Oral disorders and chronic systemic diseases in very old adults living in institutions

This study evaluated whether oral disorders were associated with chronic systemic diseases in 532 Canadian adults who are old and very old and living in institutions. A brief oral examination documented tooth retention, caries, and periodontal and gingival health. Medical records provided information about chronic systemic conditions. A history of stroke was associated with a higher experience of caries, a higher ratio of decayed-to-present teeth, and more gingival and periodontal problems. Participants with high blood pressure, osteoporosis, or diabetes were more likely to be edentulous or to have fewer teeth than participants who did not have these conditions. Participants who had arthritis retained more teeth with age. Participants who had more diseases also tended to have poorer gingival or periodontal conditions, fewer teeth, and higher risk of edentulousness. The associations between systemic diseases and more severe oral disorders may be direct or may be mediated by underlying factors such as health behaviors.

Making clinical decisions for dental care: concepts to consider

Clinical decisions are often made with incomplete information, yet patient care decisions are made every day. Patients vary clinically, uncertainty exists in diagnostic and prognostic information, and many preventive and treatment alternatives have not been formally assessed for their effectiveness. Because scientific information will never answer all clinical questions, clinical decisions are partially based on probabilistic information. This paper describes how to apply clinical decision making to diagnosing and managing dental caries and periodontal diseases. By using explicit information to quantify probabilities and outcomes, clinical decision making analyzes decisions made under uncertain conditions and the uncertain impact of clinical information. Clinical decision making incorporates concepts for preventing, diagnosing and treating dental caries and periodontal diseases: risk assessment, evidence-based dentistry, and multiple oral health outcomes. This information can serve as a tool for clinicians to augment clinical judgment and expertise.

Socio-demographic features and fluoride technologies contributing to higher fluorosis scores in permanent teeth of Canadian children

OBJECTIVE

To examine levels of fluorosis among children in two Canadian communities exposed to fluoride.

BACKGROUND

One community had discontinued fluoride, the other had maintained it. Water supplies, however, were fluoridated for all the children when their esthetically important teeth were mineralized.

METHODS

We examined 8,277 children to assess Thystrup-Fejerskov Index (TFI) scores. Multivariate Poisson regression models were used to identify the relationship between TFI and water fluoride status, age, gender, SES, and dietary and fluoride exposure histories (supplements, rinses, toothpaste amount, tooth brushing frequency, and tooth brushing starting age). Parent(s) completed questionnaires.

RESULTS

Overall, levels of fluorosis were low to mild, with residents of the fluoridation-ended communities having marginally higher TFI scores than those of the still-fluoridated community. Females had higher TFI scores than males. Children aged 10 years or more had higher TFI scores than younger children. Consuming bottled water between birth and 6 months of age was protective. Exposure to fluoridation technologies was consistently associated with fluorosis experience. Children who began brushing with fluoride toothpaste between their first and second birthdays had higher TFI scores than those who began between their second and third birthdays, regardless of daily brushing frequency. Children who regularly used supplements had higher TFI scores than those who did not. Children with a college-educated father had higher TFI scores than those whose fathers had less education.

CONCLUSIONS

Higher fluoride exposure slightly increased the likelihood that a child had a higher TFI score, especially when more fluoridation technologies were used at home.

Attitudes of a group of Mexico City residents toward HIV/AIDS in the dental office

OBJECTIVE

To ascertain the intention of the public to undergo dental treatment at dental clinics where other patients or a dentist are infected with HIV/AIDS.

STUDY DESIGN

A cross-sectional design was used to interview a stratified sample of persons 18 years and older in Mexico City with use of a standardized questionnaire. Questions included the type of dental service used, the perception of risk for HIV/AIDS contagion in the dental environment, and the reported intention to continue treatment in a dental office where patients or a dentist were affected by HIV/AIDS.

RESULTS

Of the 490 participants, 74.9% were concerned about HIV/AIDS transmission in the dental office. Only 21.2% intended to continue treatment at a dental office where HIV/AIDS patients were treated, and only 20.0% intended to continue treatment when the dentist was HIV-positive. The degree of concern about HIV/AIDS contagion and the modality of dental service used were associated with the stated intention to continue dental treatment.

CONCLUSIONS

There is a need to have good infection control standards in dental practice; to increase public trust in such standards by making them more apparent; and/or to establish educational programs to improve public knowledge and attitudes toward HIV/AIDS risks in dental practice.

Oral hygiene, gingivitis, and periodontitis in persons with Down syndrome

This study was conducted to determine and compare the prevalence, severity, and extent of gingivitis and periodontitis in patients with Down syndrome and patients who did not have Down syndrome. The authors also assessed the relationship of these conditions and compared them to the age, gender, and oral hygiene profiles in both groups. Using a case-control study design, the authors examined 32 individuals with Down syndrome (DS) and matched each with a participant from the control group (CG) according to age and gender. Researchers determined the Simplified Oral Hygiene Index, Gingival Index, and measured the level of gingival attachment for each participant. The authors found that the relationship between the presence of dental plaque and the severity of gingivitis was moderate among participants with DS. While the overall characteristics of the periodontal and gingival health status were not markedly different between the two groups, the extent and severity of gingivitis and the extent of periodontitis were greater in the group with DS than in the CG.

Oral disorders in institution-dwelling elderly adults: a graphic representation

This study was conducted to assess the oral health status and dental care needs of elderly adults living in long-term care facilities. Dentists examined 601 elderly adults, living in one of six extended-or intermediate-care facilities, between September 1999 and May 2000. Data from 532 of the subjects were analyzed with descriptive statistics and zero-order inverse polynomials. Using a computer program, the authors compiled summaries of oral health data on individuals and institutional levels. This study suggests that there are numerous unmet dental needs among elderly adults who live in institutions. The CODE index used to assess the oral health of these residents offers a systematic portrayal of oral disorders in terms of severity. As the authors demonstrated, this index can be readily analyzed using zero-order inverse polynomials to summarize collected data into a graphic description, which can be helpful in managing and administrating oral health care interventions in long-term care facilities.

Explanatory models in the interpretations of clinical features of dental patients within a university dental education setting

Clinicians may acquire biased perceptions during their dental education that can affect decisions about treatment/management of dental decay. This study established explanatory models used by students to interpret clinical features of patients. It employed a stereotypical dental patient under standardised consultation conditions to identify the interpretation of oral health/disease features in the eyes of student clinicians. The study aimed to establish the perceptions of the patient as a client of the university dental clinic, as seen through the ideological lens of a formal Dental Education system. The discourse during simulated clinical consultations was qualitatively analysed to interpret values and concepts relevant to the assessment of restorative treatment needs and oral health status. Three constructs during the consultation were identified: the Dual Therapeutic Realms, the Choices Underlying Treatment Options, and the High-Risk Triad. Comparing these discourse components, the Patient Factors of the Bader and Shugars model for treatment decisions supported the existence of a core set of themes. It was concluded that certain consultation circumstances influenced the adequacy of diagnostic strategies, mainly by introducing loosely defined but highly specific socio-cultural biases ingrained in the Dental Education concepts and diagnostic/treatment needs systems.

Attitudes toward HIV-infected individuals and infection control practices among a group of dentists in Mexico City--a 1999 update of the 1992 survey

BACKGROUND

The teaching of infection control (IC) was introduced at dental schools in Mexico during the 1990s. A 1992 survey indicated that some dentists had limited access to current IC standards. Deficient knowledge of bloodborne pathogens may influence dentists' attitudes about infected individuals and reduce compliance with IC recommendations.

OBJECTIVE

To update the 1992 appraisal of attitudes about persons infected with HIV or the hepatitis B virus (HBV) and IC knowledge and practices in a nonrepresentative sample of dentists in Mexico City.

METHOD

One hundred eighty dentists were interviewed in 1999 (response rate, 84.1%) with the same methods used in 1992.

RESULTS

Seventy-nine percent of respondents perceived the risk of HIV infection as "considerable" to "very strong." The risk of HBV infection was considered higher than that of HIV. Only 32% of respondents had not been immunized against HBV. Reported use of personal protective equipment remained high. Dry heat was the preferred method for sterilization in 1992, but by 1999 it had been displaced by steam under pressure. Reported preference for more effective disinfectants was also evident overall.

CONCLUSIONS

We found certain improvements in IC knowledge and practices between 1992 and 1999, and the results suggest targets for educational and regulatory efforts that are needed to promote better adherence to current IC standards.

Perceptions of the importance and control of professional problems in the clinical setting

The objective of this study was to identify the relative importance of culturally relevant professional problems and the degree of control over them, as perceived by dentists and dental students in Mexico City, Mexico. The dentists and students ranked 13 problems according to importance and then according to the perceived degree of control over each one. Novice clinicians were less secure about their ability to cope with the legal, financial, and clinical performance problems, whereas experienced clinicians were more concerned about occupational hazards and the dental market and culture. Both reported similar perceptions of their control of the problems. This preliminary information should support introducing into dental schools relevant practice-management courses, targeting continuing education efforts, and instituting professional counseling measures to meet the challenges posed by these problems.

Effects of diameter, chemical impregnation and hydration on the tensile strength of gingival retraction cords

Gingival retraction cords are useful clinical aids but little information is available regarding desirable physical features that would preserve their integrity under tensile forces. The study aimed to establish under experimental conditions the extent to which tensile strength is affected by variation in cord diameter; impregnation with ferric sulphate (FS) or aluminium sulphate (AS); and cord hydration (wet/dry). Commercial cords and standard cotton cords were assayed in an Instron 1137 machine. Data were analysed using t-test, and one- and four-way ANOVA. Results indicated that tensile strength for 200 commercial cords was 1.4950 +/- 1.032 kg; and for 560 cotton cords was 1.2964 +/- 1.4560 kg. Cord hydration had no significant effect on tensile strength, whereas impregnation with AS or FS, a smaller diameter, and/or being a cotton cord decreased tensile strength (P < 0.001). Bivariate analyses showed that hydrated commercial cords had higher tensile strength than dry specimens; hydrated or dry cotton cords were not different. The FS-impregnated cotton cords had lower tensile strength than AS-impregnated or control cords, and the effect was greater at higher FS concentrations. This study is one of the first evaluations of the physical properties of cords, highlighting characteristics that may minimize the risk of tearing.

Clinical decision-making for dental caries management

Scientific information on diagnosis, prevention, and management of dental caries and associated indicators of risk continues to increase rapidly. Patients vary in clinically important ways, however, and uncertainty affects our understanding of risk; diagnostic and prognostic information; efficacy and effectiveness of many preventive, diagnostic, and treatment alternatives; and outcomes associated with clinical strategies. Consequently, challenges abound for clinicians to identify, evaluate, and incorporate new information, patient preferences, and uncertainties into clinical practice. Clinical decision-making--an analytical approach that makes explicit use of information to quantify probabilities and outcomes to analyze decisions under conditions of uncertainty--can provide a framework to analyze the impact of uncertainty of clinical information. Diagnostic, effectiveness, and outcome information is quantified and combined in an explicit way to serve as a tool for clinicians, not as a replacement for clinical judgment or experience. Such an approach has the potential to improve clinical practice and help dentists do their jobs better by structuring the decision problem and assessing probabilities and utilities. Clinical decision-making also helps dentists communicate with each other by identifying clinical controversies, thereby characterizing how and why disagreements may arise and what additional data may be needed to address a clinical question.

Tooth-surface progression and reversal changes in fluoridated and no-longer-fluoridated communities over a 3-year period

OBJECTIVE

To compare permanent tooth surface-specific progression/reversal changes between fluoridation-ended (F-E) and still-fluoridated (S-F) communities in British Columbia, Canada, over a 3-year period.

METHODS

D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories.

RESULTS

Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit-and-fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F-E site compared to the S-F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F-E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables.

CONCLUSION

Progressions were found to be weakly linked to socio-demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F-E communities had more frequent progressions than a S-F community.

Is there a sound basis for deciding how many dentists should be trained to meet the dental needs of the Canadian population? Systematic review of literature (1968-1999)

A systematic review was conducted of the literature on human resources planning (HRP) in dentistry in Canada, critically assessing the scientific strength of 1968-1999 publications. Inclusion and exclusion criteria were applied to 176 peer-reviewed publications and "grey literature" reports. Thirty papers were subsequently assessed for strength of design and relevance of evidence to objectively address HRP. Twelve papers were position statements or experts' reports not amenable for inclusion in the system. Of the remaining 18 papers, 4 were classified as projections from manpower-to-population ratios, 4 as dental practitioner opinion surveys, 8 as estimates of requisite demand to absorb current capacity and 2 as need-based, demand-weighted studies. Within the 30.5 years reviewed, 53.4% of papers were published between 1982 and 1987. Overall, many papers called for a reduction in human resources, a message that dominated HRP during the 1980s, or noted an increase in the demand for services. HRP publications often had questionable strength or analytic frameworks. The paradigm of busyness-scarcity evolved from a belief around an economic model for the profession into a fundamental tenet of HRP. A formal analysis to establish its existence beyond arbitrary dentist:population ratios has usually been lacking.

Patterns of dental caries following the cessation of water fluoridation

OBJECTIVES

To compare prevalence and incidence of caries between fluoridation-ended and still-fluoridated communities in British Columbia, Canada, from a baseline survey and after three years.

METHODS

At the baseline (1993/4 academic year) and follow-up (1996/7) surveys, children were examined at their schools. Data were collected on snacking, oral hygiene, exposure to fluoride technologies, and socio-economic level. These variables were used together with D1D2MFS indices in multiple regression models.

RESULTS

The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9) decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community. While numbers of filled surfaces did not vary between surveys, sealed surfaces increased at both study sites. Caries incidence (assessed in 2,994 life-long residents, grades 5, 6, 11, 12) expressed in terms of D1D2MFS was not different between the still-fluoridating and fluoridation-ended communities. There were, however, differences in caries experienced when D1D2MFS components and surfaces at risk were investigated in detail. Regression models did not identify specific variables markedly affecting changes in the incidence of dental decay.

CONCLUSIONS

Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas.

Clinical decision-making in restorative dentistry. Content-analysis of diagnostic thinking processes and concurrent concepts used in an educational environment

CONTEXT

Dental practice is affected by variation in diagnosis and treatment planning between clinicians. The process underlying the decisions leading to management of dental caries is poorly understood.

OBJECTIVE

To explore diagnostic thinking and identify information used in the diagnosis, management and treatment of caries.

SUBJECTS/MATERIALS

15 senior dental students (mean age, 23.1 years; 66% female) in Mexico City were interviewed using a Simulated Patient Model (SPM).

METHODS

The SPM consultation session and its review, aimed at eliciting an introspective recall description of the Diagnostic Thinking Processes (DTP) and the pieces of information (concepts) employed, were transcribed and content-analyzed (CA). CA reproducibility coefficients were 0.53 to 0.64. The cognitive psychology Gale & Marsden (GM) model was used to structure DTP and concepts. Data were analyzed with chi-squared tests.

RESULTS

DTP utilization was similar to the original report in endocrinology and neurology cases. A wide variety of concepts were combined with DTP to describe the strategies and information preferentially resorted to while addressing four areas identified in the consultation.

CONCLUSIONS

Narrow arrays of concepts of restorative concern (mostly physical features present in/on teeth) were often investigated using DTP 1, 2 and 4 in combination with the use of dental explorers. The heuristics detected link features common to the GM model and to an indirect pattern-recognition model, whereby reliance on visual/tactile concepts facilitates the acquisition of a clinically meaningful image. Non-clinical factors believed to be at play in the application of strategies were not investigated but were controlled for in the SPM.

In vitro quantitative assessment of enamel microhardness after exposure to eroding immersion in a cola drink

Studies assessing the erosive potential of soft drinks have employed long time intervals of immersion that may not accurately depict the impact of frequent soft drink consumption on enamel. This in vitro study assessed the effect of a cola drink on enamel, replicating an actual drinking pattern. Six groups of 4 human enamel slabs were immersed (5 min each bath) in fresh cola drink, with immersions taking place with or without agitation, and under 3 regimes of frequency intake (low intake, 1 immersion/day; medium, 5/day; high, 10/day). Quantitative assessments of surface erosion were done over an 8-day interval using surface microhardness testing (Vickers). Results showed a sharp decrease from baseline (mean value 352.1 Vickers Hardness Number, SD 32.5) to day 1 (269.3, SD 41.0) and then continued decreasing throughout the assay, although less markedly, to reach 204.5, SD 45.4 on day 8. Microhardness decreased regardless of frequency regime, except on day 8, on which slabs from the low intake group were harder (233.2, SD 25.0) than slabs from the high intake group (169.8, SD 49.5; p < 0.05). Results from the ANOVA on the factorial experiment indicated that the role of agitation was statistically significant (d.f. = 1, F = 7.2, p = 0.020) while the level of intake was of borderline significance (d.f. = 2, F = 3.2, p = 0.075). The main effect resulting from the joint roles of agitation and intake indicated that there was an important interaction between the two variables (d.f. = 3, F = 4.5, p = 0.023).

In vitro quantitative microhardness assessment of enamel with early salivary pellicles after exposure to an eroding cola drink

To assess the erosive effect of a cola drink on enamel incorporating early salivary pellicles, 72 groups of human enamel slabs were immersed in fresh cola, with groups differing in that slabs were (1) incubated in whole or in clarified saliva, (2) under three regimes of frequency intake (1, 5 and 10 times/day); (3) immersed with or without agitation, and (4) the pellicle was incubated for 20 min, 6 or 24 h. Quantitative assessments were done over an 8-day interval using surface microhardness testing. Results for primary enamel showed a sharp decrease from baseline (344.2+/-32.4 Vickers Units; mean +/-SD) to day 1 (268.9+/-36.8), and reached 155.2+/-68.6 on day 8. Results for permanent enamel were 350.8+/-42.2, 315.9+/-39.2, and 149.8+/-85.2. Microhardness was affected by agitation, level of intake and type of saliva, but not by the pellicle incubation interval nor the type of enamel. The joint effect of static baths and higher immersion frequency was the most important factor in decreasing hardness.

Cumulative assessment of factors leading to restorative decisions in an educational environment. A graphical demonstration using an in vitro case

Even though accuracy and inter-examiner variation assessments of borderline restorative items have been previously reported, no attempt has been made to replicate the effect of cumulative, sequential diagnostic and treatment planning decisions. This study assesses the cumulative effect of factors indicating restorative needs by evaluating how readily tooth restoration was proposed on the basis of restoration quality and presence of caries (compared to gold standards). Ninety-one senior dental students in Mexico City (79% female; mean age 22.8 years) assembled in 19 teams of five students each. They sequentially evaluated 56 restored and unrestored posterior teeth in an in vitro model. Each student examined the set, removed those teeth needing restorative intervention and returned the remaining set for examination by a second student. When the second assessment was completed, the remaining teeth were turned over to the third teammate and so on. Teeth were subsequently assessed for restoration quality and enamel and dentinal caries. When a tooth showed a carious lesion, a dentinal lesion or a defective restoration, the likelihood of it being selected for restorative treatment increased. When more than one feature was present, the chances of the tooth being selected more frequently and earlier increased, accordingly. The specificity of restorative treatment needs was not excellent. A strong graphical association between the presence of caries and/or defects in restorations with proposed restorative treatment was demonstrated using a non-quantitative research model. The more abundant these features were, the higher the probability appeared for a tooth to fit the clinical picture suitable for restorative intervention.

Structured review of enamel erosion literature (1980-1998): a critical appraisal of experimental, clinical and review publications

OBJECTIVE

To attain an objective account of the methods to measure enamel erosion used in 1980-1998 publications, a structured review of the literature was undertaken.

METHODS

Inclusion and exclusion criteria were applied to 731 clinical/experimental research and review reports. Eighty-five included papers were subsequently rated according to 'hierarchy of evidence' guidelines to assess the strength of the report's design and the relevance of the evidence to replicating enamel erosion in vivo in humans. Scores were assigned to rate each aspect in the guidelines.

RESULTS

A total of 16 clinical, 13 review and 56 experimental papers were assessed; 36.4% were published during 1996-1998. Excluding reviews, 16 papers were qualitative and 56 quantitative; 51 used human enamel. Our classification yielded nine groups of methods (five scoring systems and 26 measurement techniques). CTFPHE (Can Med Assoc J 1992; 147: 443) grading of research reports indicated that 2.8% provided evidence grade I; 20.8%, grade IIa; 63.9%, grade III; and 12.5%, grade IV.

CONCLUSIONS

There has been a consistent increase in the body of knowledge. The overall quality of publications has not substantially changed over time. Experimental studies were more often quantitative, and quantitative studies had better research designs. No single group of research methods had obviously superior research designs.

Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol

PURPOSE

The purpose of this pilot investigation was to study the efficacy, physiologic responses, and safety of a multi-drug intravenous conscious sedation technique in an outpatient setting in children who demonstrated uncooperative behavior when comprehensive restorative dental treatment was attempted.

METHODS

Using a time-based sedation record, the physiologic responses of 153 healthy children, age range 23 months to 14.5 years, were measured after they had received midazolam (Versed), nalbuphine (Nubain), and droperidol (Inapsine), each administered intravenously, and nitrous oxide and oxygen administered by nasal mask, while each child received comprehensive restorative or surgical dental care. Each patient was monitored according to the American Academy of Pediatrics Sedation Guidelines. Heart rate and rhythm, blood pressure, respiratory rate, hemoglobin oxygen saturation, end-tidal CO2, level of sedation, and behavioral responses were recorded preoperatively, at 5 minute intervals during treatment and in recovery until discharge. Sedation was titrated to Level 2 or 3 during treatment as defined by the American Academy of Pediatric Dentistry Reference Manual.

RESULTS

For each child, the sedation level was judged to be either acceptable or optimal for the completion of all planned dental treatment. There were no sedation failures. Children under 20 kg required significantly higher dosages of each sedative medication than children more than 20 kg to achieve the same level of sedation (P < 0.001, ANOVA). There were no episodes of intraoperative vomiting, hypotension, cardiac arrhythmias, respiratory depression requiring respiratory support, or dysphoria during treatment, in the recovery period, or after discharge.

CONCLUSION

This multi-drug intravenous conscious sedation technique is a safe and effective method to control the behavior of uncooperative children who require comprehensive dental treatment.

Survey on attitudes toward HIV-infected individuals and infection control practices among dentists in Mexico City

BACKGROUND

The teaching of infection control is gradually being introduced at dental schools in Mexico. However, most practicing dentists have limited access to current infection control standards. Deficiencies of knowledge with regard to blood-borne pathogens such as HIV and hepatitis B virus may influence attitudes toward infected individuals and reduce compliance with infection control recommendations.

OBJECTIVE

The purpose of this study was to assess (1) attitudes toward HIV-infected patients and hepatitis B virus-infected patients and (2) infection control knowledge and practices among dental practitioners in Mexico City.

METHOD

A total of 196 dentists were interviewed by means of a questionnaire with Likert-type scales and open-ended questions (response rate, 86.1%).

RESULTS

Most respondents had no previous social or professional contact with HIV-positive individuals. Nine percent indicated that they had knowingly treated HIV-positive patients. Perceived professional and moral obligations to treat HIV-positive patients were high. Thirty-five percent of the respondents perceived the risk of HIV infection as "considerable" to "very strong." The risk of hepatitis B infection was considered significantly higher than the risk of HIV infection (P <.01); however, 78% of the respondents had not been immunized against hepatitis B. Reported use of personal protective equipment was high. Most respondents used dry heat sterilization. The principal disinfectants used were quaternary ammonium compounds, bleach, and glutaraldehyde. Fifty-four percent of the respondents acknowledged that clinical precautions reduced occupational risks.

CONCLUSIONS

This survey revealed contradictory attitudes toward HIV-positive individuals and limited understanding of infection control recommendations. Educational and regulatory efforts are needed to promote better adherence to current infection control standards.