal [Internet]. 2008;25(3):170\u0026ndash;2. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/pubmed/18839724\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/pubmed/18839724\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBernhardt O, Gesch D, Splieth C, Schwahn C, Mack F, Kocher T et al. Risk factors for high occlusal wear scores in a population-based sample: results of the Study of Health in Pomerania (SHIP). Int J Prosthodont [Internet]. 2004;17(3):333\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/pubmed/15237882\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/pubmed/15237882\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tooth wear, HIV, risk factors, Rwanda","lastPublishedDoi":"10.21203/rs.3.rs-7215743/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7215743/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTooth wear has been reported to be on an increasing prevalence repeatedly. More importantly, tooth wear was found to be considerably higher and severer among People Living with HIV/AIDS (PLWHA) compared to HIV negative counterparts. There is scarce of information on tooth wear and associated factors in general. Specifically, no single study done in Rwanda to provide baseline data on this topic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to determine the prevalence of tooth wear and associated risk factors among PLWHA in Rwanda\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted among 237 PLWHA aged 18 years and above attending HIV clinics outside Kigali city (Nyamata and kagayi hospitals) and within Kigali city (Muhima hospital) in Rwanda. Oral examination was done by calibrated examiners and tooth wear was assesses using Tooth wear index (TWI). Descriptive statistics, Chi square, and multiple binary logistic regression analysis were used for data analysis using Stata version 15 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, the results revealed a higher prevalence of tooth wear among PLWHA 220 (92.83%) in Rwanda. Among them, more than a half 133 (56.12%) had dentinal wear up to 1/3 of the crown, a considerable number 33(13.92%) had excess tooth wear that extends to more than 1/3 of the crown. Only 54 (22.78%) had enamel wear to dentine in a single spot. Regarding the location and categories of teeth affected, a big number 142 (60%) of participants had tooth wear in 4 to 6 sextants. More participants had tooth wear in both anterior and posterior teeth 160 (67.51%) and majority of PLWHA had tooth wear in both upper and lower jaws 219 (81.02%). The Predictors of tooth wear were older age of 55+ (OR: 20.872; 95% CI:1.704-255.733), longer duration on HIV medication (OR: 6.594; 95%CI:1.053-40.719); and horizontal brushing technique. Although not statistically significant, males were 3.547 more like to have tooth wear than females. In addition, PLWHA who grind teeth were 2 times more likely to have tooth wear than those who do not grind teeth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to study results, tooth wear is a highly prevalent and a notably severe condition generalized to all teeth in the oral cavity among PLWHA in Rwanda. Longer duration on HIV medication, older age, horizontal brushing techniques were strongly associated with tooth wear. Therefore, there is a need of efforts from multidisciplinary health workers (dental professionals, nurses/ physicians in HIV services to raise awareness on tooth wear and its risk among this high risk group of people. In addition, tooth wear in PLWHA are left untreated. Hence the need to integrate oral health services to HIV cervices to provide oral health care to this high risk group of PLWHA.\u003c/p\u003e\n\u003cp\u003eClinical trial number not applicable.\u003c/p\u003e","manuscriptTitle":"Prevalence of tooth wear and associated risk factors among People Living with HIV/AIDS in Rwanda: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:02:58","doi":"10.21203/rs.3.rs-7215743/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-03T06:55:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-30T00:26:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-29T07:15:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-26T11:33:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80980266438303104737281603193457542443","date":"2025-08-18T09:25:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29133880776483285875135337346660071881","date":"2025-08-17T10:39:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306402273356031601940775823884545894400","date":"2025-08-08T13:04:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-06T20:53:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117072951054568077353452733237052146388","date":"2025-08-06T15:22:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77318845041229654022653270552546666964","date":"2025-08-06T13:22:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192696686262180277947129240621715076624","date":"2025-08-05T20:03:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339864261885794453095330089812923604593","date":"2025-08-04T20:45:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-04T11:46:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-02T16:46:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-30T04:05:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-30T04:03:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-07-25T15:37:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d882c786-35a4-4d82-8ef9-e18379b8f3db","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:01:10+00:00","versionOfRecord":{"articleIdentity":"rs-7215743","link":"https://doi.org/10.1186/s12903-025-07261-y","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-11-28 15:57:27","publishedOnDateReadable":"November 28th, 2025"},"versionCreatedAt":"2025-08-06 08:02:58","video":"","vorDoi":"10.1186/s12903-025-07261-y","vorDoiUrl":"https://doi.org/10.1186/s12903-025-07261-y","workflowStages":[]},"version":"v1","identity":"rs-7215743","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7215743","identity":"rs-7215743","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}