Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria

OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV.     

Oral Hygiene and dental student's knowledge, attitude and behaviour in managing HIV/AIDS patients

Abstract:  The human immunodeficiency virus (AIDS) and the acquired immunodeficiency syndrome (AIDS) have profoundly affected every aspect of the public health sector. The possibility of HIV transmission in the oral health care setting is very rare. Nonetheless, the oral health care environment has become a helpful setting for early detection, as most lesions of HIV infection present orally during the first stages of the disease. Willingness to treat patients with HIV/AIDS appears to be related to knowledge of the disease process, its oral manifestations and modes of transmission, thus influencing health workers' attitudes and behaviour towards management of HIV/AIDS patients. This study assessed the level of management of HIV/AIDS patients amongst dental and oral hygiene students at the University of the Western Cape Dental faculty. Student's knowledge of HIV/AIDS, their behaviour and attitude in treating HIV/AIDS patients, the precautionary measures practiced and their perceptions of curriculum preparation on HIV/AIDS were assessed. Data were collected by means of a self- administered questionnaire. The results indicated that students' knowledge on HIV/AIDS generally increased as they progressed throughout their curriculum but their utilization of all barrier techniques for infection control and clinical protocol, lacked consistency and compliance. Given the fact that the possibility of transmission of HIV/AIDS does exist within the dental setting, it is important that supervisors reinforce universal precautions. Clinical application of these precautions has a direct impact on the spread of the disease.     

Transmission of HIV in the dental clinic and elsewhere

This review focuses on the risk of transmission of HIV in dental practice in developed and developing countries; and as a result of oral sex, perinatal transmission and breast feeding. Postexposure prophylaxis (PEP) and practical measures to control cross-infection with TB are also discussed. There are few data from resource-poor countries where prevalence of HIV and risk of infection are higher – issues that deserve priority. Available information indicates that the risk of HIV transmission in the dental office is very low. Transmission of HIV from three healthcare workers to patients has been confirmed, including a dentist who infected six patients. There are >300 reports (102 confirmed) of occupational transmission to healthcare workers, including nine dental workers (unconfirmed). Exposure to HIV has been reported by 0.5% dentists/year. The risk of HIV infection after percutaneous exposure (0.3%) can be reduced by 81% with zidovudine PEP. However, risk assessment is required to assess the need and appropriate regimen. The risk of HIV transmission associated with orogenital sex exists, but is considered extremely low: barrier protection is recommended. Conversely, the proportion of babies who acquire HIV from untreated HIV-seropositive mothers is 15–25% in developed countries and 25–45% in developing countries. The frequency of HIV transmission attributable to breastfeeding is 16%. Airborne transmission of TB can be avoided by the prompt referral of known/suspected cases of active TB for chemotherapy, deferral of elective procedures until patients are not infectious, and the use of appropriate standard/isolation precautions including adequate ventilation of treatment areas.     

Hepatitis B vaccination and infection control practices of Jordanian clinical dental students

The knowledge of occupational hazards from blood-borne viruses, and practices related to cross-infection control were studied in Jordanian dental students. A survey in July 1990 showed that over 90% were aware of the existence of vaccines against hepatitis B virus and most appreciated the possible long-term hepatic sequelae of hepatitis B virus infection. Nearly 50% had already been immunized against hepatitis B and a further 4% intended to be vaccinated. Autoclaves were used by more than 80% for the sterilization of dental instruments.     

Public perception of cross-infection control in dentistry in Nigeria

OBJECTIVES: To assess the perception of patients on the use of gloves and facemasks in dental practice, methods of sterilisation and the risk of cross-infection. METHODS: Questionnaire survey of patients attending two teaching hospitals and a private dental clinic in Lagos, Nigeria. RESULTS: 228 respondents returned the questionnaires. Nearly all (98.6%) regarded the use of gloves as necessary and 189 (82.9%) did not mind the use of gloves, only 129 (56.6%) felt the facemask was necessary although 132 (57.9%) did not mind its use. More than half of the respondents (54%) felt they could contract an infection in the dental clinic and 43% of them identified HIV as a risk. This response was significantly affected by educational status (p<0.05). 140 patients (61.4%) would not attend a clinic if they knew that HIV patients were treated there. Females were significantly more unwilling to attend (p<0.05). CONCLUSION: While this survey shows a high level of acceptance of the use of gloves, there is a glaring lack of knowledge and acceptance of the use of the facemask indicating a need for more effective public enlightenment on the use of barrier methods. It also reveals a great deal of fear for HIV among Nigerians.     

Oral cancer education in dental schools: knowledge and experience of Nigerian undergraduate students

The objective of this study was to determine the knowledge and experiences of clinical dental students of the College of Medicine, University of Lagos, Nigeria related to the management and prevention of oral malignancy and premalignancy. A self-administered questionnaire was distributed to all clinical dental students. Most of the students (87.7 percent; n=57) had witnessed at least a patient with oral malignancy, while 61.5 percent (n=40) had witnessed or examined a patient with oral premalignancy. While 61.5 percent of the students had observed biopsies of malignant and premalignant lesions, only 13.8 percent (n=9) had ever performed one under supervision. All the respondents believed that oral malignancy is always or sometimes associated with pain, and most of the students were more familiar with the late signs of oral malignancy than the early signs. Almost two-thirds (64.6 percent) of the respondents believed that oral screening programs were effective for early diagnosis and management of oral malignancies. This study revealed a need for a more structured teaching program with increased emphasis on the early signs and symptoms of oral malignancies and involvement of the students in the examination and biopsies of malignant and premalignant lesions.     

Do maternal factors influence the dental health status of Nigerian pre‐school children?

Objective.  This study was designed to investigate the relationship between maternal related factors and the dental health status of pre-school children in Lagos State, Nigeria.
Methods.  A cross-sectional study of 404 pairs of mothers and their pre-school children was conducted at two selected primary health centres in Lagos State Nigeria. An interviewer administered questionnaire recorded the mother's socio-demographic characteristics and assessed her perception of her child's dental needs, attitude to oral disease prevention, level of dental health knowledge and attitude to oral health. The child's dental status was assessed using the dft index (caries status) and the simplified oral hygiene index. Data analysis tools included Spearman's correlation coefficient and multivariate logistic regression.
Results.  Maternal age, maternal education, location of residence, maternal knowledge, and attitudes were all positively correlated with the child's caries and oral hygiene status. There were statistically significant correlations between maternal attitude and the oral hygiene index ( P  = 0.01) and dft score ( P  = 0.001). Maternal age also had a significant relationship with the child's caries status ( P  = 0.003).
Conclusion.  This study concluded that maternal age and attitude were important determinants of caries experience whereas the mother's attitude was an important determinant of oral cleanliness in pre-school children in Lagos State Nigeria.     

Perceived sources of stress in Nigerian dental students

The objective of this study was to identify sources of stress among dental students at the University of Lagos, Lagos, Nigeria. A modified Dental Environment Stress (DES) questionnaire was used to study the 137 students in years 3-6, of which 105 (76.6%) responded. Results show that the year 5 students indicated the highest level of stress overall on items relating to pre-clinical training with 21 (70%) recording aggregate DES score over the cut-off point for high stress. For clinical items, nearly all the students - 27(90%) of year 5 and 24 (100%) of year 6 recorded aggregates over the cut-off point. The most important stressors were those related to the lack of provision of a well-supported system of dental education in Nigeria in terms of availability of materials for clinical training and study materials. There were no significant differences in stress perception between genders. However, students who chose Medicine as their first choice for admission with Dentistry as an alternative experienced significantly higher overall mean and higher mean scores for most items. In conclusion, it appears there is a need to improve support for dental education in Nigeria.     

Group II and III lesions in HIV positive Nigerians attending the General Hospital Lagos, Nigeria.

OBJECTIVE: To document the prevalence of Group II and Ill oral lesions of HIV in adult seropositive Nigerians. STUDY DESIGN: A longitudinal study of 100 HIV infected adult Nigerian patients attending the HIV Clinic of the General Hospital, Lagos, Nigeria. STUDY PERIOD: January 2001 to October 2002. METHOD: Oral lesions were diagnosed based on documented diagnostic criteria by GREENSPAN et al, for oral manifestation of HIV. WHO classification of oral lesions based on the degree of association with HIV infection was also used. Oral lesions were treated using established treatment protocols. RESULTS: Seventy patients had oral lesions of HIV, of these fourteen (20%) patients had Group II and III oral lesions of HIV infection: Five (7%) patients had recurrent aphthous ulcers (RAU), 4 (6%) had herpes zoster of the trigeminal nerve. Majority of patients presented with oral symptoms severe enough to require use of appropriate medication. Recurrence of oral lesions occurred in all cases of RAU seen. CONCLUSION: Group II and III lesions are less prevalent than group I lesions in HIV infected adult Nigerians. They may be the presenting oral lesions of HIV/AIDS. These oral lesions of HIV are associated with a lot of pain, morbidity and may also compromise aesthetics. By compromising adequate nutrition and practice of good oral hygiene, they may lead to further deterioration of the health of the patient and can accelerate the course of the disease. Early recognition and diagnosis of these lesions by the oral clinician and/or trained dental practitioner affords the patient the opportunity of receiving prompt and appropriate medical treatment as well as counseling.     

Infection control in dentistry.

The risk of transmission of infection within the dental workplace is low, but recent data have indicated that human immunodeficiency virus transmission between dentist and patient can occur, and that while nosocomial transmission of hepatitis B virus is now less likely, a small but significant number of staff may be at risk of hepatitis C virus and varicella zoster virus infection during dental treatment. Despite these continued risks, shortcomings remain in cross-infection control in the dental workplace. Dental clinicians still fail to take adequate steps to minimize nosocomial infection, inconsistently using appropriate methods of sterilization and not providing ancillary staff with suitable protective clothing. Similarly, although vaccinated against hepatitis B virus, a substantial number of clinicians are reluctant to treat hepatitis B virus- or human immunodeficiency virus-infected patients. Cross-infection control procedures continue to be modified. Of importance, it has been confirmed that protective rubber gloves cannot be reused, as micropunctures develop during rewashing. Sharps injuries are common in dental practice, but there are still no effective measures to prevent postinjury human immunodeficiency virus or hepatitis C virus infection. Instrument sterilization is generally safe and effective, but the contamination of dental unit water supplies remains to be overcome, and while impressions can be placed in disinfectants for up to 1 hour without significant dimensional change, it is not known if infectious agents within the impression material are inactivated by this procedure.     

Precautions reported to be used against cross-infection and attitudes to the dental treatment of HIV-positive patients in routine clinical dental practice in Scotland

The purpose of this study was to ascertain the precautions against cross-infection currently employed in routine practice by Scottish dentists, to relate these to current recommendations and to determine Scottish dentists' views on how dental treatment should be provided for patients known to be HIV positive. The subjects were 926 general dental practitioners and 201 clinical community dental officers among respondents to a questionnaire sent to a list of 1726 dental practitioners in Scotland. The results suggest that while some dentists are prepared to take an element of personal risk (in spite of recent improvements 18 per cent are still unvaccinated against hepatitis B, 66 per cent do not wear surgical gloves during routine treatment and 21 per cent claim not to wear gloves during procedures involving ‘bloodletting’), the vast majority (95 per cent) are nevertheless taking steps to protect their patients from cross-infection by using autoclave and dry heat sterilization. One-quarter of general dental practitioners and one-half of clinical community dental officers felt that HIV-positive patients should generally be treated in the branch of the dental service in which they worked, although greater proportions (52 per cent and 69 per cent respectively) said they were prepared to treat a regular patient who became HIV positive.     

Knowledge and attitudes towards HIV/AIDS amongst Kuwait university dental students

The HIV and AIDS have emerged as complex health threats to the world population. As future dentists, it is pertinent that the dental students have sufficient knowledge and a positive approach towards the disease. Accordingly, the aim of this study was to assess the HIV/AIDS related knowledge and attitudes amongst clinical dental students at Kuwait University. A cross‐sectional survey was conducted amongst the clinical dental students using a structured questionnaire with 60 questions to examine their knowledge under various categories and 13 questions to examine their attitudes towards the disease. The survey revealed that almost 58% of the respondents demonstrated a high level of knowledge (mean score: 45.23 ± 4.35 SD). Majority of the students (63.6%) expressed negative attitude (mean score: 5.36 ± 2.56 SD). The mean knowledge score of the fifth year dental students was significantly higher (P = 0.022) than that of the final year dental students regarding the knowledge of virus and disease process. However, no significant difference was observed with respect to other knowledge categories. Despite their high level of knowledge, the majority displayed a negative attitude towards HIV/AIDS. Hence, the findings imply that there is a need to address, more clearly, the students’ misconceptions and attitudes towards the disease.     

Hepatitis B vaccination and infection control in Brazilian dental practice, 1990

The aims of the study were to examine the knowledge of occupational hazards from blood-borne viruses, and practices related to cross-infection control in Brazil, by a survey of 947 Brazilian dental practitioners at a National Dental Congress in January 1990. Over 80% were aware that hepatitis B virus can be present in the oral cavity and constitutes an occupational hazard but their perceptions as to the hazards from other agents were at variance with the published evidence. Over 75% were aware of the existence of vaccines against hepatitis B virus but less than 60% appreciated the possible long-term hepatic sequelae of hepatitis B virus infection and, less than 40% were aware of the oncogenic potential. Less than 10% had been immunized against hepatitis B and only a further 30% intended to be vaccinated. Autoclaves were used by less than 10%: most appeared to use chemical means for disinfection of dental instruments. These results indicate the urgent need for a campaign to improve infection control procedures in Brazilian dental practice.     

Education about treating patients with HIV infections/AIDS: the student perspective

This study investigated dental and dental hygiene students' a) perceptions of their education about treating patients with HIV infections/AIDS, b) knowledge of universal precautions, c) attitudes towards treating these patients and patients perceived to be at risk for HIV infections, and d) evaluations of potential curricular activities such as discussion groups with HIV-infected patients. Data were collected with self-administered questionnaires from 315 dental and 89 dental hygiene students. On average, dental students reported having learned about this topic in fever courses than dental hygiene students. However, dental students answered significantly more knowledge questions about universal precautions correctly than did dental hygiene students. This knowledge increased over the program course. Male students had significantly stronger negative attitudes towards patients at risk for or with HIV infections/AIDS than female students. Overall, dental and dental hygiene students responded positively to the suggested methods for including more material about patients with HIV infections/AIDS such as case studies, discussion groups, and closely supervised clinical experiences. This study shows that dental and dental hygiene students are interested in learning more about treating patients with HIV infections/AIDS. It also adds information to previous research on factors involved in the dental healthcare providers' decisions to treat patients at risk for or with HIV infections/AIDS. The implications of these findings for curriculum development efforts are discussed.     

The prevention of cross-infection. Progress in the West Midlands

A questionnaire was sent to a group of general dental practitioners in the West Midlands, one year after they had participated in a previous survey and a year following publication of the British Dental Association's 'Guide to blood-borne viruses and the control of cross-infection in dentistry'. Results show that awareness of the need to safeguard patients and staff from the risks of cross-infection continues to grow and that procedures undertaken to reduce the possibility of cross-infection continue to be improved.     

The oral care of HIV positive patients at Berlin clinic.

Two final year dental students spent an elective period in the HIV clinic of the Dental Hospital of the Freie University of Berlin. The oral manifestations and management of 50 HIV patients were observed.     

A comparative study of oral health knowledge,attitude and behaviour of first and final year dental students of Udaipur city,Rajasthan, India

Abstract: Objective: To assess and compare differences in oral health knowledge, attitudes and behaviour among first and final year dental students in Udaipur city, Rajasthan, India. Materials and methods: In a cross‐sectional study, 182 first year students (59 males and 123 females) and 157 final year students (75 males and 82 females) of the two dental colleges in Udaipur city; Rajasthan, were surveyed using a self‐administered structured questionnaire including 37 multiple choice questions pretested through a pilot survey. The data was analysed using the spss version 10.0. The mean percentage scores, standard deviation and frequency distribution were calculated. The Student’s t‐test and anova test were used as test of significance. The linear regression analysis were used to assess the relation of knowledge, attitude and behaviour. Results: The mean % score for oral health knowledge, attitude and behaviour were significantly higher in final year students compared to first year students (P < 0.001). The linear regression analysis showed a statistically significant linear relationship of attitude with the knowledge (P < 0.001) and behaviour with the attitude (P < 0.001) of the students. Conclusion: Besides the positive changes revealed in the oral health knowledge, attitude and behaviour, among the students from first to final year of dental studies, preventive behaviour among the students could still be improved.     

Does exposure to dental education change the perceptions of Nigerian students to dentistry as a profession?

Aim:  To assess any effect of exposure to dental education and training on the perception and acceptance of dentistry by dental students at a Nigerian dental school.
Participants and methods:  The study was conducted by means of an anonymous self-administered questionnaire distributed to second-, fifth- and sixth-year dental students at the College of Medicine, University of Lagos. Participation was voluntary and 67 students agreed to participate in the study. Majority (51%) were aged between 24 and 27 years. The questionnaire contained questions on demography, preferred choice of course on admission, attempts at change of course, their present perception to dentistry and future dental practice.
Result:  Over 90% of them were admitted through the Joint admission and matriculation board and 40 (60%) chose Medicine as their first course choice. Of the 40, 18 had attempted a change of course and eight were still interested in a career change (four were in the fifth year). Most of the change in attitude occurred in fourth year. Sixty (90%) intend to practice dentistry but 38 (63%) of these would like to practice outside Nigeria.
Conclusion:  Exposure to dental training appears to improve students' perception about dental practice but uncertainty about future prospects in Nigeria may lead to brain drain in the dental profession.     

A SURVEY OF CROSS-INFECTION CONTROL PROCEDURES: KNOWLEDGE AND ATTITUDES OF TURKISH DENTISTS

Objectives:

The objective of this study was to investigate the knowledge, attitudes and behavior of Turkish dentists in Samsun City regarding cross-infection control.

Material and methods:

A questionnaire was designed to obtain information about procedures used for the prevention of cross-infection in dental practices and determine the attitudes and perceptions of respondent dental practitioners to their procedures. The study population included all dentists in the city of Samsun, Turkey, in April 2005 (n=184). The questionnaire collected data on sociodemographic characteristics, knowledge and practice of infection control procedures, sterilization, wearing of gloves, mask, use of rubber dam, method of storing instruments and disposal methods of contaminated material, etc. Questionnaire data was entered into a computer and analyzed by SPSS statistical software.

Results:

From the 184 dentists to whom the questionnaires were submitted, 135 participated in the study (overall response rate of 73.36%). As much as 74.10% dentists expressed concern about the risk of cross-infection from patients to themselves and their dental assistants. Forty-three percent of the participants were able to define "cross-infection" correctly. The greatest majority of the respondents (95.60%) stated that all patients have to be considered as infectious and universal precautions must apply to all of them. The overall responses to the questionnaire showed that the dentists had moderate knowledge of infection control procedures.

Conclusions:

Improved compliance with recommended infection control procedures is required for all dentists evaluated in the present survey. Continuing education programs and short-time courses about cross-infection and infection control procedures are suitable to improve the knowledge of dentists.     

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.