· Accomplishment of an accurate exam of oral hard and soft tissues
· Accomplishment of the proper steps for infection control in dental office
· Humanization of the services and practice to treat all patients, regardless of their degree of infection.
These three aspects represent a great challenge to be overcome by most dentists, and their responses to these challenges may contribute to change their image.
The appearance of AIDS has undoubtedly showed the risks of the profession and alerted to the poor work conditions of many professionals.
From the first AIDS reports until the present classification by the USA Diseases Control Center, the oral cavity has been important because it shows manifestations both in hard and soft tissues, and these may indicate the stage of the infection. It is necessary, therefore, the early diagnosis of these manifestations through a proper and accurate exam.
Since the HIV and its transmission were first studied, the dentists have been panic-driven, especially due to the similarity with the transmission characteristics of the hepatitis B virus (to which dentists are highly exposed). National and international authorities have published articles stating that the HIV is not as easily transmitted as the hepatitis B virus, but it is necessary that certain procedures must be followed in order to avoid the dissemination of these and other virus, as well as most microorganisms capable of causing infection and that can be transmitted through the oral cavity.
On the other side, there is the prejudice involving the HIV patient, the professionals who fear infected patients, and the professional reluctance in adopting protective measures. This is the paradox of the epidemic, thus contradicting the humanity principles, the same ones that these professionals swore to follow in their graduation oath.
The working group of Stomatology of the CEDROS Network, being sensitive to the AIDS problem in Dentistry, has been developing activities that may be useful in fighting the disease.
The first accomplishment was the Oral Health Booklet n. 3: "Manual on oral manifestations and infection control". This manual aims at presenting the main oral manifestations of AIDS, guiding dental professionals as to the basic questions on the infection control.
The working group of Stomatology/AIDS counts on a team of professionals used to the treatment of infected patients in their daily clinic. The group is formed by professionals who work at the HIV Special Unity of the Dental School of UFRJ; an Oral Diagnosis teacher from the Dental School of UFRJ; an Oral Diagnosis teacher from the Dental School of UFF and a professional from the AIDS Reference Center of São Paulo. They are all interested in joining their efforts to face the common enemy.
The group from the HIV Special Unity of UFRJ has been working with infected patients since October, 1988. They have made a survey of the patients treated until April, 1992, with the purpose of defining the features of these patients.
In this survey, the following aspects were considered: percentage of patients with oral manifestation, most frequent oral manifestations, marital status, age, education, profession, sex, ethnic group, and the number of new patients per year. In this work, the data were only nominal and the general frequency was established in relation to the total of patients studied.
The results show that the frequency of oral manifestations is very high (314 or 54% of the patients).
The most often oral manifestations are showed in Tables 1, 2 and 3. The oral candidiasis was the most common lesion, with emphasis on the pseudo membranous one, representing 64.3% of the total of the lesions found. The second was the erithematous candidiasis (30.6%), followed by the angular lesion of the lips (17.5%).
In Figure 1 we can see the associations of the pseudo membranous candidiasis to the other oral manifestations. Only 6.9% of the patients studied presented an association of the three most common types of lesions. However, the pseudo membranous and the erithematous candidiasis were often associated (28.7%), what may indicate a strong relation between these two lesions.
The hairy leukoplakia was the second lesion more often observed after the candidiasis group, with 15.9%. This lesion was initially described as exclusive of HIV infected patients. Today it is known that any patient with low immunity is liable to this oral manifestation. This lesion is caused by a virus (Epstein Barr), it is observed in all groups of patients and it appears in the USA Center for Disease Control (CDC) classification as an aspect of great importance in the prognosis of HIV infected patients.
The Kaposi's sarcoma - a neoplasy - is the most common tumor associated to the AIDS. In this survey we found it as the most frequent lesion following the candidiasis and the hairy leucoplakia. It represented a percentage of 14.3% of the total of lesions studied. Evidences have demonstrated that this tumor is more often observed in men who are adept of homosexual practices, and rare in women, involving in the female sex mainly drug users. In this survey two women contaminated through infected blood showed oral Kaposi's sarcoma.
The HIV gingivitis/periodontitis was observed in only 0.9% of the patients, despite the lesion had been included in the Group I of the HIV oral manifestations (those significantly associated with the HIV infection). Although there is a great prevalence of gingivitis/periodontitis in Brazilian adults in general, and a high prevalence of the lesion in HIV infected patients, we have not observed a significant percentage of this oral manifestation in our study.
Most of the patients studied were single (77.5%), aged approximately 35 years (range from 4 to 60 years), being the most common range 30-34 years. (Figure 2).
As to Education, 39.4% of the patients concluded high school and 31.4% had a college degree (fig. 3). However, as we can see in this figure, only 6.3% of the patients worked in the health area.
Dental School UFRJ
· Arley Silva Junior - COPIPED - Dental School UFRJ
· Catalina Rieira Costa - Reference Unity - São Paulo
· Ellen Brilhante de Albuquerque - COPIPED - UFRJ
· Sonia Maria Soares Ferreira - COPIPED UFRJ
· Sandra Regina Torres - Dental School UFF
The male sex (85.5%) is predominant, and 69.1% of the patients were Caucasian (figure 4).
In Figure 5 we can see the increase of new patients each year (more than 27% a year).
As it regards to age and sex, our data are similar to those of the Brazilian Health Ministry.
As it was previously mentioned, the dentist must know the main oral manifestations of the HIV, since they are highly prevalent. It is necessary to make a firm diagnosis and an effective treatment, or to refer the patient to the proper services in case of doubt.
It is useful to know the profile of the patient who seeks the HIV Unity, because it helps in the elaboration of more convenient, adequate oral health policies. We have to be aware of our limited budget. We notice an accumulated prevalence, which could only be reverted if proper funds were supplied, specially in the hiring of personnel to work directly with the increasing demand.
The HIV Unity group, however, tries to develop actions that will enable people to understand the disease and its relation with Dentistry. This will be done by means of explanation and information, so that fear and prejudice can be reduced and more people feel confident to treat infected patients.
Members of the Unity of HIV Infected Patients:
· Arley Silva Junior
· Andréia Oliveira Vicente
· Ellen Brilhante de Albuquerque
· Roberto Camillo
· Silvana de Assis
· Sonia Maria Soares Ferreira
· Wagner Mattos
We take this opportunity to thank Dr. Sandra Regina Torres, a former member of our team, who helped in the oral diagnosis of most of the patients studied here.
Working group of Stomatology/CEDROS Network:
· Abel Silveira Cardoso - Reporter - Dental School UFRJ
· Arley Silva Junior - COPIPED - Dental School UFRJ
· Catalina Rieira Costa - Reference Unity - São Paulo
· Ellen Brilhante de Albuquerque - COPIPED - UFRJ
· Sonia Maria Soares Ferreira - COPIPED UFRJ
· Sandra Regina Torres - Dental School UFF