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

Indonesian Dental Students' Attitudes, Knowledge, Preparation, and Willingness to Treat HIV/AIDS Patients

OBJECTIVE

 To assess the Indonesian dental students' knowledge of HIV/AIDS in terms of transmission and oral manifestation, the attitudes toward people living with HIV/AIDS (PLWHA), the preparedness in infection control, and willingness to treat PLWHA, and assess the factors for willingness to treat PLWHA.

MATERIALS AND METHODS

 A modified version of a questionnaire used to assess dental students' knowledge, attitude, preparedness, and willingness to treat PLWHA in China was used. The questionnaire was cross-culturally adapted into Indonesian and had been pre-tested for face validity and test and retest reliability. The dental students from 32 dental schools in Indonesia were invited to participate in the study.

RESULTS

 A total of 1,280 dental students from 23 dental schools participated in the study. This study found that only 63% of students scored higher than 70% for knowledge of HIV/AIDS, and the mean score for knowledge was 15.02 (2.4). Higher than 80% of students had a positive professional attitude toward PWLHA; however, 80% of students worried about possible disease transmission in the dental office by PLWHA and 70% of students overestimated the occupational risk when treating PLWHA. The dental students had good preparedness for infection control with a mean score for preparedness of 3.19 (0.4). The mean score for willingness was 2.5 (0.9). Willingness to treat significantly differed by the type of universities, gender, age, and clinical experience. This study showed that knowledge about HIV/AIDS correlated with the willingness to treat PLWHA among dental students.

CONCLUSION

 Dental students who have good knowledge about HIV infection tend to have a good willingness to treat PLWHA. The knowledge would in turn affect their attitude, preparedness, and willingness to provide care for PLWHA with confidence and comfort. This study suggests that the improvement of dental training may play an important role in changing students' perception of willingness to treat PLWHA.

Exploring dental students' knowledge of HIV and attitudes towards saliva screening for HIV

INTRODUCTION

Early detection of human immunodeficiency virus (HIV) allows antiretroviral therapy to commence, improving patient outcomes. Screening for HIV with saliva can be undertaken by dental practitioners. Research has found the procedure to be better accepted by patients than traditional blood testing. However, lack of knowledge and time constraints were identified as barriers to implementation for dental practitioners. This study aimed to explore dental students' knowledge of HIV and their attitudes towards implementing saliva screening for HIV in a dental setting.

METHODS

Convenience sampling was used to recruit four focus groups of six to nine dentistry students from the University of Queensland. Participants also completed a questionnaire prior to the focus group.

RESULTS

Thirty-three students participated in the focus groups. Students recognised their knowledge of HIV was limited, and 46% (n = 15) reported having treated a HIV-positive patient in the last year. Three key themes emerged from discussions; knowledge and experience of HIV; barriers and enablers; and scope of practice. Students identified stigma, lack of training, cost and time restraints as barriers to implementing saliva screening for HIV. Opinions varied on if screening was within a dental practitioner's scope of practice.

CONCLUSIONS

Whilst students were open to conducting saliva screening for HIV, they identified prominent barriers limiting its implementation within a dental setting. Education on saliva screening for HIV, patient counselling and referral pathways could be integrated into dentistry curriculums to reduce these barriers. Further investigation is needed into the cost-effectiveness of implementing screening for HIV in a dental setting.

Evaluation of oral care protocols practice by dentists in Rio de Janeiro towards HIV/AIDS individuals

Background

The aim of this study was to evaluate the dentists’ knowledge and practice regarding HIV positive individuals’ oral care in Rio de Janeiro State.

Methods

Dentists from Rio de Janeiro State (n = 242) answered an electronic questionnaire on biosafety procedures, oral manifestations of AIDS, and knowledge of HIV infection. Collected information was stratified by gender, and data were analyzed using Chi-square and t tests.

Results

From the 14 oral manifestations investigated, oral candidiasis, necrotizing ulcerative gingivitis, and hairy leucoplakia were more associated with HIV, with no differences between the responses from men and women. Above 85% of the participants would be concerned about becoming infected with HIV after a needle/ sharp object injury and more than 80% of them were willing to be tested for HIV. However, significantly more women (98.8%), compared to men (91.3%), said they knew that HIV/ AIDS patients can contaminate dental care professionals, p = 0.007. There was a significant difference in the answers for the questions: “Are there special dental clinics for treatment of HIV/AIDS patients in Brazil?” (p = 0.044), and “Do the negative HIV tests surely indicate that the persons are free of viruses?” (p = 0.005). Significant differences between men and women were also observed regarding use of disposable mask (p = 0.01), and cap (p < 0.0001).

Conclusion

Most dentists who participated in the study presented a good knowledge on the care of HIV/ AIDS individuals, including biosafety protocols and in terms of the oral manifestations commonly associated to AIDS.

Candida is a protractive factor of chronic oral ulcers among usual outpatients

Although many oral ulcers have similar clinical appearances, their etiologies can range from reactive to neoplastic to oral manifestations of dermatological diseases. In patients with an HIV infection, fungal diseases may cause ulceration in the oral cavity; however, there have been few studies of oral ulcerative lesions associated with Candida in patients without an HIV infection. Nevertheless, we encountered chronic oral ulcer associated with Candida among our frequent outpatients without an HIV infection. The present article reviews the causes of oral ulcers, focusing on Candida as a protractive factor for chronic oral ulcers, and it is recommended that Candida involvement be considered in diagnosis of a certain chronic oral ulcer, that remains of unknown origin even if some examinations have been performed.

Australian dentists' perspectives on rapid HIV testing

BACKGROUND

Fourteen per cent of people living with HIV in Australia, as in other countries, are not aware of their infection or their infective status. Dentists have the necessary expertise and are well-placed for access by those sections of the population who would not normally access screening for HIV.

METHODS

A national cross-sectional online survey of 532 Australian dentists was conducted during the period June to October 2013. We surveyed dentists' understanding and willingness to undertake rapid HIV testing (RHT).

RESULTS

The majority of respondents (65.1%) believed that RHT was needed in dental clinics, with approximately two-thirds of respondents indicating that RHT should be made available immediately. If RHT was to be undertaken in a dental setting, 51.1% of dentists thought that it should be conducted on saliva only, as opposed to blood or blood/saliva. Only 21.9% of dentists would currently be comfortable advising a patient of a reactive (i.e. positive) result indicative of HIV infection, with male dentists (26.1% comfortable) more comfortable than female dentists (17.5% comfortable) (p = 0.009).

CONCLUSIONS

The majority of respondents were willing to provide RHT in their community settings. However, our data indicate that dentists would need additional training in HIV medicine, test administration and giving reactive results.

Prevalence of oral lesions in hospitalized patients with infectious diseases in northern Brazil

The aim of this study was to assess the prevalence of oral lesions in infectious-contagious diseases patients being treated in the University Hospital of the Federal University of Pará, northern Brazil. One hundred seven patients with infectious diseases were clinically investigated for oral lesions at the University Hospital of Pará, northern Brazil. From total sample, most patients were men (65.7%) with a mean age of 45.4 years. About prevalence of systemic diseases, tuberculosis was the most frequent illness, followed by AIDS, hepatitis types B and C, leishmaniasis, and meningitis. Analyzing oral manifestations, periodontal diseases and candidiasis were the most prevalent diseases in both genders, followed by recurrent aphthous ulcers, saburral tongue, simplex herpes, and squamous cell carcinoma. Of all 107 patients, only 10 males and 6 females did not present any oral manifestation. There was no statistical difference between genders with any systemic condition (P>0.05). The great prevalence of oral manifestations in hospitalized patients with systemic disorder emphasizes the need of integral dental care in this context, aiming at a multidisciplinary approach of patients. Therefore, presence of some oral conditions, such as candidiasis, should be an alert to different systemic conditions, once in assistance with physicians; dentists can influence the early diagnosis and treatment.