Human Immunodeficiency Virus (HIV) Transmission in Dentistry

The Effectiveness of Pre-Operative Screening Tests in Determining Viral Infections in Patients Undergoing Oral and Maxillofacial Surgery

We analyzed the rate of patients with hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection diagnosed by pre-operative screening and estimated its cost. We retrospectively analyzed patients who underwent elective surgery at our maxillofacial surgery department between April 2014 and March 2022. We compared the number of patients with each infection identified by pre-operative screening and a pre-operative questionnaire. We also compared the prevalence of infections with varying age, sex, and oral diseases, and calculated the cost of screening per positive result. The prevalence of HBV, HCV, and HIV was 0.39% (62/15,842), 0.76% (153/15,839), and 0.07% (10/12,745), respectively. The self-reported rates were as follows: HBV, 63.4% (26/41); HCV, 50.4% (62/123); HIV, 87.5% (7/8). Differences in sex were statistically significant for all infectious diseases; age significantly affected HBV and HCV rates. There was no association between the odds ratio of oral disease and viral infections. The cost per positive result was $1873.8, $905.8, and $11,895.3 for HBV, HCV, and HIV, respectively. Although self-assessment using questionnaires is partially effective, it has inadequate screening accuracy. Formulating an auxiliary diagnosis of infectious diseases with oral diseases was challenging. The cost determined was useful for hepatitis, but not HIV.

Assessment of occupational hazards among dentists practicing in Mumbai

Aim:

To assess the awareness of various occupational hazards experienced and the preventive measures undertaken by the dentists in and around Mumbai.

Methods:

The present study was conducted using self-administered questionnaire, which was circulated to 200 dentists practicing in and around Mumbai. The questionnaire also included questions on personal information like age, gender, position (student or faculty), years of experience, and number of working hours per day. Those who completed the questionnaire form completely and willing to participate were only included in the study. The results were analyzed using SPSS version 22.0.

Results:

23.5% of the participants had the dental working experience more than 10 years and 28.5% dentists worked for ≥8 h. 69% were general practitioners and 40% of the participants treat nearly 10 to 20 patients per day. 45% of them experienced needle stick injury in clinical practice. 1.5% of dentists in our study admitted receiving some litigation from their patients.

Conclusion:

The present study indicated that occupational hazards, awareness about biological hazards, and preventive measures observed by dentists in Mumbai are generally consistent with published guidelines for infection control and also in accordance with the previous research. The majority of the dental practitioners were suffering from pain in the muscles of neck or back. Regular training and workshops can help lower such problems.

Knowledge, attitude and compliance of infection control guidelines among dental faculty members and students in KSU

Background

Infection is one of the most crucial problems in health care services worldwide. It is considered one of the most important causes of morbidity and mortality associated with clinical, diagnostic and therapeutic procedures. Therefore, the purpose of this study was to investigate knowledge, attitude, and compliance with recommended infection control guidelines among dental faculty members and students at King Saud University, Riyadh, Kingdom of Saudi Arabia.

Methods

A cross-sectional study was conducted to obtain information regarding knowledge, attitude, and compliance with recommended infection control guidelines. The sample (n = 317) comprised of dental faculty members and students (3rd, 4th and 5th year) in both male and female campuses of College of Dentistry (KSU).

This questionnaire contained three parts (knowledge, attitude, and compliance) and was distributed to the participants. After validation of the survey, data were collected, entered and analyzed by SPSS software.

Results

A total of 317 dental faculty members and students participated in this study. Out of the total study subjects, 141 (44.5%) were female and 176 (55.5%) were male. A comparison between dental faculty members and students was made based on their knowledge, attitude, and compliance, which resulted in almost equal percentages of knowledge (49.6, 49.0% respectively). In addition, it revealed that faculty members’ attitude toward infection control in the dental clinic was more positive compared to their compliance with the infection control guidelines (70.6, 65.2% respectively) while with the students it was vice versa (67.2, 69.6% respectively).

There is no statistically significant difference in the knowledge and attitude of dental faculty members and students regarding infection control guidelines (P > 0.05).

Conclusion

Our study showed that dental undergraduate student and faculty members at KSU demonstrated a good adherence to infection control guidelines. On the other hand, there was a lack in the knowledge of the basics of infection control standards.

Chinese dental students' knowledge and attitudes toward HIV/AIDS

Background/purpose

Oral care is vital to human immunodeficiency virus (HIV)-positive individuals. As future dentists, it is pertinent that dental students have sufficient knowledge and a positive approach toward this disease. The purpose of this study was to assess HIV/AIDS-related knowledge and attitudes among clinical dental students in central China.

Materials and methods

This survey was conducted on 103 dental students in the final year of a 5-year program. A structured questionnaire with 50 questions examining their knowledge under various categories and 17 questions examining their attitudes toward the disease was employed.

Results

The survey was completed by 92.2% (95/103) of the students. The results revealed that more than half of the respondents demonstrated a good level of knowledge, although few exhibited an excellent level. The mean scores on knowledge was 79.41 ± 6.3 out of a maximum possible score of 100, and there was no significant difference regarding sex. Despite their good level of knowledge, the majority (93.68%) displayed a negative attitude (nonprofessional attitude) toward HIV/AIDS.

Conclusion

These findings might help to define strategies to improve the quality of education among Chinese dental students and suggests that there is a need to address student misconceptions and attitudes toward the disease.

HIV/AIDS: dental assistants' self-reported knowledge and attitudes in Kuwait

Although several studies have been conducted to assess dentists' knowledge of and attitudes towards human immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS), few have targeted dental assistants. The main aims of this study were to assess the knowledge of and attitudes towards HIV/AIDS among dental assistants in Kuwait and to compare the knowledge and attitudes of dental assistants at Kuwait University Dental Center (KUDC) with those of dental assistants in Ministry of Health (MoH) hospitals. The secondary objective was to determine if any intervention was needed to provide more information to dental assistants on HIV/AIDS. A cross-sectional study was conducted by distributing questionnaires. The study sample included 85 dental assistants from each of KUDC and the MoH. The questionnaire included questions to assess the assistants' knowledge and attitude towards HIV/AIDS. Statistical data analysis was conducted using SPSS 20.0. Qualitative data were analysed using the Pearson chi-square text for any association or the Z-test for proportion to test the significance of differences. A total of 167 questionnaires were completed, returned and analysed. KUDC dental assistants were found to have significantly more knowledge about HIV/AIDS than their MoH counterparts, whereas the assistants at the MoH clinics displayed a more positive attitude towards patients with HIV/AIDS (P < 0.05). Although dental assistants at KUDC were more knowledgeable than those at the MoH clinics, there are still some misconceptions that need to be addressed, in addition to the negative attitudes displayed by some of the respondents. It would therefore be beneficial to increase awareness about HIV/AIDS patients through lectures, seminars and workshops targeting dental assistants.

Factors related to the willingness of Palestinian dentists to treat patients with blood-borne diseases

This study aimed to explore, using groups of simulated patients, the willingness of Palestinian dentists to treat patients with blood-borne diseases. Simulated patients conducted a telephone survey of a random sample of dentists registered with the Palestinian Dental Association. A random system was used to assign dentists to one of two groups, in which simulated patients randomly identified themselves with either human immunodeficiency virus (HIV) or hepatitis B virus (HBV) and asked for a dental appointment. Three-hundred and four dentists (76%) responded to our telephone survey. Sixty-six per cent accepted requests for appointments and 34% declined the appointment requests. Sixty-eight per cent of the dentists declined appointment requests from patients with HIV and 32% declined appointments from patients with HBV. Dentist's gender, 'blood-borne disease type', 'place of private practice', 'country of graduation' and 'years since graduation' were all significant predictors in the final logistic model. More than one-third of our respondents declined appointment requests from patients with blood-borne disease, two-thirds of which were for patients who identified themselves as having HIV. Education and training programmes are needed to improve attitudes of dentists - especially female dentists, older dentists and dentists practising in northern governorates - towards patients with blood-borne diseases.

Dental practice, human immunodeficiency virus transmission and occupational risks: views from a teaching hospital in Nigeria

Background:

More than 40 oral manifestations of human immunodeficiency virus (HIV) infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at some time during the course of their disease. Oral health-care workers (OHCWs) are therefore, key players in the prevention and management of HIV-infection.

Aim:

The aim of this study was toassess the perceptions of the OHCWs from a Teaching Hospital in Nigeria toward HIV transmission in dental practice and occupational risk.

Subjects and Methods:

A cross-sectional study. A self-administered questionnaire was used for data collection. A total of 113 OHCWs comprising students, house officers, resident doctors, dental nurses and consultants participated. Analysis was by Statistical Package for the Social Sciences version 17 (SPSS Inc., Chicago, IL, USA). Data analysis included descriptive statistics (frequency distribution and cross tabulation).

Results:

More than half 64/113 (56%) of the respondents were in the age group 20-30 years and females 68/113 (60%). Though 88% (100/113) of the respondents demonstrated a good knowledge about HIV transmission, 82/113 respondents (72%) disagreed that the risk of HIV transmission in the dental clinic was very low. 82.4% (93/113) did not know that saliva contains anti-HIV activity while 46% (52/113) agreed that pure saliva does not contain the virus except when contaminated by blood. 86.7% (98/113) of the OHCWs disagreed that dental professionals have a lower risk of being infected with HIV compared with other health-care providers.

Conclusion:

The OHCWs studied manifested some inaccurate perception of occupational risks as regards HIV transmission in dental practice. This could lead to potential stigma and discrimination of people living with HIV/acquired immune deficiency syndrome and thus hindering efforts geared at curtailing the spread of the virus.

Knowledge of and attitudes towards HIV/AIDS: a survey among dental students in Ajman, UAE

AIM

Encounters between dentists and patients with HIV/AIDS are bound to rise due to increased prevalence and emerging new treatments. This study assessed dental students' knowledge about transmission and oral manifestations of HIV/AIDS, and their attitudes towards patients regarding obligations to treat.

METHODS

Out of 109 students in 4 years of a 6-year dental undergraduate program, 106 responded to a questionnaire on knowledge of and attitudes towards HIV/AIDS. Knowledge and attitude scores were analyzed with Kruskal-Wallis one-way anova and the gender differences with the Wilcoxon signed-rank test.

RESULTS

The median score for students' overall knowledge was 39.5 (67%; maximum possible 59). The median knowledge scores for males and females were 38 and 40 respectively, although the difference was not statistically significant. The knowledge levels in Year 4 (42.5 ± 4.7), Year 3 (44 ± 6.5), and Year 2 (42 ± 5.8), were similar but significantly higher than in Year 1 (33 ± 7.9; P < 0.01). The median attitude score was 14 out of 24, with no significant differences within genders and years of study. Although the level of knowledge of the senior students was higher than that of the first years, the negative attitudes remained largely unchanged.

CONCLUSIONS

Appropriate educational programs may alter the misconceptions and the negative attitudes.

Management of an incident of failed sterilization of surgical instruments in a dental clinic in Hong Kong

BACKGROUND/PURPOSE

We describe an investigation of an incident of failed sterilization procedure in a dental clinic. We aim to illustrate the principles in performing such investigations and to highlight some of the important checkpoints in sterilization procedures.

METHODS

In response to this incident, proper sterilization of all equipment was performed immediately. On-site investigation was conducted by the investigation panel to identify the cause and risks, to coordinate post-exposure management in affected patients, and to make recommendations to prevent similar occurrence of such incidents in the future.

RESULTS

The incident was due to a rare lapse of monitoring during the autoclaving cycle. A total of 127 sources and 250 exposed patients were identified within 24 hours of the discovery of the incident for risk assessment and testing for blood-borne viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). A protocol was devised to manage the exposed patients against HBV, HCV, and HIV. Immunization and hyperimmune globulin for hepatitis B, and tetanus toxoids were given to the exposed patients where indicated. Exposed patients were followed-up for 6 months. We came to the decision that dating of instrument packages and signed documentation of each autoclave printout, color change of chemical indicators of each load and daily autoclave performance should be made mandatory with immediate effect.

CONCLUSION

Rapid response is extremely crucial in minimizing the impact of this incident and relieving the anxiety of the affected patients. Proper recording and documentation of autoclave cycles and regular auditing should be enforced to prevent similar incidents.

Association between matrix metalloproteinase (MMP)-2, MMP-9 and total antioxidant status of patients with asymptomatic hepatitis C virus infection

The aim of this study is to predict potential hepatocellular damage by determining total antioxidant status (TAS) and matrix metalloproteinases (MMPs) 2 and 9 levels of different groups of dental surgery patients who are asymptomatic (normal alanine aminotransferase, aspartate aminotransferase records). Patients were divided into five groups according to the anamnesis [to be diagnosed formerly as hepatitis C virus (HCV) infection or not], microbiological (positive-anti-HCV antibodies and HCV RNA-positive or negative) and biochemical test results. Except for the control group, serum anti-HCV antibody levels and line immunoassay tests were found positive in all groups. HCV RNAs were found positive only in group 3 whom were formerly diagnosed with HCV infection, not under medical treatment and in group 5 under medical treatment (<2 × 10(5) IU ml(-1)). Statistical analyses were performed using one-way multifactorial anova (manova) at the statistical significance level of 5% and were confirmed that the changes in biochemical markers had significant effects on subjects who had been in different groups. Following multiple comparisons, significant groups' differences were obtained in all biochemical markers. In conclusion, to determine not only TAS levels but also the MMPs and evaluate those together may be noninvasive biomarkers for predicting the inflammation in liver and approaching the prognosis of HCV infection.

The HIV positive dentist in the United Kingdom - the dilemma of the undiagnosed clinician

This article considers the position of the HIV positive dentist in the United Kingdom who is unaware of their HIV status, or who at least has had no positive HIV test result. It outlines the current UK guidance that relates to HIV positive dentists, and the challenges to those guidelines. It considers how the behaviour of a practising seropositive dentist who has had no positive test result might be interpreted by regulatory bodies and the courts, and highlights the importance of clinicians being fully aware of their HIV status.

Genomic detection of human immunodeficiency virus (HIV) by nucleic acid amplification test in a frequent platelet donor during the pre-seroconversion period

Since serological donor-screening tests for HIV were introduced in 1985, the safety of donated blood components has improved dramatically. However, these tests do not completely prevent the risk of transfusion-associated HIV infection related to the use of blood donated during the pre-seroconversion window period. Testing based on nucleic acid amplification is being implemented to screen for HIV-infected blood donated during this period, which has reduced the probability of transmitting HIV through transfusion by shortening the window period. This article describes a case of acute HIV-1 infection, detected using a nucleic acid amplification test (NAT) in a repeat blood donor who donated during the pre-seroconversion window period and whose antigen and anti-HIV antibody expression was observed after molecular marker detection. In addition, the possible route of infection is discussed based on the patient's history, and finally, the need for NAT technology for blood donor screening is emphasized.

Oral lesions, HIV phenotypes, and management of HIV-related disease: Workshop 4A

The workshop considered 5 questions related to oral lesions, HIV phenotypes, and the management of HIV-related disease, with a focus on evidence and challenges in resource-poor settings. First, are oral lesions unique with respect to geographic location or phenotype? Second, how useful would an oral lesion index be to predict HIV in resource-poor countries with no access to CD4 counts or viral load? Third, what are the latest methods and delivery modes for drugs used to treat oral lesions associated with HIV? Fourth, what is the role of the oral health care worker in rapid diagnostic testing for HIV? Fifth, what ethical and legal issues are to be considered when managing the HIV patient? The consensus of the workshop was the need for additional research in 4 key areas in developing countries: (1) additional investigation of comorbidities associated with HIV infection that may affect oral lesion presentation and distribution, especially in pediatric populations; (2) the development of region-specific algorithms involving HIV oral lesions, indicating cumulative risk of immune suppression and the presence of HIV disease; (3) well-designed clinical trials to test new therapies for oral lesions, new treatments for resistant oral fungal and viral diseases, effectiveness of therapies in children, and new drug delivery systems; and (4) the role of the oral health care worker in rapid diagnostic testing for HIV in various regions of the world.

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.

HIV transmission in the dental setting and the HIV-infected oral health care professional: workshop 1C

This workshop addressed two important issues: first, the global evidence of HIV transmission from health care provider to patient and from patient to health care provider in the general health care environment and the dental practice setting; second, in the era of highly active antiretroviral therapy, whether oral health care professionals living with HIV pose a risk of transmission to their patients and whether standard infection control is adequate to protect both the patient and the oral health care professional in dental practice. The workshop culminated in a general discussion and the formulation of a consensus statement from the participating delegates, representing more than 30 countries, on the criteria under which an HIV-infected oral health care professional might practice dentistry without putting patients at risk. This consensus statement, the Beijing Declaration, was agreed nem con.

Confidentiality of the medical records of HIV-positive patients in the United Kingdom - a medicolegal and ethical perspective

This article examines the legal and ethical issues that surround the confidentiality of medical records, particularly in relation to patients who are HIV positive. It records some historical background of the HIV epidemic, and considers the relative risks of transmission of HIV from individual to individual. It explains the law as it pertains to confidentiality, and reports the professional guidance in these matters. It then considers how these relate to HIV-positive individuals in particular.

The HIV positive dentist in the United Kingdom--a legal perspective

In 1991, the United Kingdom Advisory Panel (UKAP) was set up under the aegis of the Expert Advisory Group on AIDS (EAGA) to consider individual cases of HIV infected healthcare workers. Policy and guidance relating to HIV infected healthcare workers is set out in a Department of Health report. Although more recently the EAGA has advised that an HIV positive dentist may under certain conditions provide clinical treatment for patients who are also HIV positive, the advice from UKAP relating to exposure-prone procedures means, in effect, that dentists who become HIV positive must cease contemporary clinical dentistry. The plight of dentists who become HIV positive and face this situation has been poignantly described as '...the dental practice equivalent of clearing your desk and being escorted off the premises.'

Oral complications of HIV disease

Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.

Written off

David Croser considers the appalling situation faced by UK dentists if they are diagnosed HIV positive.