Managing the care of patients infected with bloodborne diseases

BACKGROUND: The emergence of the bloodborne pathogens HIV, the cause of AIDS; hepatitis B virus, or HBV; and hepatitis C virus, or HCV, has been a milestone in the history of the dental profession. In the early 1980s, new cases of AIDS increased dramatically, and fear of acquiring this disease compelled clinicians to modify the delivery of medical and dental care to allay fears of transmission on the part of both patients and health care workers. Arguably, the AIDS pandemic has been the most significant factor in the evolution and delivery of modern medical and dental care in the last century. OVERVIEW: To help ally fears and remove barriers to caring for the HIV population, the Centers for Disease Control and Prevention, or CDC, introduced the concept of universal precautions in 1983. This was followed by the Occupational Safety and Health Administration's Bloodborne Pathogens Standard in 1991. Specific to the dental profession was the development of the principles of infection control in dentistry recommended by the CDC (1993); the American Dental Association (1995) and the Organization for Safety & Asepsis Procedures (1997). While initially difficult for some clinicians to acknowledge, these recommendations now are universally accepted throughout the profession, and provision of oral health care to patients infected with bloodborne disease is becoming commonplace. Compliance with recommended infection control practices remains an important component of dental practice. But it must be accompanied by an understanding of infectious and bloodborne diseases and the medical/dental management of the care of infected dental patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: The emergence of the bloodborne pathogens and the increasing number of infected patients who seek oral health care compel clinicians to have a thorough knowledge about bloodborne diseases and the medical/dental management of the care of patients presenting with HIV, HBV or HCV infection.     

Dental care for cancer patients: a survey of Texas dental school graduates

A survey of recent Texas dental school graduates regarding their preparedness for addressing the oral health care needs of cancer patients in their practices suggests several trends. Many graduates (26%) do not feel adequately prepared to manage and provide oral care for cancer patients. Over 95% of the dentists surveyed expressed interest in locally sponsored continuing education courses on the oral health care of cancer patients. Clearly, both predoctoral and postdoctoral dental education must recognize the need for formalized instruction on the oral cre of cancer patients if general dentists are to provide high-quality, comprehensive dental care for these patients.     

Underreporting of bloodborne exposures in a dental school clinic

This study explored the rate of underreporting of bloodborne exposures among dental students in a U.S. dental school during the final two years of clinical practice. It also explored the reasons students cite for failing to report bloodborne exposures. Surveys of the dental students found that senior students reported only 43 percent of the exposure incidents they experienced in their final year of clinical education and that the rate of reporting declined from the junior year to the senior year. We subsequently undertook an educational campaign to raise awareness among the students regarding the importance of reporting exposure incidents. Surveys were repeated for the next two years at the end of each academic year. The following year, the senior class indicated they had reported 79 percent of the experienced exposure incidents. This was not only a significant improvement over the previous year, but also demonstrated an improvement in reporting from their junior year to senior year, reversing the previously noted trend for exposure reporting to drop off in the senior year.     

Public knowledge about AIDS: a survey of dental school patients. Part II

Responses to a questionnaire on acquired immunodeficiency syndrome (AIDS) returned by patients of the Louisiana State University School of Dentistry were compared with responses to an AIDS questionnaire administered by the National Center for Health Statistics (NCHS). Although the questionnaire in this study was not patterned after that used by NCHS, some of the questions were either similar or directly opposite in content. Response patterns were compared and contrasted. In addition, those response patterns in Part I which are significantly different on the basis of demographic characteristics were compared with their counterparts in the NCHS survey.     

Public knowledge about AIDS: a survey of dental school patients. Part I

Surveys have demonstrated that the general public has many misconceptions about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection. Education has been the mainstay of the public health effort to combat the spread of HIV and AIDS. Some studies have shown an increase in the public's understanding of this disease. A survey of dental patients at a dental school clinic revealed that although misconceptions continue to exist, particularly with regard to AIDS and the dentist, this population had higher levels of knowledge about AIDS than did those in earlier studies.     

Impact of underreporting on the management of occupational bloodborne exposures in a dental teaching environment

The objectives of this study were to determine the rates of bloodborne exposures experienced by junior and senior dental students at a large dental teaching institution during 2001-02 and the percentages of these bloodborne exposures that were reported by the students to their designated counselors. Two hundred and four third- and fourth-year students voluntarily and anonymously filled out a questionnaire on the numbers of bloodborne exposures they had experienced and reported. Sixty-seven (32.8 percent) reported experiencing 109 occupational exposures (OEs) to blood or other potentially infectious materials. This corresponds to an OE rate of 80 +/- 7.7 exposures/100 person-years, far in excess of the highest recorded student rate (7.18 +/- 0.52) in a previous study. Twenty-six students (39 percent) reported two or more exposures each. Only 19 percent of exposures were reported to the school counselor, with 35 percent reported by third-year students and only 14.5 percent by fourth-year students. Thus the large differential in reported exposure rates between third- and fourth-year students found in our earlier study might have been an artifact of the sharply different reporting rates of these two groups. These results suggest an urgent need to reexamine the reliability of the present reporting system for such OEs. Also this study indicates that the gender differences in OE rates reported in our earlier study were due primarily to differential reporting by male and female students, not differences in their underlying OE rates.     

Compliance with guidelines for management of dental school patients susceptible to infective endocarditis

The purpose of the investigation was to determine the extent to which the 1984 American Heart Association prophylaxis guidelines were adopted in a sample of dental school patients and to determine whether implementation strategies resulted in change in the management of patients at risk for infective endocarditis (IE). Dental records of 330 patients requiring medical consultation on the basis of a heart problem identified in the medical history questionnaire were reviewed. One hundred fifty-four patients required IE prophylaxis according to their physicians. Only 11 percent of IE-susceptible patient charts showed documentation of correct prophylaxis for every appointment at which a bacteremia was possible. Only 35 percent of patients receiving prophylaxis after December 1984 were covered according to the new American Heart Association guidelines.     

Survey of dental school policies on the management of patients with hepatitis B or AIDS

A survey was conducted of dental school Deans in 18 different countries to determine dental school policy on hepatitis B and AIDS. Almost one-third of the dental schools do not have a policy recommending that clinical staff and students be immunized against hepatitis B. Some 18 dental schools had no procedure for screening patients for hepatitis B, and only 13 per cent of dental schools were actively screening patients in high risk groups for AIDS. The article provides details on the handling of patients who have or are suspected of having hepatitis B or AIDS.     

Providing dental care to pregnant patients: A survey of Oregon general dentists

BackgroundA growing number of studies and reports indicate preventive, routine and emergency dental procedures can be provided safely to pregnant patients to alleviate dental problems and promote oral health of mothers and children.MethodsIn 2006 and 2007, the authors conducted a survey of 1,604 general dentists in Oregon. The survey asked dentists about their attitudes, beliefs and practices regarding dental care for pregnant patients. The authors compared the responses with 2006 guidelines from a New York State Department of Health expert panel.ResultsThe response rate was 55.2 percent. Most respondents (91.7 percent) agreed that dental treatment should be part of prenatal care. Two-thirds of respondents (67.7 percent) were interested in receiving continuing dental education (CDE) regarding the care of pregnant patients. Comparisons of self-reported knowledge and practice with the aforementioned guidelines revealed several points of difference; the greatest regarded obtaining full-mouth radiographs, providing nitrous oxide, administering long-acting anesthetic injections and use of over-the-counter pain medications.ConclusionsDentists need pregnancy-specific education to provide up-to-date preventive and curative care to pregnant patients. The results of the study identified specific skills and misinformation that could be addressed through CDE.Clinical ImplicationsComprehensive dental care provided during pregnancy is needed to ensure the oral health of all women at risk of experiencing pregnancy-specific problems, as well as the prevention of early childhood caries.