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Ranganathan K, Umadevi KMR. Common oral opportunistic infections in Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome: Changing epidemiology; diagnostic criteria and methods; management protocols. Periodontol 2000 2019; 80:177-188. [PMID: 31090147 DOI: 10.1111/prd.12274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There were 36.9 million in the world living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) as of 2017, and new infections have seen a reduction by 18% since 2010. But this rate of decline is not sufficient for the goal of eradication of AIDS by 2030. Only 21.7 million people infected with HIV have accesses to antiretroviral therapy, with the rest at risk of the potential complications of HIV infection. It has been shown that oral lesions are diagnostic and prognostic of HIV infection, and many oral opportunistic infections continue to be a major problem, particularly in developing countries. It is therefore important that dental surgeons be aware and updated to recognize and manage the oral effects of HIV infection/AIDS. This chapter describes the classification, diagnosis, and management of oral lesions in these patients, based on our current understanding of the infection. This review also discusses the standardization of diagnosis of oral lesions in HIV infection/AIDS patients, immune reconstitution inflammatory syndrome case definition, and the research priorities formulated at the 7th World Workshop on Oral Health and Disease in AIDS.
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Affiliation(s)
- Kannan Ranganathan
- Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Chennai, India
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2
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Odgers HL, Tong A, Lopez-Vargas P, Davidson A, Jaffe A, McKenzie A, Pinkerton R, Wake M, Richmond P, Crowe S, Caldwell PHY, Hill S, Couper J, Haddad S, Kassai B, Craig JC. Research priority setting in childhood chronic disease: a systematic review. Arch Dis Child 2018; 103:942-951. [PMID: 29643102 DOI: 10.1136/archdischild-2017-314631] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals. DESIGN We conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholder priorities for paediatric chronic disease research were eligible for inclusion. Data on the prioritisation process were extracted using an appraisal checklist. Generated priorities were collated into common topic areas. RESULTS We identified 83 studies (n=15 722). Twenty (24%) studies involved parents/caregivers and four (5%) children. The top three health areas were cancer (11%), neurology (8%) and endocrine/metabolism (8%). Priority topic areas were treatment (78%), disease trajectory (48%), quality of life/psychosocial impact (48%), disease onset/prevention (43%), knowledge/self-management (33%), prevalence (30%), diagnostic methods (28%), access to healthcare (25%) and transition to adulthood (12%). The methods included workshops, Delphi techniques, surveys and focus groups/interviews. Specific methods for collecting and prioritising research topics were described in only 60% of studies. Most reviewed studies were conducted in high-income nations. CONCLUSIONS Research priority setting activities in paediatric chronic disease cover many discipline areas and have elicited a broad range of topics. However, child/caregiver involvement is uncommon, and the methods often lack clarity. A systematic and explicit process that involves patients and families in partnership may help to inform a more patient and family-relevant research agenda in paediatric chronic disease.
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Affiliation(s)
- Harrison Lindsay Odgers
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Pamela Lopez-Vargas
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kid's Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrew Davidson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, France.,Department of Anaesthesiology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, The Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Discipline of Paediatrics, The University of New South Wales, Sydney, New South Wales, Australia
| | - Anne McKenzie
- Western Australian Health Translation Network, The University of Western Australia, Perth, Western Australia, Australia
| | - Ross Pinkerton
- Department of Oncology, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Melissa Wake
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, France.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Peter Richmond
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Departments of General Paediatrics and Immunology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | | | - Patrina Ha Yuen Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Nephrology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sophie Hill
- Center for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
| | - Jennifer Couper
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzy Haddad
- Patient and Carer Representative, Sydney, New South Wales, Australia
| | - Behrouz Kassai
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Centre d'Investigation Clinique de Lyon, Lyon, France
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Nittayananta W, Weinberg A, Malamud D, Moyes D, Webster-Cyriaque J, Ghosh S. Innate immunity in HIV-1 infection: epithelial and non-specific host factors of mucosal immunity- a workshop report. Oral Dis 2017; 22 Suppl 1:171-80. [PMID: 27109285 DOI: 10.1111/odi.12451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The interplay between HIV-1 and epithelial cells represents a critical aspect in mucosal HIV-1 transmission. Epithelial cells lining the oral cavity cover subepithelial tissues, which contain virus-susceptible host cells including CD4(+) T lymphocytes, monocytes/macrophages, and dendritic cells. Oral epithelia are among the sites of first exposure to both cell-free and cell-associated virus HIV-1 through breast-feeding and oral-genital contact. However, oral mucosa is considered to be naturally resistant to HIV-1 transmission. Oral epithelial cells have been shown to play a crucial role in innate host defense. Nevertheless, it is not clear to what degree these local innate immune factors contribute to HIV-1 resistance of the oral mucosa. This review paper addressed the following issues that were discussed at the 7th World Workshop on Oral Health and Disease in AIDS held in Hyderabad, India, during November 6-9, 2014: (i) What is the fate of HIV-1 after interactions with oral epithelial cells?; (ii) What are the keratinocyte and other anti-HIV effector oral factors, and how do they contribute to mucosal protection?; (iii) How can HIV-1 interactions with oral epithelium affect activation and populations of local immune cells?; (iv) How can HIV-1 interactions alter functions of oral epithelial cells?
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Affiliation(s)
- W Nittayananta
- Excellent Research Laboratory, Phytomedicine and Pharmaceutical Biotechnology Excellence Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand.,Natural Products Research Center of Excellence, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - A Weinberg
- Department of Biological Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - D Malamud
- Department of Basic Science, NYU College of Dentistry, New York, NY, USA
| | - D Moyes
- Mucosal and Salivary Biology Division, King's College Dental Institute, King's College, London, UK
| | - J Webster-Cyriaque
- University of North Carolina Chapel Hill Schools of Dentistry and Medicine, Chapel Hill, NC, USA
| | - S Ghosh
- Department of Biological Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
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4
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Dimba E, Yengopal V, Joshua E, Thavarajah R, Balasundaram S. Access and management of HIV-related diseases in resource-constrained settings: a workshop report. Oral Dis 2017; 22 Suppl 1:206-10. [PMID: 27109288 DOI: 10.1111/odi.12424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With advancement of medical interventions, the lifespan of people living with HIV has increased globally. However, low- and middle-income countries (LMICs) which bear the greatest burden of the HIV pandemic face a constant challenge in addressing the treatment needs of immune-suppressed patients. An analysis of the current management protocols and access to medication in resource-poor settings was conducted at this workshop, with emphasis on the situation in resource-poor settings. The participants developed a consensus document based on the need to respond to the constantly changing HIV pandemic. Provision of oral health care must be guided by interconnecting principles based on population based strategies that address upstream determinants of health. Basic oral health coverage in developing countries can only be realized with a strong foundation at the primary health level. Early diagnosis of HIV-related comorbidities including the adverse effects of ARVs is essential for the improvement of treatment outcomes. Standardization of oral health care delivery mechanisms will facilitate evaluation at national and regional levels. Oral health care workers have a moral obligation to participate in sustained campaigns to reduce the social stigma associated with HIV/AIDS in their work places at every stage of the referral chain. Future research also needs to realign itself towards prevention using the common risk factor approach, which has a broader impact on non-communicable diseases, which are increasingly affecting patients with HIV/AIDS as their life expectancies increase.
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Affiliation(s)
- Eao Dimba
- School of Dental Sciences, University of Nairobi, Nairobi, Kenya
| | - V Yengopal
- Division of Public Oral Health, University of the Witwatersrand, Johannesburg, South Africa
| | - E Joshua
- Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - R Thavarajah
- Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S Balasundaram
- Departments of Oral Pathology, Chennai Dental Research Foundation, Chennai, Tamil Nadu, India
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5
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Mothi SN, Lala MM, Tappuni AR. HIV/AIDS in women and children in India. Oral Dis 2017; 22 Suppl 1:19-24. [PMID: 27109269 DOI: 10.1111/odi.12450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/20/2016] [Accepted: 01/24/2016] [Indexed: 12/18/2022]
Abstract
Management of HIV in India has significantly improved with many international and local programmes supporting prevention and treatment. However, there are areas in India where women and children living with HIV endure a myriad of medical, psychological and social challenges. Women in rural poor areas in India have little control over important aspects of their life. Often, they have little decision-making powers within their families on matters that affect them personally. They find themselves unable to negotiate to protect themselves from harm or risk of infection. Those who are known to have contracted HIV are reluctant to access health care for fear of discrimination and marginalization, leading to a disproportionate death rate in HIV women. India is arguably home to the largest number of orphans of the HIV epidemic. These children face an impenetrable barrier in many Indian societies and endure stigmatization. This situation encourages concealment of the disease and discourages children and their guardians from accessing available essential services. This article provides an overview of the relevant literature and presents an insight into a complex mix of issues that arise directly out of the HIV diagnosis, including the role of social attitudes in the spread of HIV, and in creating barriers to accessing care. The review identifies international programmes and local initiatives that have ensured better access to antiretroviral therapy and have led to prolonged survival and reduction in the vertical transmission of HIV in India.
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Affiliation(s)
| | - M M Lala
- LTMMC & LTMGH, Wadia Group of Hospitals, CCDT, Mumbai, India
| | - A R Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
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6
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Vernon LT, Jayashantha P, Chidzonga MM, Komesu MC, Nair RG, Johnson NW. Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report. Oral Dis 2016; 22 Suppl 1:135-48. [PMID: 27109282 PMCID: PMC5986297 DOI: 10.1111/odi.12412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 12/23/2022]
Abstract
In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.
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Affiliation(s)
- L T Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Plp Jayashantha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia and Dental Hospital, and Sri Lanka Air Force Station Colombo, Sri Lanka, Australia
| | - M M Chidzonga
- College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - M C Komesu
- Department of Morphology, Stomatology Physiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - R G Nair
- Oral Medicine, School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia and Cancer Services, Gold Coast University Hospital, Queensland Health, Qld, Autralia, Australia
| | - N W Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
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7
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Speicher DJ, Ramirez-Amador V, Dittmer DP, Webster-Cyriaque J, Goodman MT, Moscicki AB. Viral infections associated with oral cancers and diseases in the context of HIV: a workshop report. Oral Dis 2016; 22 Suppl 1:181-92. [PMID: 27109286 PMCID: PMC5590239 DOI: 10.1111/odi.12418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/25/2015] [Accepted: 12/09/2015] [Indexed: 12/11/2022]
Abstract
Human herpesviruses (HHVs) and human papillomavirus (HPV) are common in the general population and, in immunocompetent people, are mostly carried asymptomatically. However, once an individual becomes immunocompromised by age, illness or HIV infection these dormant viruses can manifest and produce disease. In HIV-positive patients, there is an increased risk of disease caused by HHVs and HPV infections and cancers caused by the oncoviruses Epstein-Barr Virus, HHV-8 and HPV. This workshop examined four questions regarding the viruses associated with oral cancers and disease in the HIV-positive and -negative populations, the immune response, and biomarkers useful for accurate diagnostics of these infections and their sequalae. Each presenter identified a number of key areas where further research is required.
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Affiliation(s)
- D J Speicher
- Molecular Basis of Disease Research Program, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - V Ramirez-Amador
- Health Care Department, Universidad Autónoma Metropolitana-Xochimilco, México City, Mexico
| | - D P Dittmer
- Department of Microbiology and Immunology School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J Webster-Cyriaque
- Department of Microbiology and Immunology School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - M T Goodman
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - A-B Moscicki
- David Geffen, School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
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8
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Arrive E, Meless D, Anaya-Saavedra G, Gallottini M, Pinzon LM, Ramirez-Amador V. The global burden of oral diseases in pediatric HIV-infected populations: a workshop report. Oral Dis 2016; 22 Suppl 1:149-57. [PMID: 26882532 DOI: 10.1111/odi.12417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/22/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To achieve a comprehensive understanding about the global burden of oral diseases in HIV-infected children and to identify research needs. MATERIALS AND METHODS A literature search was conducted in PubMed (2009-2014) to address five questions: (i) prevalence of oral diseases in HIV-infected compared with uninfected children, (ii) impact of oral diseases on quality of life, (iii) effect of antiretroviral exposure in utero on craniofacial and dental development, (iv) important co-infections and antiretroviral complications, and (v) value of atraumatic restorative treatment. RESULTS Studies showed a high prevalence of dental caries in HIV-infected children but the relationship between HIV infection and dental caries remains unclear. Also quality of life needs further investigation supported by better study designs and improvement of the instruments used. Up-to-date evidence suggested long-term harms associated with in utero antiretroviral exposure were minor but would require long-term follow-up through National Registries. The reviews also revealed the wide spectrum of metabolic disease due to antiretroviral therapy and co-infections such as tuberculosis. Finally, atraumatic restorative technique appears to be a simple and safe technique to treat dental caries but outcomes need further evaluation. CONCLUSIONS The impact of antiretroviral therapy in HIV-infected children has raised novel challenging questions in the field of oral health warranting future research.
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Affiliation(s)
- E Arrive
- UFR d'Odontologie, University of Bordeaux, Bordeaux, France.,Equipe VIH et Santé Globale, INSERM U897, Bordeaux, France
| | - D Meless
- UFR d'Odontostomatologie, Félix Houphouët Boigny University of Abidjan, Abidjan, Côte d'Ivoire
| | - G Anaya-Saavedra
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, México City, Mexico
| | - M Gallottini
- Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - L M Pinzon
- School of Dentistry, University of California, San Francisco, CA, USA.,School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - V Ramirez-Amador
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, México City, Mexico
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Reznik DA, Croser D, Kadrianto TH, Lavanya R. Ethics, research and HIV: lessons learned- a workshop report. Oral Dis 2016; 22 Suppl 1:193-8. [PMID: 26864354 DOI: 10.1111/odi.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Assessing risk for transmission of a blood-borne pathogen requires the use of the hazard and risk model. Infection control is a system that uses a number of individual processes to eliminate or reduce the probability of a hazard occurring. Strategies employed to reduce risk should be rehearsed, used routinely, audited, reviewed, and the results shared. Continuing dental education has improved dental healthcare worker willingness to treat people living with HIV/AIDS (PLWHA) and has decreased negative attitudes and staff fears. Providing care for PLWHA during undergraduate dental school or dental hygiene programme is also associated with a greater willingness to treat. Whether by identifying suspect oral lesions or offering rapid screening tests in the dental setting for HIV, the dental team can play an important role in linkage to confirmatory diagnosis and care with the goal of reducing to zero the number of undiagnosed cases.
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Affiliation(s)
- D A Reznik
- Grady Health System, Atlanta, GA, USA.,Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - D Croser
- Dental Protection (part of MPS Ltd), London, UK
| | - T H Kadrianto
- Oral Medicine Residency Program, Faculty of Dentistry Universitas Indonesia, Jakarta, Indonesia
| | - R Lavanya
- Department Oral Medicine & Radiology, Panineeya Mahavidyalaya Institute of Dental Science & Research Centre, Hyderabad, India
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