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Doughty J, Tran C, Santella AJ, Fitzgerald R, Burns F, Porter S, Watt RG. Point of care HIV testing in dental settings in high-income countries: A mixed-methods systematic review. Community Dent Oral Epidemiol 2024. [PMID: 38822596 DOI: 10.1111/cdoe.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES Expanding HIV testing beyond specialized services has been a key strategic approach to eliminating the transmission of HIV. In recent years, dental settings have been identified as offering an opportunity for delivering point of care HIV testing (POCT) interventions. Intervention components and implementation strategies have varied across studies and there is uncertainty about the prevalence of undiagnosed HIV in the dental patient population. Therefore, this systematic review aimed to synthesize the HIV testing outcomes of intervention studies, identify the core components of POCT interventions implemented in dental settings; and understand the barriers and facilitators to intervention implementation. METHODS A mixed-methods systematic review was undertaken. Two authors reviewed abstracts and full papers for inclusion and appraised the studies using the Mixed Methods Appraisal Tool. A convergent integrated mixed methods study design underpinned the synthesis. Outcomes were presented using descriptive statistics. Intervention components were mapped to the Template for Intervention Description and Replication (TIDieR) checklist. Barriers and facilitators were described using a narrative thematic analysis. RESULTS POCT was offered to 22 146 dental patients, 62.5% accepted POCT. Intervention studies that reported higher uptake of testing utilized a dedicated dental or researcher staff member to provide testing, integrated testing and provided results within the routine dental appointment and adopted a provider-initiated universal approach to offering testing. Six themes emerged that were pertinent to the barriers and facilitators to HIV testing in dental setting. CONCLUSIONS POCT uptake in dental settings was comparable with other non-specialized health settings. Key to the operationalization of the intervention were perceptions about its value and relevance to the dental patient population, attitudes toward the intervention, logistical barriers to its implementation, the risk of HIV testing stigma to the patient-practitioner relationship and maximising the fit of the intervention within the constraints of the dental setting.
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Affiliation(s)
- J Doughty
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
- School of Dentistry, University of Liverpool
| | - C Tran
- Oral and Maxillofacial Surgery department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A J Santella
- Marion Peckham Egan School of Nursing & Health Studies, Fairfield University, Fairfield, Connecticut, USA
| | - R Fitzgerald
- Department of Special Care Dentistry, Surrey and Sussex Healthcare Trust
| | - F Burns
- Institute for Global Health, University College London, London, UK
| | - Stephen Porter
- Eastman Dental Institute, Faculty of Medical Sciences, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
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Parish CL, Feaster DJ, Pollack HA, Horigian VE, Wang X, Jacobs P, Pereyra MR, Drymon C, Allen E, Gooden LK, Del Rio C, Metsch LR. Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey. JMIR Res Protoc 2023; 12:e47548. [PMID: 37751236 PMCID: PMC10565625 DOI: 10.2196/47548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. OBJECTIVE To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. METHODS Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. RESULTS Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. CONCLUSIONS Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47548.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Daniel J Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Xiaoming Wang
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Petra Jacobs
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | | | - Elizabeth Allen
- National Opinion Research Center, Chicago, IL, United States
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- School of General Studies, Columbia University, New York, NY, United States
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Weatherspoon DJ, Dye BA. Firmly establishing oral health care professionals' roles as vaccinators within the health care system. J Am Dent Assoc 2022; 153:925-928. [PMID: 35985882 PMCID: PMC9385764 DOI: 10.1016/j.adaj.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022]
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Parish CL, Pereyra MR, Yanez IG, Vidot DC, Metsch LR. Patient acceptance of HIV rapid testing in the dental care setting. AIDS Care 2022; 35:745-752. [PMID: 35603879 DOI: 10.1080/09540121.2022.2073326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dental settings are untapped venues to identify patients with undiagnosed HIV who may otherwise lack testing opportunities. Perceived lack of patient acceptance has been a significant barrier limiting dentists' willingness to offer HIV testing. This study implemented rapid HIV testing in dental settings located in an HIV prevalent region to evaluate patient acceptance. Two South Florida community health centers implemented routine oral rapid HIV testing as part of clinical practice, followed by exit interviews with patients immediately after to determine patient acceptance. The binary primary outcome was patient's acceptance of the rapid HIV test. Multivariable logistic regression assessed associations between patient characteristics and acceptance. Overall acceptance by dental patients (N = 600) was 84.5%. Patients who were more likely to participate in other medical screenings in dental settings were more than twice as likely to accept the test compared to those who were neutral/less likely (OR: 2.373; 95% CI: 1.406-4.004). Study findings highlight the high patient acceptance of HIV testing in dental settings. Widespread implementation of such testing will require an expanded societal view of the traditional role of the dentist that will embrace the potentially valuable role of dentistry in preventive health screenings and population health.
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Affiliation(s)
- Carrigan L. Parish
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | | | - Iveth G. Yanez
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Denise C. Vidot
- School of Nursing and Health Sciences, University of Miami, Miami, FL, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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The role of stigma in U.S. primary care physicians' treatment of opioid use disorder. Drug Alcohol Depend 2021; 221:108627. [PMID: 33621805 PMCID: PMC8026666 DOI: 10.1016/j.drugalcdep.2021.108627] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To characterize primary care physicians' (PCPs) attitudes and beliefs about people with opioid use disorder (OUD) and to understand the association between PCPs' stigmatizing attitudes and their OUD treatment practices, beliefs about treatment effectiveness, and support for policies designed to improve access to OUD medications. METHODS We conducted a national postal survey of U.S. PCPs from January to August 2019. Survey items measured respondents' attitudes, beliefs, and current treatment practices. Data were analyzed using descriptive statistics and logistic regression. RESULTS Of the original 1000 PCPs in the survey sample, 668 were deemed eligible to participate in the study. The survey was completed by 361 PCPs for an adjusted response rate of 54 %. PCPs reported high levels of stigmatizing attitudes. Less than 30 % of PCPs reported that they were willing to have a person taking medication for OUD as a neighbor or marry into their family, even if that person was being treated with medication. Greater stigma was associated with an 11 percentage point lower likelihood that PCPs prescribed OUD medication and lower support for policies intended to increase access to OUD medication. CONCLUSIONS Addressing OUD stigma among PCPs is a public health priority in addressing the ongoing opioid crisis.
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Gao B, Wang L, Santella AJ, Zhuang G, Huang R, Xu B, Liu Y, Xiao S, Wang S. HIV testing behaviors and willingness to receive oral rapid HIV testing among dental patients in Xi'an, China. PLoS One 2021; 16:e0248585. [PMID: 33765025 PMCID: PMC7993620 DOI: 10.1371/journal.pone.0248585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction HIV testing is an important strategy for controlling and ultimately ending the global pandemic. Oral rapid HIV testing (ORHT) is an evidence-based strategy and the evidence-based shows is favored over traditional blood tests in many key populations. The dental setting has been found to be a trusted, convenient, and yet untapped venue to conduct ORHT. This study assessed the HIV testing behaviors and willingness to receive ORHT among dental patients in Xi’an, China. Methods A cross-sectional survey of dental patients from Xi’an was conducted from August to September 2017. Dental patients were recruited using a stratified cluster sampling. A 44-item survey was used to measure HIV/AIDS knowledge, HIV testing behaviors, and willingness to receive ORHT. Results Nine hundred and nine dental patients completed the survey with a mean HIV/AIDS knowledge score of 10.7/15 (SD 2.8). Eighty-four participants (9.2%) had previously received an HIV test. Participants would have a high rate of HIV testing if they had higher monthly income (OR = 1.982, 95% CI: 1.251–3.140) and a higher HIV/AIDS knowledge score (OR = 1.137, 95% CI: 1.032–1.252). Five hundred and eighty-two participants (64.0%) were willing to receive ORHT before a dental treatment, 198 (21.8%) were not sure, and 129 (14.2%) were unwilling. Logistic regression showed that age (OR = 0.970, 95% CI: 0.959–0.982), HIV/AIDS knowledge score (OR = 1.087, 95% CI: 1.031–1.145), previous HIV test (OR = 2.057, 95% CI: 1.136–3.723), having advanced HIV testing knowledge (OR = 1.570, 95% CI: 1.158–2.128), and having advanced ORHT knowledge (OR = 2.074, 95%: CI 1.469–2.928) were the factors affecting the willingness to receive ORHT. Conclusions The majority of dental patients had not previously received an HIV test, although many were receptive to being tested in the dental setting. The dental setting as a venue to screen people for HIV needs further exploration, particularly because many people do not associate dentistry with chairside screenings. Increasing awareness of ORHT and reducing testing price can further improve the patient’s willingness to receive ORHT.
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Affiliation(s)
- Bei Gao
- Department of Orthodontics, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
- * E-mail:
| | - Anthony J. Santella
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, New York, United States of America
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Ruizhe Huang
- Department of Preventive Dentistry, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Boya Xu
- Department of Oral Implantology, Stomatology Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yujiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shuya Xiao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shifan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
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Khoury ZH, Meeks V. The influence of antiretroviral therapy on HIV-related oral manifestations. J Natl Med Assoc 2021; 113:449-456. [PMID: 33762122 DOI: 10.1016/j.jnma.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This review aims to provide primary medical and dental healthcare professionals with the current state of information on the oral manifestations of HIV infection in the era of antiretroviral therapy (ART) advancements. RESULTS Infection with the human immunodeficiency virus (HIV) is associated with an increased risk of infectious, neoplastic, and immune-mediated oral complications that are regarded as a major constituent of this global epidemic. HIV-related oral manifestations have been subject to changes in their prevalence with the employment of ART, particularly in this period of enhanced patient accessibility to ART. Available antiretroviral medications (ARVs), the clinical presentation of common HIV-related oral manifestations, and patients and healthcare providers' perceptions are also discussed. CONCLUSIONS Screening, diagnosing, and treating patients with HIV/Acquired immunodeficiency syndrome (AIDS) has improved drastically since the isolation and characterization of HIV. Oral manifestations have been acknowledged to correlate with treatment responses and disease progression. Healthcare providers should be familiar with HIV-related oral manifestations and comfortable in managing and referring patients with HIV/AIDS, they are also key stakeholders in facilitating the elimination of the stigma associated with the infection.
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Affiliation(s)
- Zaid H Khoury
- Department of Oncology & Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, 650W Baltimore St, 7th Floor North, Baltimore, MD 21201, United States.
| | - Valli Meeks
- Department of Oncology & Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, 650W Baltimore St, 7th Floor North, Baltimore, MD 21201, United States
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Santella AJ. HIV testing in the dental setting: A global perspective of feasibility and acceptability. Oral Dis 2020; 26 Suppl 1:34-39. [PMID: 32862538 DOI: 10.1111/odi.13388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Surveillance data, however, suggest that one in four people globally living with HIV are unaware of their HIV infection and remains at risk of transmitting their infection if having unprotected sex. A wider array of testing opportunities and settings are thus needed to address this issue of public health significance. Evidence suggests there is a role for the dental team, particularly dentists, in offering chairside point-of-care HIV screening to patients during their dental appointments. Dentists, dental hygienists, and other members of the dental team may still have a role in helping to identify new cases of HIV with the goal of improving health outcomes, addressing health inequalities and improving the quality and quantity of life. This paper reviews the global epidemiology of HIV/AIDS, summarizes the point-of-care HIV testing process, highlights key findings of international studies (from high-, middle-, and low-income countries) on the role of dental professionals in point-of-care HIV testing, and offers suggestions for what additional evidence is needed to make point-of-care HIV testing a routine part of dental care.
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Affiliation(s)
- Anthony J Santella
- Department of Health Professions, Hofstra University, Hempstead, NY, USA
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Riddle MW. HIV screening in dental settings: Challenges, opportunities, and a call to action. Oral Dis 2020; 26 Suppl 1:9-15. [PMID: 32862545 DOI: 10.1111/odi.13468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 01/03/2023]
Abstract
HIV is responsible for tremendous suffering and loss around the world, but many advances in HIV screening, diagnosis, treatment, and prevention provide hope for an end to the HIV epidemic. Global and national campaigns facilitate access to these HIV advances, but some individuals and communities still lack access, particularly in developing countries. To reach those who remain under-served, campaigns encourage greater integration of HIV services with non-HIV services. As members of the healthcare team with a clinical stake in HIV, dental care providers have a unique contribution to make. Much research on the role of dental care providers in HIV has focused on HIV screening in the dental setting, and researchers have identified possible ways forward but also daunting challenges. Approaches for screening, brief intervention, and referral to treatment used in primary care and dental care settings for other health risks may help overcome challenges related to provider scope of practice and need for training. Approaches to managing distress and uncertainty in other clinical contexts may help overcome challenges related to patient acceptability, equipping providers to manage sensitive topics and emotional aspects of HIV screening. While not panaceas, these approaches may be useful to dental care providers interested in answering the global "call to action" for contributing to ending the HIV epidemic.
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Affiliation(s)
- Melissa Wiseman Riddle
- Division of Extramural Research, Behavioral and Social Sciences Research Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
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Rosso MT, Sharma A. Willingness of Adults in the United States to Receive HIV Testing in Dental Care Settings: Cross-Sectional Web-Based Study. JMIR Public Health Surveill 2020; 6:e17677. [PMID: 32706732 PMCID: PMC7404012 DOI: 10.2196/17677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 01/30/2023] Open
Abstract
Background The Centers for Disease Control and Prevention estimates that 1.1 million people in the United States are living with HIV and 1 in 8 are estimated to be unaware of their serostatus. Little is known about whether individuals would consider being tested for HIV in nontraditional health care settings such as a dentist’s office. Studies in selected US cities have indicated high acceptability of receiving an HIV test among people attending dental clinics. However, we are not aware of studies that have assessed willingness to receive HIV testing in dental care settings at a national level. Objective Using a web-based sample of adult residents of the United States, we sought to assess the self-reported willingness to receive any type of HIV testing (ie, oral fluid rapid testing, finger-stick blood rapid testing, or venipuncture blood testing) in a dental care setting and evaluate independent associations of willingness with the extent to which dental care providers were perceived as knowledgeable about HIV and how comfortable participants felt discussing HIV with their dental care providers. Methods Participants were recruited using banner advertisements featured on social networking platforms (Facebook and Instagram) from December 2018 to February 2019. Demographic and behavioral data including information on sexual behaviors in the past 6 months, HIV testing history, and dental/health care–seeking history were collected using an anonymous web-based survey. Willingness to receive any type of HIV testing in a dental care setting was assessed on 4-point scale from very willing to very unwilling. Factors independently associated with participants’ willingness were identified using a multivariable logistic regression model. Results Of the 421 participants in our study aged 18 to 73 years, 271 (64.4%) reported having oral sex, 197 (46.8%) reported having vaginal sex, and 136 (32.3%) reported having anal sex in the past 6 months. Approximately one-third had never been tested for HIV (137/421, 32.5%), and the same proportion had not been tested in the past year (137/421, 32.5%). Most participants had dental insurance coverage (356/421, 84.6%), and more than three-fourths reported being very or somewhat willing (326/421, 77.4%) to receive any type of HIV testing in a dental care setting. Higher levels of willingness were associated with being 18 to 24 years versus ≥35 years (aOR 3.22, 95% CI 1.48-6.98), 25 to 34 years versus ≥35 years (aOR 5.26, 95% CI 2.52-10.98), believing that one’s dental care provider is knowledgeable about HIV (aOR 2.04, 95% CI 1.06-3.92), and feeling comfortable discussing HIV with one’s dental care provider (aOR 9.84, 95% CI 3.99-24.27). Conclusions Our data indicate high acceptability of receiving HIV testing in a dental care setting, especially among those who report having a positive patient-provider relationship. Future research should focus on assessing dental care providers’ attitudes, self-efficacy, and beliefs about whether HIV testing fits into the scope of dentistry.
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Affiliation(s)
- Matthew T Rosso
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, United States.,Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
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Sexual behavior and its association with persistent oral lesions: analysis of the POP-Brazil study. Clin Oral Investig 2020; 25:1107-1116. [PMID: 32583241 PMCID: PMC7878220 DOI: 10.1007/s00784-020-03407-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Objectives To investigate whether the presence of persistent self-reported oral lesions (PSOLs) is associated with sexual behaviors and with the presence of sexually transmitted infections (STIs) in individuals aged 16–25 years in the state capitals of Brazil. Materials and Methods Data from the POP-Brazil study were analyzed. An association analysis was performed by Poisson regression with the presence of PSOLs as the outcome. The exposure variables were the age at first sexual intercourse, the number of partners, oral sex practice, and aspects of condom use for model 1, and the presence of a self-reported STI or a positive rapid test for HIV/syphilis and the presence of genital human papillomavirus (HPV) for model 2. The results were adjusted for socioeconomic variables. Results The prevalence of PSOLs was 76% higher among individuals who had two or more sexual partners in the past year (p = 0.046) and 68% higher in those who reported not using condoms for contraception (p = 0.032). The group with HIV/syphilis or self-reported STI had a 140% higher PSOL prevalence (p = 0.003). Conclusions The self-report of oral lesions in adolescents and young adults may suggest risky sexual behavior and the presence of STI. Clinical relevance It is necessary to contextualize the reality of the young person to optimize oral health care.
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Chung R, Leung SYJ, Abel SN, Hatton MN, Ren Y, Seiver J, Sloane C, Lavigne H, O’Donnell T, O’Shea L. HIV screening in the dental setting in New York State. PLoS One 2020; 15:e0231638. [PMID: 32298336 PMCID: PMC7161960 DOI: 10.1371/journal.pone.0231638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/29/2020] [Indexed: 12/14/2022] Open
Abstract
While primary care providers in New York State (NYS) are mandated to offer all patients a HIV test, still many NYS residents miss the HIV screening opportunity. To fill the gap, and as the CDC recommends, this study aimed to examine the feasibility of implementing HIV screening in dental setting, identify patient characteristics associated with acceptance of HIV rapid testing, and discuss best practices of HIV screening in dental setting. New York State Department of Health (NYSDOH) collaborated with the Northeast/Caribbean AIDS Education and Training Center (NECA AETC) and three dental schools in New York State to offer free HIV screening tests as a component of routine dental care between February 2016 and March 2018. Ten clinics in upstate New York and Long Island participated in the study. HIV screening was performed using the OraQuick™ In-Home HIV Test. 14,887 dental patients were offered HIV screening tests; 9,057 (60.8%) were screened; and one patient (0.011%) was confirmed HIV positive and linked to medical care. Of all dental patients, 33% had never been screened for HIV; and 56% had not had a primary care visit or had not been offered an HIV screening test by primary care providers in the previous 12 months. Multi-level generalized linear modeling analysis indicated that test acceptance was significantly associated with patient's age, race/ethnicity, gender, country of origin, primary payer (or insurance), past primary care visits, past HIV testing experiences, and the poverty level of patient's community. HIV screening is well accepted by dental patients and can be effectively integrated into routine dental care. HIV screening in the dental setting can be a good option for first-time testers, those who have not seen a primary care provider in the last 12 months, and those who have not been offered HIV screening at their last primary care visit.
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Affiliation(s)
- Rakkoo Chung
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
- * E-mail:
| | - Shu-Yin John Leung
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
| | - Stephen N. Abel
- School of Dental Medicine, University at Buffalo, Buffalo, New York, United States of America
| | - Michael N. Hatton
- School of Dental Medicine, University at Buffalo, Buffalo, New York, United States of America
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York, United States of America
| | - Jeffrey Seiver
- School of Dental Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Carol Sloane
- School of Dental Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Howard Lavigne
- Northeast/Caribbean AIDS Education and Training Center, Syracuse, New York, United States of America
| | - Travis O’Donnell
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
| | - Laura O’Shea
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
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Raja S, da Fonseca M, Rabinowitz EP. Patient preferences on sharing private information in dental settings. J Am Dent Assoc 2020; 151:33-42. [PMID: 31902397 DOI: 10.1016/j.adaj.2019.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The authors conducted a study to understand patients' preferences and comfort levels in discussing personal medical, behavioral, and social information with their oral health care providers. METHODS A self-report survey was completed by US adults 18 years and older (N = 387) using Amazon Mechanical Turk, an online research portal for survey-based research. The survey assessed comfort discussing demographics, physical health, behavioral health, oral health, and living conditions with oral health providers. RESULTS Factor analysis suggested that participants were comfortable discussing demographics and standard dental questions but were less comfortable answering questions about trauma, stress, coping, and living and behavioral patterns. Demographics did not predict comfort with disclosure, and many participants did not feel personal information was relevant to oral health care. CONCLUSIONS Community education efforts can focus on helping patients understand how oral health is related to behavioral health and social conditions. PRACTICAL IMPLICATIONS Dental education should focus on helping oral health care providers communicate comfortably around these topics, balancing education with respect for a patient's willingness to disclose.
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Goel D, Patthi B, Singla A, Malhi R, Chaudhary PK, Khan A. Assessment of knowledge and attitude regarding management of patients with substance usage in dental clinics in Modinagar- A cross-sectional study. J Family Med Prim Care 2019; 8:3683-3688. [PMID: 31803673 PMCID: PMC6881923 DOI: 10.4103/jfmpc.jfmpc_733_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction The consequences of oral issues among drug users necessitate the implementation of a comprehensive dental care program. Integrated oral health-care services should be programmed for the management of drug addiction as a multi-organ disease needs a multi-disciplinary approach. Aim The aim of the present study was to assess the knowledge and attitude regarding the management of patients with substance usage at a dental clinic. Methodology A cross-sectional study was conducted among 208 dentists working as clinicians. A self-structured 27-item questionnaire consisting of questions related to the management of patients with substance usage at a dental clinic was distributed to them. Data were analyzed using Statistical Package for Social Sciences (SPSS) 20.0 (SPSS Inc., Chicago, IL, USA) and descriptive and analytical tests, including mean, standard deviation, and Chi-square test were used. P < 0.05 was considered statistically significant. Results Majority of the dentist irrespective of qualification were unaware of the modalities regarding the management of the patients with substance usage at the dental clinic. Most dental clinicians were having a positive attitude regarding such patients and agreed that abuser should be identified and managed in dental settings. Conclusion Educating dental graduates and postgraduates about the oral implications of substance usage and making it a part of the dental curriculum may help us deal with the global issues of substance usage. The dental setting is recognized increasingly as an untapped venue for the delivery of medical screenings, given the long-term nature and frequent contacts associated with the patient-dentist relationship.
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Affiliation(s)
- Divyangi Goel
- Department of Public Health Dentistry, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Basavaraj Patthi
- Department of Public Health Dentistry, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Ashish Singla
- Department of Public Health Dentistry, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Ravneet Malhi
- Department of Public Health Dentistry, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Pankaj Kumar Chaudhary
- Department of Public Health Dentistry, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Ambar Khan
- Department of Public Health Dentistry, D.J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
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Traynor SM, Rosen-Metsch L, Feaster DJ. Missed Opportunities for HIV Testing Among STD Clinic Patients. J Community Health 2019; 43:1128-1136. [PMID: 29796786 DOI: 10.1007/s10900-018-0531-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Current HIV testing guidelines recommend that all adolescents and adults aged 13-64 be routinely screened for HIV in healthcare settings. Sexually transmitted disease (STD) clinic patients represent a population at increased risk for HIV, justifying more frequent risk assessment and testing. This analysis describes missed opportunities for HIV testing among a sample of STD clinic patients to identify areas where HIV testing services may be improved. Secondary analysis was conducted using data from Project AWARE, a randomized trial of 5012 adult patients from 9 STD clinics in the United States, enrolled April-December 2010. HIV testing history, healthcare service utilization, and behavioral risks were obtained through audio computer-assisted self-interview. Missed opportunities for HIV testing, defined as having a healthcare visit but no HIV test in the last 12 months, were characterized by location and frequency. Of 2315 (46.2%) participants not tested for HIV in the last 12 months, 1715 (74.1%) had a missed opportunity for HIV testing. These missed opportunities occurred in both traditional (54.9% at family doctor, 20.3% at other medical doctor visits) and non-traditional (28.5% at dental, 19.0% at eye doctor, 13.9% at correctional facility, and 13.3% at psychology visits) testing settings. Of 53 participants positive for HIV at baseline, 16 (30.2%) had a missed testing opportunity. Missed opportunities for HIV testing were common in this population of STD clinic patients. There is a need to increase routinized HIV screening and expand testing services to a broader range of healthcare settings.
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Affiliation(s)
- Sharleen M Traynor
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1066, Miami, FL, 33136, USA.
| | - Lisa Rosen-Metsch
- School of General Studies, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1059, Miami, FL, 33136, USA
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16
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Santella AJ, Leuwaisee P, Davide SH, Horowitz H, Krishnamachari B. Oral rapid HIV testing in the dental setting: Experiences from three dental hygiene clinics. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2019; 53:125-129. [PMID: 33240350 PMCID: PMC7533818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/04/2018] [Accepted: 03/15/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Oral rapid HIV testing (ORHT) is implemented in the dental setting to make individuals aware of their possibly undiagnosed HIV infection. The testing process and characteristics of clients willing to receive ORHT has yet, however, to be systematically collected. CASE DESCRIPTION Three dental hygiene clinics located in academic institutions implemented ORHT from March 2016 to April 2017. RESULTS 231 persons received ORHT; all had non-reactive results. Most had seen a primary care provider in the past year (n = 130), had had a previous ORHT (n = 111), and described themselves as extremely likely or likely to accept a chairside screening in the future (n = 169). The main reason cited for accepting ORHT was that it was free (n = 138). CONCLUSION In order to ensure everyone living with HIV is aware of their infection, HIV testing should be expanded into non-traditional settings. The dental setting may help achieve this important public health milestone.
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Affiliation(s)
- Anthony J Santella
- Associate professor, Department of Health Professions, Hofstra University, Hempstead, NY, USA
| | - Petal Leuwaisee
- Assistant professor, Dental Hygiene Program, Department of Allied Health, Hostos Community College, Bronx, NY, USA
| | - Susan H Davide
- Associate professor, Department of Dental Hygiene, New York City College of Technology, Brooklyn, NY, USA
| | - Hanna Horowitz
- Professor, Department of Dental Hygiene, Farmingdale State College, Farmingdale, NY, USA
| | - Bhuma Krishnamachari
- Associate professor, Department of Medicine; assistant dean of research, New York Institute of Technology, Old Westbury, NY, USA
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17
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Singer RH, Feaster DJ, Stoutenberg M, Hlaing WM, Pereyra M, Abel S, Pollack H, Gellman MD, Schneiderman N, Metsch LR. Dentists' willingness to screen for cardiovascular disease in the dental care setting: Findings from a nationally representative survey. Community Dent Oral Epidemiol 2019; 47:299-308. [PMID: 30908721 DOI: 10.1111/cdoe.12457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Dental clinics offer an untapped health care setting to expand access to screening and early identification of cardiovascular disease (CVD) risk. This study examined the correlates of dentists' willingness to provide CVD screening in the dental care setting. METHODS Private practice and public health general dentists in the U.S. participated in a nationally representative survey from 2010 to 2011. The survey examined dentists' willingness to provide a finger stick test to support CVD screening and agreement that their professional role should include CVD screening. RESULTS Data analysed from 1802 respondents indicated that 46.6% of dentists were willing to provide CVD screening. The adjusted odds ratio (AOR) of dentists' willingness to screen for CVD was associated with currently screening for hypertension (AOR = 1.49, 95% CI 1.01, 2.20), screening for obesity (AOR = 1.66, 95% CI 1.17, 2.36) and agreement that their role as health care professionals includes CVD screening (AOR = 3.03, 95% CI 2.15, 4.29). Dentists' agreement that their role includes CVD screening was associated with self-rated knowledge of CVD (good vs none or limited) and CVD training during their professional education (5 to 8 hours of training vs none or limited), (AOR = 5.75, 95% CI 2.26, 14.62) and (AOR = 3.84, 95% CI 2.17, 6.80), respectively. CONCLUSIONS Our study highlights strategies that may be employed to expand future access to early detection of CVD risk. Including CVD screening instruction and clinical screening experiences in dental school curriculum may serve as catalysts to reshape the future scope of dental practice.
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Affiliation(s)
- Richard H Singer
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.,College of Dental Medicine, Nova Southeastern University, Ft. Lauderdale, Florida
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mark Stoutenberg
- Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee
| | - WayWay M Hlaing
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Stephen Abel
- School of Dental Medicine, University at Buffalo, Buffalo, New York
| | - Harold Pollack
- School of Social Service Administration, University of Chicago, Chicago, Illinois
| | - Marc D Gellman
- Department of Psychology, University of Miami, Miami, Florida
| | - Neil Schneiderman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Department of Psychology, University of Miami, Miami, Florida
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
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Elizondo JE, Treviño AC, Violant D, Rivas-Estilla AM, Álvarez MM. Hombres que tienen sexo con hombres y detección del virus de la inmunodeficiencia humana en odontología. GACETA SANITARIA 2018. [DOI: 10.1016/j.gaceta.2017.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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19
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Bradley ELP, Vidot DC, Gaul Z, Sutton MY, Pereyra M. Acceptability of oral rapid HIV testing at dental clinics in communities with high HIV prevalence in South Florida. PLoS One 2018; 13:e0196323. [PMID: 29702677 PMCID: PMC5922539 DOI: 10.1371/journal.pone.0196323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Expanding HIV screening for populations at risk necessitates testing in nontraditional settings. We assessed HIV testing in dental clinics in South Florida, an urban area with the highest rates of HIV diagnoses in the United States in 2015. Aims We explored patients’ acceptance of oral HIV rapid tests administered by dental providers and identified reasons for accepting or declining HIV testing. Methods During 2014 and 2015, dentists and hygienists at two federally qualified health center (FQHC) dental clinics who serve racial/ethnic minority patient populations in South Florida were trained to administer oral HIV rapid tests as a part of a routine dental visit. Patients presenting for dental services were offered a rapid HIV test and brief survey regarding their demographics, HIV testing history and behaviors. Results We enrolled 600 patients (median age = 43 years; IQR: 29–56 years), 45% non-Hispanic black and 35% Hispanic/Latino, 83% graduated high school, and 50% unemployed. Most (85%) accepted oral HIV rapid testing (none tested HIV-positive); 14% had never been tested for HIV. The most common reasons for testing were a desire to know HIV status (56%) and free testing (54%). Among 93 (15%) patients who declined testing, 58% were tested recently and 31% felt confident that they were HIV-negative; however, 74 (80%) who declined testing said they would feel comfortable discussing HIV prevention with their dentist. Additionally, 290 of 600 patients (48%) reported condomless vaginal or anal sex in the past 6 months. Further, among 119 patients who had condomless sex with an HIV-positive partner and/or one whose HIV status was unknown, 98 (82%) accepted the oral HIV test. Conclusion Dental clinics may provide expanded opportunities for oral HIV rapid testing and conversations about HIV prevention in high HIV prevalence communities.
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Affiliation(s)
- Erin L. P. Bradley
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Denise C. Vidot
- School of Nursing and Health Studies, University of Miami, Miami, FL, United States of America
| | | | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Margaret Pereyra
- Sociomedical Sciences at the Columbia University Medical Center, Columbia University, New York, NY, United States of America
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20
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Kline N, Vamos C, Thompson E, Catalanotto F, Petrila J, DeBate R, Griner S, Vázquez-Otero C, Merrell L, Daley E. Are dental providers the next line of HPV-related prevention? Providers' perceived role and needs. PAPILLOMAVIRUS RESEARCH 2018. [PMID: 29524676 PMCID: PMC5887011 DOI: 10.1016/j.pvr.2018.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The rise in HPV-related oropharyngeal cancer incidence necessitates novel prevention efforts including multiple provider types. Although dental providers screen for HPV-related oropharyngeal cancers, little is known about their needs to advance “primordial prevention,” or interventions at the earliest possible stage, to prevent HPV-related cancers. This study assessed dentists' and dental hygienists’ perceived roles and needs regarding HPV-related primordial prevention. We conducted a mixed-method study with data from focus groups with dentists (n= 33) and dental hygienists (n= 48) and surveys from both provider types (n= 203) among providers from a diverse set of practice settings and geographic communities. Data were analyzed using qualitative thematic analysis and chi square tests. Participants affirmed dental professionals’ roles in preventing HPV-related cancers and identified needs to overcome barriers to fulfilling prevention objectives. Barriers included: (1) practice environment and patient characteristics, and (2) the sensitive topic of HPV. Further, participants identified needs to improve HPV-related cancer prevention. Findings from this study suggest that dental providers may become the next line of prevention for HPV-related cancers. Dental providers’ professional associations have provided guidance on HPV and oropharyngeal cancers, but our study reveals dental providers’ needs for following professional organizations’ guidance to advance prevention efforts and reduce HPV-related cancer incidence.
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Affiliation(s)
- Nolan Kline
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Cheryl Vamos
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Erika Thompson
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Frank Catalanotto
- University of Florida College of Dentistry, P.O. Box 103628, 329 SW 16th St., Gainesville, FL 3261, USA.
| | - John Petrila
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA; The Meadows Mental Health Policy Institute, 2800 Swiss Avenue, Dallas, TX 75204, USA.
| | - Rita DeBate
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Stacey Griner
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Coralia Vázquez-Otero
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Laura Merrell
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Ellen Daley
- University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
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21
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Parish CL, Pereyra MR, Abel SN, Siegel K, Pollack HA, Metsch LR. Intimate partner violence screening in the dental setting: Results of a nationally representative survey. J Am Dent Assoc 2018; 149:112-121. [PMID: 29389334 PMCID: PMC5797993 DOI: 10.1016/j.adaj.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/31/2017] [Accepted: 09/03/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The dental setting is a potential venue for identifying patients experiencing intimate partner violence (IPV). The study objective was to assess dentists' current practices and attitudes about IPV screening. METHODS A nationally representative survey of US general dentists assessed dentists' use of health history forms that queried about IPV and their acceptance of IPV screening as part of their professional roles. Parsimonious Poisson regression models were used in multivariable analysis to estimate risk ratios for the 2 dependent variables. RESULTS Almost all dentists did not include a question to screen for IPV on their patient history forms. More than one-half of dentists also did not know of a referral place for patients experiencing IPV and did not believe that IPV screening should be part of their professional roles. CONCLUSIONS Uptake of IPV screening and favorable attitudes toward screening were low among dentists studied. However, prior IPV training and clinical knowledge plus awareness of IPV referral mechanisms were positively associated with greater screening uptake and attitudes. PRACTICAL IMPLICATIONS The inclusion of brief, focused IPV interventions in dental education and the establishment of collaborations between dentists and IPV agencies for referral mechanisms, in conjunction with an overall shift in dentists' attitudes about their professional responsibilities, may facilitate IPV screening uptake in the dental setting.
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22
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Santella AJ, Schlub TE, Schifter M, Tolani M, Hillman RJ. Australian dentists' perspectives on rapid HIV testing. Aust Dent J 2017; 61:270-6. [PMID: 26305044 DOI: 10.1111/adj.12371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- A J Santella
- Department of Health Professions, School of Health Professions and Health Sciences, Hofstra University, Hempstead, New York, USA
| | - T E Schlub
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - M Schifter
- Department of Oral Medicine, Oral Pathology and Special Care Dentistry, Westmead Centre for Oral Health, Westmead Hospital, Westmead, New South Wales, Australia.,Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
| | - M Tolani
- School of Dentistry and Oral Health, Griffith University, Nathan, Queensland, Australia
| | - R J Hillman
- Western Sydney Sexual Health Centre, Sydney Medical School, The University of Sydney, Parramatta, New South Wales, Australia
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23
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Lamster IB, Myers-Wright N. Oral Health Care in the Future: Expansion of the Scope of Dental Practice to Improve Health. J Dent Educ 2017; 81:eS83-eS90. [PMID: 28864808 DOI: 10.21815/jde.017.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/06/2017] [Indexed: 12/30/2022]
Abstract
The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21st Century."
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Affiliation(s)
- Ira B Lamster
- Dr. Lamster is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University; Dr. Myers-Wright is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University.
| | - Noreen Myers-Wright
- Dr. Lamster is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University; Dr. Myers-Wright is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University
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24
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Parish CL, Siegel K, Liguori T, Abel SN, Pollack HA, Pereyra MR, Metsch LR. HIV testing in the dental setting: perspectives and practices of experienced dental professionals. AIDS Care 2017; 30:347-352. [PMID: 28819982 DOI: 10.1080/09540121.2017.1367087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The dental setting is a largely untapped venue to identify patients with undiagnosed HIV infection. Yet, uptake of rapid HIV testing within the dental community remains low. This study sought to better understand the experiences of dental professionals who have administered the test and how these experiences might inform efforts to promote greater uptake of rapid HIV testing in dental settings. Qualitative interviews were conducted with United States dentists (N = 37) and hygienists (N = 5) who offered rapid HIV testing in their practices. The data revealed both the impeding and facilitating factors they experienced in implementing testing in their setting, as well as the reactions of their staff, colleagues, and patients. Overall, participants viewed rapid HIV testing favorably, regarding it as a valuable public health service that is simple to administer, generally well accepted by patients and staff, and easily integrated into clinical practice. Many had experience with a reactive test result. Participants described facilitating factors, such as supportive follow-up resources. However, they also cited persistent barriers that limit acceptance by their dental colleagues, including insufficient reimbursement and perceived incompatibility with scope of practice. The widespread adoption of routine HIV testing amongst dental professionals will likely require an expanded notion of the proper scope of their professional role in overall patient health, along with greater support from national dental organizations, dental education, and dental insurance companies, especially in the form of sufficient reimbursement.
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Affiliation(s)
- Carrigan L Parish
- a Department of Sociomedical Sciences , Columbia University, Miami Research Center, Mailman School of Public Health , Miami , FL , USA
| | - Karolynn Siegel
- b Department of Sociomedical Sciences , Columbia University, Mailman School of Public Health , New York , NY , USA
| | - Terri Liguori
- a Department of Sociomedical Sciences , Columbia University, Miami Research Center, Mailman School of Public Health , Miami , FL , USA
| | - Stephen N Abel
- c School of Dental Medicine , University at Buffalo , Buffalo , NY , USA
| | - Harold A Pollack
- d School of Social Service Administration , University of Chicago , Chicago , IL , USA
| | - Margaret R Pereyra
- a Department of Sociomedical Sciences , Columbia University, Miami Research Center, Mailman School of Public Health , Miami , FL , USA
| | - Lisa R Metsch
- b Department of Sociomedical Sciences , Columbia University, Mailman School of Public Health , New York , NY , USA
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25
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Glick M, Greenberg BL. The Role of Oral Health Care Professionals in Providing Medical Services. J Dent Educ 2017; 81:eS180-eS185. [DOI: 10.21815/jde.017.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/17/2017] [Indexed: 12/19/2022]
Affiliation(s)
| | - Barbara L. Greenberg
- Department of Epidemiology and Community Health; School of Health Sciences and Practice, New York Medical College
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Abstract
Recent evidence suggests there is a role for the dental team, particularly dentists, in offering chairside HIV screening to patients during dental appointments. HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Despite the availability of both venipuncture diagnostic and rapid saliva/finger prick screening tests for HIV infection, 25% of people living with HIV in the United Kingdom are undiagnosed and remain at risk of transmitting their infection if having unprotected sex. This paper highlights the international evidence that supports dentists' willingness to conduct HIV screening and dental patient acceptance, and explores whether this is an opportunity or a step too far.
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Abstract
Tooth wear is a condition that affects a substantial cohort of dental patients. It has a measurable impact on patients' satisfaction, and overall quality of life. Recently, with growing evidence, our understanding of the aetiology, progression, and management of tooth wear has evolved. The paper argues that pathological tooth wear should not be solely considered as a dental condition, but rather a dental manifestation of other mental and medical disorders. As such, successful management of tooth wear, and its underlying aetiology, requires a holistic, multidisciplinary management approach, involving dental, medical, and mental healthcare providers.
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Affiliation(s)
- Khaled E Ahmed
- Operative/Conservative Dentistry University of Hong Kong Faculty of Dentistry
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Greenberg BL, Kantor ML, Bednarsh H. American dental hygienists' attitudes towards chairside medical screening in a dental setting. Int J Dent Hyg 2016; 15:e61-e68. [PMID: 27021627 DOI: 10.1111/idh.12217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Targeted screening for medical conditions in a dental setting can be an effective strategy for early identification of individuals at increased disease risk. Dentists, patients and physicians have a favourable attitude towards this strategy. Given that dental hygienists (DHs) are involved in preventive and educational activities, this seems like a natural extension to their roles. We report on the attitudes of American DHs towards chairside medical screening. METHODS A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide random sample of US practicing DHs. Descriptive statistics were used for all questions, and the Friedman nonparametric analysis of variance was used for multi-element questions. RESULTS A total of 3133 respondents returned the completed questionnaires for an effective response rate of 49.2% and a margin of error 1.8%. The majority of respondents felt it was important to perform/conduct chairside screening for hypertension (94%), diabetes mellitus (89%), cardiovascular disease (85%), HIV (79%) and hepatitis infection (78%); were willing to refer a patient for medical consult (94%), conduct screening that yields immediate results (85%); and were willing to collect the data/samples needed (57-95%). The most important considerations were dentist/owner support (98%), training (97%), patient willingness (98%) and time (98%). CONCLUSION Similar to dentists, physicians and patients, the majority of the DHs had a favourable attitude towards chairside medical screening. Integrating the DH into screening activities is likely to require additional training and education regarding the diseases of interest, something that could be accomplished through continuing education courses and eventually incorporation into the educational curriculum.
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Affiliation(s)
- B L Greenberg
- School of Health Science and Practice, New York Medical College, Valhalla, NY, USA
| | - M L Kantor
- Institute for Health Sciences, University of Wisconsin-Eau Claire, Eau Claire, WI, USA
| | - H Bednarsh
- HIV Dental Ombudsperson Program, HIV/AIDS Services Division, Boston Public Health Commission, Boston, MA, USA
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Parish CL, Pereyra MR, Pollack HA, Cardenas G, Castellon PC, Abel SN, Singer R, Metsch LR. Screening for substance misuse in the dental care setting: findings from a nationally representative survey of dentists. Addiction 2015; 110:1516-23. [PMID: 26032243 PMCID: PMC4521977 DOI: 10.1111/add.13004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/13/2015] [Accepted: 05/21/2015] [Indexed: 01/21/2023]
Abstract
AIMS The dental setting is a potentially valuable venue for screening for substance misuse. Therefore, we assessed dentists' inquiry of substance misuse through their patient medical history forms and their agreement with the compatibility of screening as part of the dentists' professional role. DESIGN A nationally representative survey of general dentists using a sampling frame obtained from the American Dental Association Survey Center (November 2010-November 2011). SETTING United States of America. PARTICIPANTS A total of 1802 general dentists. MEASUREMENTS A 38-item survey instrument assessing the relationship between dentists' practice, knowledge, behaviors and attitudes with their query about substance misuse and their belief that such screening is part of their professional role. FINDINGS Dentists who accepted substance misuse screening as part of their professional role were more likely to query about misuse with their patients (85.8%) compared with those who did not accept such screening as part of their role (68.2%) (P < 0.001). Prior experience and knowledge about substance misuse were the strongest predictors of dentists' inquiry about patient substance use/misuse and acceptance of screening as part of their role in their clinical practice (P < 0.05). CONCLUSION While more than three-quarters of US dentists report that they ask their patients about substance misuse, two-thirds do not agree that such screening is compatible with their professional role.
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Affiliation(s)
- Carrigan L. Parish
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, 722 West 168 Street, New York, NY 10032,Department of Public Health Sciences, Miller School of Medicine,
University of Miami, 1120 NW 14 Street, Miami, FL 33136
| | - Margaret R. Pereyra
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, 722 West 168 Street, New York, NY 10032,Department of Public Health Sciences, Miller School of Medicine,
University of Miami, 1120 NW 14 Street, Miami, FL 33136
| | - Harold A. Pollack
- School of Social Service Administration, University of Chicago,
900 East 60 Street, Chicago, IL 60637
| | - Gabriel Cardenas
- Department of Public Health Sciences, Miller School of Medicine,
University of Miami, 1120 NW 14 Street, Miami, FL 33136
| | - Pedro C. Castellon
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, 722 West 168 Street, New York, NY 10032,Department of Public Health Sciences, Miller School of Medicine,
University of Miami, 1120 NW 14 Street, Miami, FL 33136
| | - Stephen N. Abel
- School of Dental Medicine, University at Buffalo, 250 Squire
Hall, Buffalo, NY 14214,College of Dental Medicine, Nova Southeastern University, 3200
South University Drive, Fort Lauderdale, FL 33328
| | - Richard Singer
- Department of Public Health Sciences, Miller School of Medicine,
University of Miami, 1120 NW 14 Street, Miami, FL 33136,College of Dental Medicine, Nova Southeastern University, 3200
South University Drive, Fort Lauderdale, FL 33328
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public
Health, Columbia University, 722 West 168 Street, New York, NY 10032,Department of Public Health Sciences, Miller School of Medicine,
University of Miami, 1120 NW 14 Street, Miami, FL 33136
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Knowledge of HIV and willingness to conduct oral rapid HIV testing among dentists in Xi'an China. PLoS One 2015; 10:e0119274. [PMID: 25742600 PMCID: PMC4351197 DOI: 10.1371/journal.pone.0119274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/12/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction China is considered a country of low HIV prevalence (780,000 people living with HIV), however, HIV infections among high-risk populations continue to grow at alarming rates. Voluntary Counseling and Testing services were first implemented in 2003, and oral rapid HIV testing (ORHT) began in 2012. Dentists, as oral health experts, would be well placed to conduct ORHT. We assessed willingness of dentists to undertake ORHT in their clinical practice. Methods A cross-sectional, paper-based survey of dentists from the Xi’an region of China was conducted from April to June 2013. Dentists were recruited from Shaanxi Stomatological Association using a stratified sampling methodology. A 40-item survey was used to measure knowledge of HIV, attitudes toward people living with HIV and willingness to conduct ORHT. Results 477 dentists completed the survey with a mean HIV knowledge test score of 13.2/18 (SD 1.9). If made available in the dental setting, 276 (57.9%) preferred to use blood to diagnose HIV, only 190 (39.8%) preferred saliva or both. Four hundred and thirty-five (91.2%) thought that ORHT was needed in dental clinics. Female dentists felt more accepting of ORHT than males (93.8% vs. 87.8%; χ2=5.145; p<0.05). 42.6% of the participants who responded thought that lack of education on ORHT for dentists was the most urgent problem to solve for ORHT, 144 (31.3%) thought that lack of support for ORHT from patients was the most urgent problem. There was statistically significant difference among dental hospital, dentistry and department of dentistry (χ2=24.176; p<0.05). Conclusions The majority of Chinese dentists thought that ORHT was needed in the dental setting. Providing opportunities for dentists and dental students to learn about HIV testing guidelines and practices is needed as well as feasibility and implementation science research.
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Jannat-Khah DP, McNeely J, Pereyra MR, Parish C, Pollack HA, Ostroff J, Metsch L, Shelley DR. Dentists' self-perceived role in offering tobacco cessation services: results from a nationally representative survey, United States, 2010-2011. Prev Chronic Dis 2014; 11:E196. [PMID: 25376018 PMCID: PMC4222784 DOI: 10.5888/pcd11.140186] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Dental visits represent an opportunity to identify and help patients quit smoking, yet dental settings remain an untapped venue for treatment of tobacco dependence. The purpose of this analysis was to assess factors that may influence patterns of tobacco-use–related practice among a national sample of dental providers. Methods We surveyed a representative sample of general dentists practicing in the United States (N = 1,802). Multivariable analysis was used to assess correlates of adherence to tobacco use treatment guidelines and to analyze factors that influence providers’ willingness to offer tobacco cessation assistance if reimbursed for this service. Results More than 90% of dental providers reported that they routinely ask patients about tobacco use, 76% counsel patients, and 45% routinely offer cessation assistance, defined as referring patients for cessation counseling, providing a cessation prescription, or both. Results from multivariable analysis indicated that cessation assistance was associated with having a practice with 1 or more hygienists, having a chart system that includes a tobacco use question, having received training on treating tobacco dependence, and having positive attitudes toward treating tobacco use. Providers who did not offer assistance but who reported that they would change their practice patterns if sufficiently reimbursed were more likely to be in a group practice, treat patients insured through Medicaid, and have positive attitudes toward treating tobacco dependence. Conclusion Findings indicate the potential benefit of increasing training opportunities and promoting system changes to increase involvement of dental providers in conducting tobacco use treatment. Reimbursement models should be tested to assess the effect on dental provider practice patterns.
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Affiliation(s)
- Deanna P Jannat-Khah
- School of Medicine, Department of Population Health, New York University, New York, New York
| | - Jennifer McNeely
- School of Medicine, Department of Population Health, New York University, New York, New York
| | - Margaret R Pereyra
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, New York
| | - Carrigan Parish
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, New York
| | - Harold A Pollack
- School of Social Service Administration, University of Chicago, Chicago, Illinois
| | - Jamie Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa Metsch
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, New York
| | - Donna R Shelley
- Director of Research Development, Associate Professor of Medicine and Population Health, Department of Population Health, New York University School of Medicine, 227 East 30th St, 6th Fl, New York, NY 10016. E-mail:
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Abe EO, Kolude B, Adeyemi BF. HIV TESTING IN DENTAL PRACTICE: PERCEPTION AND ATTITUDE OF DENTISTS IN SOUTHWESTERN NIGERIA. AFRICAN JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2014; 43:201-208. [PMID: 26709329 PMCID: PMC4689433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In recent times, the concept of routine HIV screening has been recommended to enhance early diagnosis and timely initiation of care thereby reducing morbidity and mortality among HIV infected persons. Dental practice has been identified as a unique venue of reaching at-risk individuals who may not otherwise access the conventional healthcare settings. AIM To assess the perception and attitude of dentists in Southwestern Nigeria concerning integrating HIV testing into dental practice. METHODS this descriptive cross- sectional study was conducted between January-March, 2014. Convenience sampling was used to select 113 practising dentists within Southwest Nigeria. Data collection was done using a self- administered questionnaire. RESULTS Agreement to HIV testing in dental settings was in the order of 100% for private practitioners followed by 91.7% from teaching hospitals (91.7%) and least agreement was with state hospitals (76.5%). There was a strong association between participants' years of practice and support for HIV testing in dental settings with highest support among those between 7-9 years (p= 0.002). Significantly too (p= 0.013), all the specialists (100%) agreed to HIV testing in dental settings compared to general practitioners (84.0%). CONCLUSION This study showed that most dentists in Southwest Nigeria acknowledged dental practice as being appropriate for expanded HIV testing and as well were willing to undergo training for HIV testing in their dental settings.
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Affiliation(s)
- E O Abe
- Department of Oral Pathology/ Oral Medicine, Faculty of Dentistry, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Oyo State
| | - B Kolude
- Department of Oral Pathology/ Oral Medicine, Faculty of Dentistry, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Oyo State
| | - B F Adeyemi
- Department of Oral Pathology/ Oral Medicine, Faculty of Dentistry, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Oyo State
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