HIV and dentistry. Part 3. HIV infection: pathogenesis, epidemiology, definitions and classification

The acquired immunodeficiency syndrome (AIDS) is caused by a retrovirus, the human immunodeficiency virus (HIV), that selectively deteriorates cell-mediated immunity. Consequently fatal opportunistic infections and/or malignancies occur. In this paper the pathogenesis and the epidemiology of HIV infection are described. In addition the 1993 revised classification for HIV infection and the expanded surveillance case definition for AIDS are presented.     

HIV and dentistry. Part 10. Concluding remarks

In a summarizing report of the series 'HIV and dentistry' the most important aspects of the dental treatment of HIV-seropositive patients are dealt with, supplemented with some additional comments.     

HIV and dentistry. Part 5. Practice hygiene

When complying a good standard hygiene protocol in the dental office the risk of cross-infection of whatever type of microorganism, including the hepatitis-B-virus and HIV, is almost eliminated.     

HIV and dentistry. Part 2. Needlestick injury

The risk for dentists to acquire HIV infection at work is low but not neglectable. Needlestick injuries are among the most hazardous events in this respect. Prevention of these injuries will considerably reduce the risk of occupational HIV infection in dentistry.     

HIV and dentistry. Part 7. The HIV positive dentist or student

What should a dentist or dental student do when he happens to be HIV-seropositive? Should he or she disclose the disease to the patients or, in case of a student, to the university? Does he has to give up his practice or perhaps not even open one? Apparently, the legal regulations differ in various parts of the world. In the Netherlands dentists are advised to take their own responsibility in this matter.     

HIV and dentistry in Australia: clinical and legal issues impacting on dental care

The number of people in Australia living with HIV is growing. This reflects a consistent rate of new HIV infections combined with an increased life expectancy of people with HIV. Dentists are ideally positioned to identify, manage and treat HIV-associated oral manifestations and have a responsibility to themselves and to their patients to be up-to-date with the evolving area of HIV and related issues. Those issues include medico-legal implications associated with HIV diagnosis and treatment. This article provides a review of the current clinical and medico-legal aspects of HIV in Australia. The oral manifestations of HIV can be divided into five categories: microbiological infections (fungal, bacterial and viral); oral neoplasms; neurological conditions; other oral conditions that may be associated with HIV infection; and oral conditions associated with HIV treatment. Current treatment options in the scope of general dental practice are outlined. Medico-legal issues related to the management of patients with HIV are explored, including rights of the patient regarding disclosure of HIV status; an algorithm for the management of a patient with signs or symptoms indicating possible HIV infection, including referral pathways; and an algorithm for dealing with patient management and referral issues.     

Unconventional dentistry: Part IV. Unconventional dental practices and products

This is the fourth in a series of 5 articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation to unconventional medicine (UM). Several common UD and UM practices are described to familiarize practitioners with a variety of theories, practices, products and treatments that specifically apply to dentistry. This brief review is not intended as an in-depth resource.     

HIV and dentistry. Part 6. Mouth defects in HIV infections: guidelines for referral

As for any oral lesion that cannot be properly diagnosed by the dentist, referral to the specialist is indicated for lesions that might be associated with or indicative of an underlying HIV infection. In most instances, there is no need to discuss the subject of HIV infection in the dental office. In the letter of referral the same information should be given as has been provided to the patient. The specialist should not withhold information for the referring dentist, even when requested by the patient to do so.     

Further statistics in dentistry. Part 9: Bayesian statistics

Statistics can be defined as the methods used to assimilate data, so that guidance can be given, and conclusions drawn, in situations which involve uncertainty. In particular, statistical inference is concerned with drawing conclusions about particular aspects of a population when that population cannot be studied in full. Uncertainty arises here because the totality of the information is not available. Instead, to make inferences about the population, it is necessary to rely on a sample of data which is selected from the population; this sample data may be augmented, in certain circumstances, by auxiliary information which is obtained independently of the sample data. Clearly, uncertainty lies at the heart of statistics and statistical inference. This uncertainty is measured by a probability which therefore forms the crux of statistics and must be properly understood in order to interpret a statistical analysis.     

Access to special care dentistry, part 9. Special care dentistry services for older people

This article looks at three common neurological conditions associated with later years: stroke, Parkinson's disease and dementia. All of them impact on oral health, access to dental services and delivery of dental care, and treatment goals need to be adapted to take into account patients' changing needs, medical status, pattern of recovery or the stage of dementia that they have reached. The article concludes by considering the topic of elder abuse. The dental team may have a role both in identifying abuse and ensuring appropriate action is taken.     

HIV and dentistry. Part 4. Oral deviations in HIV infections: present classification and diagnostic criteria

In the present classification of oral lesions associated with HIV infection a distinction is made between presumptive and definitive diagnostic criteria. The former relate to the initial clinical appearance of the lesion and the latter are often the result of special investigations. Candidiasis, hairy leukoplakia, specific forms of periodontal disease, Kaposi's sarcoma and non-Hodgkin's lymphoma are strongly associated with HIV infection. Lesions less commonly associated with HIV infection and lesions seen in HIV infection, but not indicative of the disease, are also listed.     

Oral research and dental treatment in HIV infection.

In June 1991, practicing, research, and academic dentists attended a symposium on oral research and dental treatment in HIV infection at Guy's Hospital in London, England. Oral lesions in HIV infection were classified as strongly associated, probably associated, and possibly associated with HIV infection. A speaker stressed that those strongly associated with HIV infection should be of the most interest to general dental practitioners. Another speaker said that chronic erythematous candidiasis has emerged as an oral infection strongly associated with HIV infection in addition to pseudomembranous candidiasis. A dentist mentioned hairy leukoplakia as a new condition strongly associated with HIV infection. Other HIV associated periodontal disease included gingivitis, necrotizing gingivitis, and periodontitis. A speaker noted that AZT increases longevity of AIDS patients and the drugs dideoxyinosine and dideooxycytidine are being tested. Another dentist spoke about the issue of HIV infected dentists citing the example of the dentist in Florida who infected 5 patients. Other speakers addressed the cases and needs of asymptomatic HIV infected people. A survey of dentists showed that only 33% of dentists would provide dental care to HIV infected people and only 20% would if the patients had AIDS. A dentist addressed the problem of a lack of data on prevention and treatment of oral lesions since their etiology and pathogenesis were unknown. Other presentations focused on research on antibodies and DNA probes in reference to saliva and subgingival flora. The symposium revealed the ran ge and depth of research going on in British schools on oral manifestations of HIV infection.     

Psychological aspects of infection control and the care of the patient with HIV in dentistry

HIV presents a number of challenges to the dentist. There is a need to control infection risks and, in spite of all the information available, a minority of dentists still have incomplete infection control procedures. The reasons for this and the implications for dental education are explored. There is also a need to ensure that the patient is optimally managed by the dentist and the importance of linkages to other services and the likely demands of patients on the dentist are reviewed. Finally the impact of treating the patient with HIV disease on the dentist and ways of minimising stress associated with the work are considered.     

HIV and dentistry. Part 1: Disclosure of HIV-seropositivity to the dentist

For a number of reasons it is recommended to disclose one's HIV-seropositivity to the dentist. This information will enable the dentist to take extra precautions during treatment. Furthermore, extra measures may be taken with regard to prevention or early treatment of dental and oral diseases, e.g. gingivitis, candidiasis. The dentist and the other members of the dental team are supposed to obey strict confidentiality.