Problems associated with providing dental care to patients with HIV-infected and AIDS patients.

Numerous articles published during the last decade have discussed the significance of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) toward the practice of dentistry. However, only since 1987 have studies been undertaken on the attitudes and behavior of dentists toward HIV-positive patients. A detailed analysis of 15 such reports suggests that concerns regarding the perceived stigma of treating such patients, together with a fear that HIV is transmitted through dental treatment are major reasons why dentists are reluctant to care for HIV-positive and AIDS patients. Successful resolution of these concerns is time consuming and expensive but necessary if dentists are to satisfy their professional obligations to patients with HIV infection and AIDS.     

Nutritional considerations and dental management of children and adolescents with HIV/AIDS

The HIV infected child has increased caloric needs, yet multiple factors interfere with adequate nutritional intake. Nutritional support is needed to maintain optimum nourishment during the symptomatic period, in order to prevent further deterioration of the nutritional status during acute episodes of infection, and to improve the nutritional status during the stable symptom free period. With the advent of better methods of detection and better therapies, we are beginning to see HIV infected children surviving longer; and thus coming under the care of a host of affiliated medical personnel, including dentists. Oral health care workers need to provide dental care for HIV-infected patients and recognize as well as understand the significance of oral manifestations associated with HIV infection. The present article reviews, on the basis of literature, nutritional status, nutrition assessment and counseling in HIV/AIDS children and adolescents. Dental treatment considerations in these, as well as modifications in treatment if required, are also discussed.     

Oral care of HIV infected patients: the knowledge and attitudes of Irish dentists.

As the numbers of people with HIV infection and AIDS increase, so will the contribution required from dental practitioners. A postal questionnaire survey was therefore conducted among dental practitioners in Ireland to determine their knowledge and attitudes towards HIV infection and the issues it raises for them. Although a majority of dentists were aware of the facts related to AIDS and the spread and oral manifestations of HIV infection, there were considerable gaps in their knowledge with regard to dental management. Only 41% were prepared to be engaged in continued care of HIV infected patients while contradicting opinions were expressed on the risk of HIV transmission in dentistry and attitudes towards HIV seropositive patients and staff. Further educational efforts on HIV infection and its implications in dentistry should be directed towards dentists in Ireland.     

Dentists and AIDS: a Survey of Knowledge, Attitudes, and Behavior in Italy

Objectives: Italy, together with Spain, is second only to France in the total number of AIDS cases” in Europe, with over 16,800 as of March 1993. The purpose of this study was to evaluate knowledge, attitudes, and behavior concerning AIDS and infection control among Italian dentists. Methods : A questionnaire was mailed to 1,000 dentists randomly selected from the Italian Dental and Maxilto-Facial Association's register of dentists. Results : Of the 715 dentists responding, 70.7 percent of dentists knew all the main risk groups able to transmit the infection and that semen is a biologic fluid potentially contaminated by HIV virus. This knowledge was greater if the number of patients per week was not higher than 55 and if the dentist had had a previous contact with an HIV-seropositive patient. Only a few (21.1%) knew all the oral manifestations of AIDS. Over 65 percent of the dentists indicated that they would treat HIV-seropositive patients (71.9%) or those with AIDS (66.8%). Dentists were more willing to care for an HIV-seropositive patient if they were involved in specialties with high blood contact, if they had a previous contact with an HIV patient, as the average number of patients per week increased, and if they did not consider saliva as a possible route of transmission of HIV. A small percentage of dentists who had the opportunity to treat patients at risk for AIDS (12.1%) or HIV seropositive (9.4%) refused to treat them. Willingness to treat was the most significant predictor of actual treatment of an infected patient. Only 24.4 percent routinely used all barrier techniques (gloves, masks, and protective eye-wear). Predictors of routine use of all barrier techniques were specialties with high blood contact, considering saliva a possible route of transmission of HIV infection, average number of patients per week fewer than 40, and number of years of practice. Conclusions : Educational efforts for improving knowledge and finding and implementing ways to motivate dentists to the correct and routine use of infection control procedures are needed.     

Knowledge and attitudes of Texas dentists concerning AIDS

A total of 1,200 practicing Texas dentists were surveyed concerning AIDS knowledge, attitudes and behaviors. The results were analyzed and an analysis of variance indicated an inverse relationship between city population and avoidance behavior towards AIDS by dentists. Additionally, dentists in practice over 10 years manifested higher avoidance characteristics towards AIDS. Increased knowledge did not correlate with less avoidance behavior. The results of this study indicate that additional methods of educating dentists concerning HIV infection and AIDS, infection control, and the role of health care professionals concerning patients with infectious diseases are needed.     

武汉市牙医对爱滋病的态度、知识及在感染控制中的行为调查分析

目的 :研究武汉市牙医对AIDS的态度、知识及在感染控制中的行为。方法 :对武汉市 5 0 0名牙医进行问卷调查和分析。结果 :收到有效问卷 46 7份。其中 6 3.2 %的牙医表示愿意治疗AIDS/HIV 病人。 6 0 .4%牙医认为血液是传播HIV的最危险的体液 ,且大多数牙医错误地认为唾液是传播HIV的媒介。 318名牙医每天戴手套操作治疗病人 ,但其中仅 12 8(40 .3% )名牙医在治疗完病人后更换手套。结论 :本研究表明牙医所掌握HIV传播的知识水平较低。同时牙医也没有提供足够的防护措施来保护自己和病人     

Changes in dentists' infection control practices,knowledge, and attitudes about HIV over a 2-year period

ObjectivesTo investigate changes in the infection control practices, attitudes, and knowledge of dentists as they relate toHIV/AIDS.Study designA comparison of responses to surveys conducted in 1992 (n=258) and 1994 (n=262) with the use of univariate/multivariate analyses and McNemar's test for paired data.ResultsThe response rates were >70%. There were significant increases in reports of continuing education related to HIV/AIDS, heat sterilization of handpieces, use of masks, and knowledge of risk of HIV infection after a needlestick injury. Significantly fewer respondents reported concerns about staff fears about HIV/AIDS. Reports of willingness to treat patients with HIV increased from 68% to 77%. The best predictors of willingness to treat changed from primarily infection control variables to lack of concern with respect to risk or loss of patients when treating persons with HIV.ConclusionsIncreased use of infection control procedures and knowledge may be partly attributable to the introduction of mandatory continuing education in 1993.     

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.     

Gender differences in characteristics, infection control practices, knowledge and attitudes related to HIV among Ontario dentists

Abstract We surveyed 5,997 dentists in Ontario to investigate gender differences in the characteristics, infection control practices, knowledge and attitudes regarding the treatment of HIV-infected patients. The response rate was 70.3%. Reports indicated that female dentists are younger and more likely to work in larger urban centres (P<0.00001), and in general practice (P<0.0001) than their male counterparts. Multiple logistic regression analyses indicated that many significant gender differences in the univariate analyses could be explained by the confounding influence of age, practice location, and specialty; however, some differences remain significant: Women were more likely than men to report attending continuing education dealing with HIV/AIDS in the past two years (P<0.001), and to use masks and eye protection (P<0.00001). Men reported more economic concerns than women: they were more concerned about the financial burden of infection control costs (P<0.00001), and losing patients from their practice if it is known that they treat patients with HIV (P<0.05). However, there were no significant differences in willingness to provide treatment for patients with HIV. We conclude that there is little evidence to show that access to oral care for patients with HIV is affected by gender differences.     

Do dentists have sufficient information about their patients to control infection?

This study examined dentists' knowledge of infection control, what dentists say they do to control infection, and what procedures they actually take to prevent the transmission of disease. A professional actor, obviously in need of dental care and playing the part of a patient, was sent to three groups of randomly selected dentists in general practice. The dentists were uninformed subjects who were debriefed about the research immediately after their part in the experiment was completed. The study found that dentists apparently know what they should do to protect themselves from contamination. However, very few dentists discussed HIV or AIDS while taking a pretreatment history of a new patient even if that patient was perceived to belong to a high-risk group. The behavior of the dentists indicates a neglect of this important aspect of a thorough history, providing more evidence that emphasis on infection and infection control is necessary in the dental school curriculum and beyond. Unless dentists learn to fully understand what infections their patients may have, they take the chance of transmitting diseases to other patients as well as to themselves, their staff, and their families.     

HIV- periodontal disease. A review of research prospects: a South African and Namibian perspective.

In the course of infection by the human immunodeficiency virus (HIV) typical changes of inflammatory periodontal disease may arise. It is estimated that the prevalence of HIV-associated periodontal diseases may vary between 5% and 12% and can occur in both symptomatic and asymptomatic individuals. These oral lesions are very important either as an initial presentation of AIDS or as a sign of established immunosuppression. For the patients, HIV-associated periodontal diseases can cause pain, severe discomfort and a decreased quality of life. It is therefore important, from both diagnostic and therapeutic aspects, for dentists to be able to distinguish and diagnose HIV-associated periodontal diseases as early recognition and treatment of these oral lesions may reduce morbidity and allow more comfort to the patient during progression of the disease. This paper reviews the current international and regional status of HIV-associated periodontal diseases and highlights research prospects in countries such as Namibia and South Africa, to further analyse periodontal diseases in HIV/AIDS patients.     

Prosthodontic Management of HIV/AIDS Subjects: An Overview

Provision for high standard of oral health care is a fundamental requirement for any individual and dentists constantly strive to provide optimal treatment to their patients. However, when it comes to treating subjects with infectious diseases particularly those attached with social stigma like HIV/AIDS, there remains doubts and hesitations. This may lead the practitioners to breach the ethical responsibility by denying or not providing adequate treatment to these patients. Such situations can easily be avoided with thorough knowledge and awareness among the oral health care providers including prosthodontists regarding the disease process, its implications and measures to be taken during their treatment. This article summarises key points in prosthodontic management of HIV/AIDS patients which in the opinion of the author may be easily incorporated in routine dental practice.     

Use of gloves among dentists in Sweden

This study among 191 public and private dentists in the Malm?hus County of southern Sweden showed that 77% of the community dentists (n = 167) and 54% of the private dentists (n = 24) used gloves regularly as infection precaution during extraction. For surgery these figures were 90% and 54% respectively. These were low figures considering the several general recommendations from both the Swedish National Board of Health and Welfare and local community authorities to dental personnel to use gloves regularly during procedures with known risk of blood contact. The survey showed that 61% (n = 167) of the public dentists and 4% (n = 24) of the private dentists used gloves regularly during all patient treatment. High cost for gloves was no major obstacle for not using them regularly but rather discomfort and old habits (79% of the answers). 21% of the dentists had experienced local infections of their hands due to patient contact, puncture wounds being the most common cause. Most of the dentists using gloves had been influenced by the general HIV/AIDS discussion in news media (65%; n = 114).     

Addressing the fears of HIV transmission in dental practice.

Recent surveys indicate that dental personnel are prepared to provide care for HIV+/AIDS patients, but do so with some reluctance. Their specific concerns have been identified and an attempt has been made to allay these fears by examining them from scientific, clinical, epidemiologic and historical perspectives. These somewhat pragmatic criteria suggest that HIV transmission in dental practice is extremely unlikely-if not impossible. However, the explanations offered to arrive at these conclusions may fail to resolve the suspicions that some dentists and their auxiliaries harbor toward individuals demonstrating lifestyles foreign to their own. If this is so, the advice of counsellors, social scientists and behavioral modification experts must be sought if dental personnel wish to provide care to HIV+/AIDS patients in an atmosphere of mutual trust, confidence and respect.     

Dentists’ knowledge,attitudes and practices regarding Hepatitis B and C and HIV/AIDS in Sanandaj,Iran

Background

Healthcare workers including physicians, dentists, nurses and laboratory workers are considered to be among the groups at the risk of blood-borne pathogen transmission. Thus, it is necessary to evaluate the Knowledge, Attitude, and Practices (KAP) of dentists regarding infection control and basic principles.

Methods

This cross-sectional study recruited 106 dentists in Sanandaj, Iran. The dentists’ KAP regarding hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV/AIDS were evaluated. Chi-square test, student’s t-test, and one-way ANOVA were used to assess differences between the groups. Data were analyzed in Stata 12.

Results

The results showed that the majority of the subjects in the study population (53.8%) were female. The mean?±?standard deviation (SD) for age and work experience was 39.6?±?9.80 and 10.6?±?8.7?years, respectively. The mean?±?SD for knowledge, attitude and practices of participants was 37.3?±?3.01, 22.9?±?4.80 and 24.07?±?5.06, respectively. The results also indicated that dentists’ higher level of knowledge about HBV, HCV and HIV/AIDS was significantly influenced by work experience (≥10?years; P?<?0.001) and graduation year (after 2006: P?<?0.001). Positive attitude towards HBV, HCV and HIV/AIDS was considerably influenced by age group (<?30?years: P?=?0.021), work experience (≥10?years: P?<?0.001), and workplace (dental office: P?=?0.016).

Conclusions

The results of this study demonstrated a satisfactory level of knowledge and attitude of dentists about HBV, HCV and HIV/AIDS infections, but some gaps were observed, suggesting that higher knowledge level of dentists plays a very important role in forming the attitudes and practices regarding patients with HBV, HCV and HIV/AIDS.

     

Differences in the perceptions of HIV risk amongst dental care providers in Western Australian clinics

This paper examines the perceived risk of occupationally contracting HIV among dental care providers. This examination is based upon responses to a mailed questionnaire from all registered dentists (76 per cent response rate, n = 550) and dental therapists (63 per cent response rate, n = 208) in Western Australia during 1992. Results indicate that: 1) dental care providers who perceive a high risk of occupationally contracting HIV report a more conservative, cautious approach to HIV infection than do providers who perceive less risk of contracting the virus; 2) dental therapists are more likely than dentists to report a higher degree of perceived risk of occupationally contracting HIV; and 3) dentists are more likely than dental therapists to perceive compliance with universal precaution guidelines in dental practices in which they work. Reasons are presented for a suspicion that both sets of perceptions may be exaggerated. The need to educate dental therapists on the realistic risks of occupationally contracting HIV and to educate dentists on the value of compliance (and of appearing to comply) with universal precaution guidelines in order to help reduce undue stress and hindrances in the provision of safe and effective dental care in this era of AIDS concludes this paper.     

Description and evaluation of an education and communication skills training course in HIV and AIDS for dental consultants

A 2‐day course was organised for dental hospital consultants as part of a project on raising awareness of dental staff about HIV and AIDS. The course comprised an information update, practical experience in the diagnosis of oral conditions and a ‘hands‐on’ exercise in infection control. The 2nd day of the course consisted of experiential communication skills training using rôle‐play with actors and video feedback. Evaluation of the course showed that the consultants perceived the course to be valuable. There was a general improvement in dentists’ confidence in their knowledge, ability to communicate with HIV‐positive patients and in talking to staff who are unwilling to provide treatment. These changes are statistically significant and these skills are still being utilized and maintained 2 years later. Information and training packs prepared by multidisciplinary groups using a variety of teaching methods should be made available to those involved in training dental staff.     

Understanding the intention of dentists to provide dental care to HIV+ and AIDS patients

OBJECTIVE: The aim of this study was to understand the intention of dentists to provide dental care to HIV+/AIDS patients. METHODS: A representative sample of 791 dentists from the province of Quebec completed a questionnaire assessing their intention to provide dental care to individuals with HIV+/AIDS as well as their attitudes, perceived social norm, perceived behavioral control, perceived behavioral norm and personal normative belief regarding this behavior. Past experience with providing dental care (habit) to HIV+/AIDS patients, fear of AIDS and socio-demographic characteristics were also assessed. RESULTS: Overall, dentists have a strong intention to provide dental care to HIV+/AIDS patients. Nevertheless, 25% of the respondents expressed a low intention to provide dental care to these patients. The main factors explaining 71% of the variance in intention were perceived behavioral control (beta=0.52, P<0.0001), personal normative belief (beta=0.33, P<0.0001) and habit of treating HIV+/AIDS patients (beta=0.12, P<0.0001). CONCLUSION: To improve the motivation of dentists to treat HIV+/AIDS patients, emphasis should be placed on increasing self-efficacy to cope with the difficulties of providing dental care to HIV+/AIDS patients as well as on the importance of acting in agreement with the Dental Association's Code of Ethics.